Open Bay Neonatal Intensive Care Research Articles

Enhancing Care for Substance-Exposed Newborns in an Open-Bay Neonatal Intensive Care Unit

Enhancing Care for Substance-Exposed Newborns in an Open-Bay Neonatal Intensive Care Unit

Impact of respiratory syncytial virus in an open bay neonatal intensive care unit

Background: Respiratory syncytial virus, RSV, is a respiratory virus that causes cold-like symptoms in adults. In infants and young children, RSV can cause severe illnesses such as bronchiolitis or pneumonia. We describe a successful response to a laboratory-confirmed RSV outbreak in a 21-bed open-pod neonatal intensive care unit (NICU) at a level 2 trauma hospital. Methods: After 2 of the 3 initial neonates were diagnosed with hospital-onset RSV, an outbreak investigation began on November 16, 2022. Following the results, testing was expanded to all neonates in the NICU. The clinical case was defined as a hospitalized neonate with laboratory confirmation of RSV by RSV antigen screen or polymerase chain reaction (PCR) detection on the Biofire respiratory panel. Outbreak resolution was determined by utilizing a viral test for the remaining positive neonates after the 2-week incubation period from the last identified positive neonate. Results: On day 1 of the investigation, 6 of 18 neonates were identified as positive for RSV. The initial 12 negative neonates received a prophylactic dose of palivizumab. Due to the increase in positive neonates, enhanced infection prevention and control measures were immediately implemented. These measures included the immediate closure of the NICU for new transfers, placing all positive neonates in a single-bay cohort in the NICU, implementing contact and droplet precautions, minimizing shared staff, increasing environmental cleaning, and using dedicated equipment. With awareness of the increased community occurrence of RSV, additional measures were taken to monitor adherence to infection prevention and control measures by staff and visitors entering the NICU, including daily symptom screening. Visitation was restricted to block scheduling to monitor the number of individuals in the NICU. Once we obtained the complete conversion of the initial neonate cohort, the additional focus shifted to maintaining the enhanced precautions until all neonate laboratory tests were negative. The NICU was successfully reopened once the remaining 3 positive neonates received no growth on their viral culture. Conclusions: The quick and effective response from a multidisciplinary team allowed a successful intervention to mitigate the identified outbreak. This investigation highlights the importance of enhanced infection prevention and control practices during increased community spread. Future efforts focus on educating staff and visitors on appropriate measures to decrease transmission risks.Disclosures: None

Music therapy intervention in an open-bay neonatal intensive care unit room is associated with less noise and higher signals: A case-control study

Music therapy intervention in an open-bay neonatal intensive care unit room is associated with less noise and higher signals: A case-control study

Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios: A Case-Control Study.

Background: Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. Objective: To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR). Study design: This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software. Results: Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT. Conclusion: Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants.

Associations Between Single-Family Room Care and Breastfeeding Rates in Preterm Infants

BackgroundHospitalization in neonatal intensive care units with a single-family room design enables continuous maternal presence, but less is known regarding the association with milk production and breastfeeding.Research aimTo compare maternal milk production, breastfeeding self-efficacy, the extent to which infants received mother’s milk, and rate of direct breastfeeding in a single-family room to an open bay neonatal intensive care unit.MethodsA longitudinal, prospective observational study comparing 77 infants born at 28– 32° weeks gestational age and their 66 mothers (n = 35 infants of n = 30 mothers in single family room and n = 42 infants of n = 36 mothers in open bay). Comparisons were made on milk volume produced, the extent to which infants were fed mother’s milk, and rate of direct breastfeeding from birth to 4 months’ corrected infant age. Breastfeeding self-efficacy was compared across mothers who directly breastfed at discharge (n = 45).ResultsFirst expression (6 hr vs. 30 hr, p < .001) and first attempt at breastfeeding (48 hr vs. 109 hr, p < .001) occurred significantly earlier, infants were fed a greater amount of mother’s milk (p < .04), and significantly more infants having single-family room care were exclusively directly breastfed from discharge until 4 months’ corrected age; OR 6.8 (95% CI [2.4, 19.1]). Volumes of milk produced and breastfeeding self-efficacy did not differ significantly between participants in either units.ConclusionTo increase the extent to which infants are fed mother’s own milk and are exclusively directly breastfed, the design of neonatal intensive care units should facilitate continuous maternal presence and privacy for the mother–infant dyad.

Traditional open bay neonatal intensive care units can be redesigned to better suit family centered care application

The current study investigated several Jordanian NICUs suitability for implementing Family Centered Care in light of its physical design. It involved direct observation of NICUs within seven Jordanian private and public hospitals in the presence of department heads. Structured interviews of 10 items were also conducted with nurses who agreed to participate in their workplace. The main outcome measures included in the interviews were unit design and regulations/policies. Descriptive statistics were employed taking into consideration comments of participants and observations by the researcher. This study asserted the role of the design in hindering the application of FCC in NICUs. More than two thirds of participants indicated unsuitability of their NICUs for FCC. However, with nurses' willingness to play their part in any proposed reformation, these units can become better equipped to apply FCC principles. Future NICUs require shifting from traditional open bay to a family centered closed unit model.

Development and validation of an instrument to assess the implementation of family-centred care in traditional open bay Neonatal Intensive Care Units

ABSTRACTObjective: To develop an instrument to study family-centred care (FCC) in traditional open bay Neonatal Intensive Care Units (NICUs).Methods: The development process involved constructing instrument's items, establishing content validity by an expert panel and testing the instrument for validity and reliability with a convenience sample of 25 parents and 29 nurses from 6 Jordanian NICUs. The tool covered FCC concepts of respect and dignity, information sharing, participation, and collaboration.Results: Both forms have satisfactory content, discriminant and construct validity. Cronbach's alpha was 0.91 for the parents' form and 0.93 for the nurses' form. While there was variation in parents' and nurses' perspectives on some aspects of FCC, the overall perspective of parents in the current study did not reflect a good application of FCC.Conclusion: This study led to the development of a validated instrument for face and content validity, construct (discriminant and convergent) validity and reliability.

Staff Perceptions before and after Adding Single-Family Rooms in the NICU

The purpose of this study is to evaluate staff perceptions of environmental quality before and after the renovation of an existing open-bay neonatal intensive care unit (NICU) and the addition of 23 single-family NICU rooms in the Wasie Neonatal ICU at Joe DiMaggio Children's Hospital. In recent years there has been an increase in the design and construction of single-family rooms (SFRs) because they provide more privacy for families, offer better control over environmental stimuli such as lighting and noise, and possibly reduce infections. On the other hand, this model can cause staff members to feel isolated from one another, reduce their ability to respond quickly in a crisis situation, or impose additional demands on them. Few studies document the advantages and disadvantages of the SFR NICU model. This study utilized pre- and post-move surveys to investigate staff perceptions of the NICU. Overall, staff members perceive the quality of the work environment, and the safety and quality of the environment provided to patients and their families, as better in the renovated, combination NICU design (SFR and open bay) when compared to the open-bay, pre-move design. In spite of the potential drawbacks of having SFRs in the NICU, the study demonstrates that nurses may perceive associated benefits, such as a reduction of job stress and improvements in parental privacy, along with other positive outcomes.

A Comparison of Parent Satisfaction in an Open-Bay and Single-Family Room Neonatal Intensive Care Unit

The purpose of this research was to test the hypothesis that parental satisfaction with neonatal intensive care is greater in a single-family room facility as compared with a conventional open-bay neonatal intensive care unit (NICU). This investigation was a prospective cohort study comparing satisfaction survey results for parents who responded to a commercially available parent NICU satisfaction survey following the provision of NICU care in open-bay and single-family room facilities. A subset of 16 items indicative of family-centered care was also computed and compared for these two NICU facilities. Parents whose babies received care in the single-family room facility expressed significantly improved survey responses in regard to the NICU environment, overall assessment of care, and total survey score than did parents of neonates in the open-bay facility. With the exception of the section on nursing in which scores in both facilities were high, nonsignificant improvement in median scores for the sections on delivery, physicians, discharge planning, and personal issues were noted. The total median item score for family-centered care was significantly greater in the single-family room than the open-bay facility. Parental satisfaction with care in the single-family room NICU was improved in comparison with the traditional open-bay NICU. The single-family room environment appears more conducive to the provision of family-centered care. Improved parental satisfaction with care and the potential for enhanced family-centered care need to be considered in decisions made regarding the configuration of NICU facilities in the future.

Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design

To compare perceived workplace quality in an open-bay neonatal intensive care unit (NICU) and a single-family room (SFR) NICU. Prospective non-randomized, non-controlled cohort study. Staff workplace quality perceptions assessed included the following: the quality of being a Sanford Health System employee (NS-not significant), the quality of the NICU physical work environment, the quality of NICU patient care, the job quality in the NICU, the quality of health and safety in the NICU (NS), the quality of safety and security in the NICU, the quality of interaction with other members of the NICU health-care team (NS; in subanalysis nurse scores significantly declined), the quality of interaction with NICU technology and the off-job quality of life (NS). Scores for each category and the total scores were statistically greater in the SFR, except as noted (NS). Staff perceptions of workplace quality were significantly greater in the SFR than the open-bay NICU.