Making the most of the single-family room NICU

18-Month Follow-Up of Infants Cared for in a Single-Family Room NICU

Objectives

To determine whether the single-family room (SFR)-neonatal intensive care unit (NICU) is associated with improved 18-month neurodevelopmental outcome, especially in infants of mothers with high maternal involvement.

Study Design

An 18-month follow-up was undertaken that compared infants born <30 weeks gestational age; 123 from a SFR-NICU vs 93 from an open-bay NICU. Infants were divided into high vs low maternal involvement based on days/week of kangaroo care, breast/bottle feeding, and maternal care. Infants with high vs low maternal involvement in the SFR and open-bay NICUs were compared on the Bayley Cognitive, Language, and Motor scores and Pervasive Developmental Disorders autism screen.

Results

There were more mothers in the high maternal involvement SFR than in the high maternal involvement open-bay group (P = .002). Infants with high maternal involvement in both NICUs had greater Cognitive (P = .029) and Language (P < .000) scores than infants with low maternal involvement. Effect sizes within NICU were moderate to large in the SFR-NICU for Language scores and moderate for the Language composite in the open-bay NICU. The number of days of maternal involvement was greater in the SFR than open-bay NICU (P < .000), and length of stay was shorter in the high maternal involvement SFR than high maternal involvement open-bay NICU (P = .024). Kangaroo and maternal care predicted Cognitive (kangaroo, P = .003) and Language scores (P = .015, P = .032, respectively). Infants with ≥1 symptom of autism were more likely to be in the open-bay low maternal involvement group vs the SFR high maternal involvement group (OR = 4.91, 95% CI = 2.2-11.1).

Conclusions

High maternal involvement is associated with improved 18-month neurodevelopmental outcome, especially in infants cared for in a SFR-NICU.

(Lester BM, et al. J Pediatr. 2016 Oct;177:84-9).

Comments:

A major change in neonatal intensive care unit (NICU) design has been the replacement of open wards with private or single-family-rooms (SFR). The anticipated advantages of family privacy, lower light and noise levels, and improved infection control seemed to merit this switch despite the drawbacks of higher construction costs and staffing inefficiencies. To add to these potential concerns, Pineda et al reported that neonates cared for in SFR had more abnormal brain structure and lower cerebral maturation scores at the time of discharge, as well as lower Bayley-III language and motor scores at age 2 years than their counterparts cared for in open wards. These findings led to speculation that the SFR environment might produce an inappropriate degree of sensory deprivation for the preterm infant. A lingering question surrounding the study by Pineda et al has been whether the low parental visitation rates of their NICU contributed to the SFR effect.

Lester et al now report that the degree of direct maternal involvement may indeed be the “secret sauce” in optimizing long-term outcomes for infants cared in SFR. Although a high level of maternal involvement was linked to better 18-month outcomes in both settings, the SFR environment was particularly effective in facilitating early kangaroo care, which in turn promoted a sustained level of highly involved parenting throughout the NICU stay and probably after discharge. In all NICU environments, an early “more is better” parenting approach may be a key component in achieving the best outcomes for premature babies.

                                                                                                — Robin H. Steinhorn, MD