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Findings: Private NICU rooms may affect preemies' development

Wednesday October 23, 2013
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In the NICU of one hospital, staying in a private room appeared to affect development of the language area of preemies’ brains differently than staying in an open unit, according to a recent study.

In recent years, NICUs have added private rooms in place of open units, partly because of concerns that excessive stimulation from noise and lights might negatively affect a preemie’s neurodevelopment. However, findings by researchers at the Washington University School of Medicine in St. Louis add new information to the discussion of the best setting for infants in the NICU.

“We had expected that babies in private rooms would do better than babies in the open ward,” the study’s first author, Bobbi Pineda, OTR/L, PhD, assistant professor in OT and pediatrics at Washington University, said in a news release. “Current practice tells us that we should minimize the amount of stimulation to the baby, so you would think that babies in private rooms would do better — but we found the contrary.”

Their findings were published Oct. 17 on the website of The Journal of Pediatrics.

The observational study included 136 premature infants who were born at less than 30 weeks gestation and were admitted to the NICU at St. Louis Children’s Hospital in 2007-10. Half of the level 3 NICU’s beds are in private rooms, and half are in open units, in which babies are kept together in groups. Infants were assigned to beds in the open units or private rooms, based on space and staffing levels, then remained in the same type of room for their entire NICU stay.

The researchers completed comprehensive neurobehavioral testing and MRI brain imaging for the infants close to their due dates and again before discharge from the NICU. Using advanced imaging techniques, they found at time of discharge (average three months after birth) the infants in private rooms showed abnormalities in the structure of the brain’s language area when compared with infants cared for in open units. They also found the infants from private rooms had lower amplitude-integrated electroencephalography brain maturation scores.

At age 2, 86 of the preemies (83% of the survivors) returned for developmental testing, which included standardized assessments of motor, language and cognitive outcomes and social-emotional development.

Researchers found the children who had stayed in private rooms had poorer language skills and trended toward lower motor scores, even after the researchers tried to account for contributing factors.

“This preliminary finding raises questions about the amount of sensory exposure and other characteristics of different NICU room types,” Pineda said in the release. “More research is needed to examine the best ways to support development in the NICU environment.”

According to Pineda, these results should be interpreted carefully. Many parents in the study experienced challenges in being able to visit and interact with their infants in the NICU, and, overall, there were low rates of parent visitation. She warned against simply eliminating private rooms in the NICU.

“Private rooms offer a great thing for the babies and especially for those families who are able to stay with their infants during NICU hospitalization,” she said in the release. “It provides a private space for parents to be engaged in care and share their first precious moments with the baby. However, if private rooms are retained, we need to rethink the levels of stimulation provided to the infants in them, especially in circumstances when the family is not involved in care.”

Developmentally appropriate sensory stimulation can be integrated into care regardless of room type, and families can be empowered to interact and engage with their infants during the NICU stay, according to Pineda. She added more research is needed to determine the best environment and types of stimulation for premature infants.

Researchers are working to measure the difference in language and sound exposure between private rooms and open units. According to Pineda, the next step will be to conduct a rigorous randomized clinical trial examining the relationships between room type and neurodevelopmental outcomes.

Study abstract: http://bit.ly/HdHJdV


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