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Objective:Pasteurized, donated milk is increasingly provided to preterm infants in the absence of mother's own milk. The aim of this study was to determine the effect of pasteurization on the concentration of selected components in donated human breast milk.Study Design:Donated milk from 34 mothers was pooled into 17 distinct batches (4 mothers per batch). Aliquots of each batch were then Holder pasteurized (62.5 °C for 30 min). Interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-2, IL-4, IL-5, IL-8, IL-10, IL-12p70 and IL-13 were measured in a multiplex enzyme-linked immunosorbent assay (ELISA). Granulocyte colony-stimulating factor (G-CSF), heparin-binding epidermal-like growth factor (HB-EGF) and hepatocyte growth factor (HGF) were measured by ELISA. Lipids were assessed by gas chromatography and gangliosides by the resorcinol-HCl reaction.Result:IFN-γ, TNF-α, IL-1β, IL-10 and HGF were significantly reduced by pasteurization (P<0.05). Gangliosides were not affected, but the proportion of medium-chain saturated fats was increased (P<0.05) with a trend towards a decreased proportion of oleic acid (P=0.057).Conclusion:Pasteurization significantly reduced the concentration of several immunoactive compounds present in breast milk, but did not have an impact on others. [ABSTRACT FROM AUTHOR]

Objective:Rates of breast milk feeding at hospital discharge are low in premature infants due to the many associated challenges. Although there are many benefits associated with breast milk, the effects of direct breast-feeding in the neonatal intensive care unit (NICU) have not been identified. The purpose of this study was to investigate the relationship between direct breast-feeding (infant sucking directly from the breast) and duration and success with breast milk feedings until discharge in premature infants.Study Design:This retrospective cohort was conducted on 66 very-low birth weight infants whose mothers initiated breast milk feedings in the NICU. Chart review revealed documented type (breast milk with or without fortifiers or type of infant formula), volume and mode (nasogastric tube, breast or bottle) of all gastric feeds for each day of NICU hospitalization. From this documentation, whether the mother initiated breast milk feedings, the number of times the mother put the infant to breast, the gestational age of the first direct breast-feeding, whether the first oral feeding was at the breast, the duration of breast milk feedings and whether breast milk feedings continued until NICU discharge were determined. Associations between breast-feeding participatory factors and breast milk feeding outcomes were investigated using linear and logistic regression.Result:Positive associations were found between breast milk feedings at discharge and mothers putting their infants directly to breast in the NICU (P=0.0005). The duration of breast milk feedings was associated with: mothers putting their infants directly to breast (P=0.0110), whether the first oral sucking feeding was at the breast (P=0.0108) and the gestational age of the first breast-feeding attempt (P<0.0001).Conclusion:Breast milk feedings are encouraged in most NICU's, but direct breast-feeding is often overlooked as an important area of research in the tightly controlled environment of the NICU. This study demonstrates a link between direct breast-feeding behaviors in the NICU and success with provision of milk at discharge, as well as how early participation can be an important factor in the breast-feeding process for mothers of NICU infants. More research on the effects of direct breast-feeding is warranted. [ABSTRACT FROM AUTHOR]

Objective:To evaluate the impact of integrating a handoff tool into the electronic medical record (EMR) on sign-out accuracy, satisfaction and workflow in a neonatal intensive care unit (NICU).Study Design:Prospective surveys of neonatal care providers in an academic children's hospital 1 month before and 6 months following EMR integration of a standalone Microsoft Access neonatal handoff tool.Result:Providers perceived sign-out information to be somewhat or very accurate at a rate of 78% with the standalone handoff tool and 91% with the EMR-integrated tool (P<0.01). Before integration of neonatal sign-out into the EMR, 35% of providers were satisfied with the process of updating sign-out information and 71% were satisfied with the printed sign-out document; following EMR integration, 92% of providers were satisfied with the process of updating sign-out information (P<0.01) and 98% were satisfied with the printed sign-out document (P<0.01). Neonatal care providers reported spending a median of 11 to 15 min/day updating the standalone sign-out and 16 to 20 min/day updating the EMR-integrated sign-out (P=0.026). The median percentage of total sign-out preparation time dedicated to transcribing information from the EMR was 25 to 49% before and <25% after EMR integration of the handoff tool (P<0.01).Conclusion:Integration of a NICU-specific handoff tool into an EMR resulted in improvements in perceived sign-out accuracy, provider satisfaction and at least one aspect of workflow. [ABSTRACT FROM AUTHOR]

Objective:Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations in the NICU.Study Design:We conducted a retrospective cohort study of infants older than 53 days who were vaccinated in the NICU at the KPMCP (Kaiser Permanente Medical Care Program). Chart reviews were carried out before and after all immunizations were administered and for all sepsis evaluations after age 53 days. The clinical characteristics of infants on the day before receiving a sepsis evaluation were compared between children undergoing post-immunization sepsis evaluations and children undergoing sepsis evaluation at other times. The incidence rate of sepsis evaluations in the post-immunization period was compared with the rate in a control time period not following immunization using Poisson regression.Result:A total of 490 infants met the inclusion criteria. The rate of fever was increased in the 24 h period after vaccination (2.3%, P<0.05). The incidence rate of sepsis evaluations was 40% lower after immunization than during the control period, although this was not statistically significant (P=0.09). Infants undergoing a sepsis evaluation after immunization were more likely to have an apneic, bradycardic or moderate-to-severe cardiorespiratory event in the day before the evaluation than were infants undergoing sepsis evaluations at other times (P<0.05).Conclusion:Despite an increase in fever and cardiorespiratory events after immunization in the NICU, routine vaccination was not associated with increased risk of receiving sepsis evaluations. Providers may be deferring immunizations until infants are clinically stable, or may have a higher threshold for initiating sepsis evaluations after immunization than at other times. [ABSTRACT FROM AUTHOR]

Objective:The objective of this study was to reduce central line-associated blood stream infections (CLABSIs) among 13 collaborating regional neonatal intensive care units by 25%. We tested the hypothesis that change could be attributed to the quality improvement collaborative by testing for ‘special cause’ variation.Study Design:Our prevention project included five features: (1) leadership commitment, (2) potentially best practices, (3) collaborative processes, (4) audit and feedback tools and (5) quality improvement techniques. Baseline (1 January 2006 to 30 August 2006) data were compared with the intervention (1 September 2006 to 30 June 2007) and post-intervention (1 July 2007 to 30 December 2007) periods and analyzed using statistical process control (SPC) methods.Result:We detected special cause variation, suggesting that the collaborative was associated with reduced infection rates, from 4.32 to 3.22 per 1000 line days (a 25% decrease) when comparing the baseline with the follow-up period.Conclusion:The collaborative's process was associated with fewer infections. SPC suggested that systematic changes occurred. The remaining challenges include sustaining or even further reducing the infection rate. [ABSTRACT FROM AUTHOR]

Objective:The Intermountain Healthcare hospitals use a clinical pathway algorithm for early-onset infection, which is based on the 2002 Centers for Disease Control and Prevention (CDC) guidelines for perinatal group B streptococcal disease. As part of this pathway, neonates in the well baby nursery, who seem to be well but have risk factors for infection, receive a ‘limited laboratory evaluation including a CBC’, and if the complete blood cell count (CBC) is abnormal, antibiotic treatment and neonatal intensive care unit (NICU) monitoring are initiated. We recently found that reference ranges for absolute neutrophil counts (ANCs) are much wider at our altitude (4800 to 5000 ft) than at sea level. On this basis, we speculated that some well babies with risk factors for infection are mistakenly judged as having an abnormal CBC, and are unnecessarily admitted to the NICU .Study Design:This was a retrospective observational cohort study of neonates of >37 weeks gestation admitted to either of two Intermountain Healthcare NICUs for intravenous antibiotic treatment during a recent 36-month period.Results:During the study period 3217 patients were admitted to the two NICUs, 1049 (32.6%) of which were born at>37 weeks gestation. Of these, 14 (1.3%) were found to have been admitted to the NICU on the basis of an abnormal CBC (elevated ANC), when in retrospect, using the appropriate ANC chart, their CBCs were completely normal. None of the 14 neonates had a leukocyte left shift (immature to total neutrophil ratio >0.3) or thrombocytopenia. None were treated with supplemental oxygen or mechanical ventilation in the NICU. All 14 had sterile blood cultures. All had antibiotics stopped in 48 to 72 h, and all were discharged home as well babies.Conclusion:We identified 14 neonates who, while in the well baby nursery, were found to have risk factors for early-onset infection, but did not seem to be infected, and were subsequently admitted to a NICU for intravenous antibiotic treatment and monitoring under the mistaken impression that they had an abnormal CBC. We maintain that use of an appropriate neutrophil reference range chart can reduce NICU admissions and can limit unnecessary antibiotic exposure. [ABSTRACT FROM AUTHOR]

Objective:Mothers of neonatal intensive care unit (NICU) patients sometimes bring expressed milk that is blood tinged to the NICU. In certain instances, the blood contamination appears minimal, whereas in others, the milk is quite dark pink. We have observed inconsistencies in practice regarding whether or not to feed blood-tinged colostrum or milk to NICU patients. We know of no evidence that establishes best practice in this area, and thus we sought to determine attitudes of NICU professionals on which to base a potentially best practice.Study Design:We conducted a web-based anonymous survey of attitudes of NICU professionals at Intermountain Healthcare regarding feeding blood-tinged expressed milk to NICU patients. These professionals included neonatologists, neonatal nurse practitioners, NICU nurses, NICU dieticians and lactation consultants.Result:Survey results were returned from 64% (426 of 667) of those to whom it was sent. A total of 75% of respondents reported that their practice was NOT to feed the blood-tinged milk illustrated in the figure as sample 2, and nearly all respondents (98%) reported that they would NOT feed the milk illustrated as sample 3. The majority of the neonatologists (56%) and the lactation consultants (58%) recommended feeding moderately bloody milk (sample 2), whereas only 22% of the neonatal nurse practitioners (NNPs), NICU nurses and NICU dieticians recommended feeding such samples (<0.001). The most frequently selected reason for NOT feeding blood-tinged milk was that it would likely cause gastrointestinal upset and feeding intolerance (selected by 77%). The majority (87%) overestimated the amount of blood contaminating a milk sample (sample 3).Conclusion:As colostrum and human milk feedings can be of value to NICU patients, evidence should be assembled to document whether feeding blood-tinged samples indeed have the problems listed by the survey respondents. Such evidence is needed to enable informed decisions involving the benefits vs risks of feeding blood-tinged expressed milk to NICU patients.Journal of Perinatology (2009) 29, 119–123; doi:10.1038/jp.2008.188; published online 15 January 2009 [ABSTRACT FROM AUTHOR]

Objective:To determine changes over time in the characteristics of early extremely low birth weight non-survivors (E-ELBW-NS), maternal characteristics and perinatal management, and the documentation of perinatal consultations.Study Design:We conducted a chart review of infants <750 g who died within 24 h divided into two epochs: 1 January 1995 to 31 December 1999 and 1 January 2000 to 31 December 2005. Maternal and neonatal characteristics, delivery room resuscitation, post-resuscitation care, and documentation of resuscitation and perinatal counseling were examined.Result:A total of 138 infants met inclusion criteria. During Epoch 2, there was an increase in black, small for gestational age infants and prior maternal preterm delivery, and decreased incidences of tocolysis and chorioamnionitis. Also, a trend toward more hemolysis elevated liver enzymes and low platelet syndrome and decreased prenatal care existed. Perinatal consultations increased in both number and quality with time.Conclusion:There has been a shift in racial distribution toward more black infants in the second epoch perhaps reflecting disparities in care. Otherwise, demographics and management of E-ELBW-NS have changed minimally. There has been a significant improvement in the documentation of perinatal consultations.Journal of Perinatology (2009) 29, 33–38; doi:10.1038/jp.2008.112; published online 14 August 2008 [ABSTRACT FROM AUTHOR]

Objective:To investigate associations between early low neutrophil count from routine blood samples, white blood count (WBC), pregnancy complications and neonatal outcomes for very low birth weight infants (VLBW 1500 g) with gestational age <32 weeks.Study Design:Information was abstracted on all infants admitted to level III neonatal intensive care units in Wisconsin 2003 to 2004. A total of 1002 VLBW neonates (78%) had differential and corrected total white counts within 2 ½ h of birth. Data analyses included frequency tables, binary logistic, ordinal logistic and ordinary regression.Result:Low neutrophil count (<1000 per μl) was strongly associated with low WBC, pregnancy complications and antenatal steroids. Low neutrophil count predicted bronchopulmonary dysplasia severity level (odds ratio, OR: 1.7, 95% confidence interval, CI: 1.1 to 2.7) and intraventricular hemorrhage grade (OR: 2.2, 95% CI: 1.3 to 3.8).Conclusion:Early neutrophil counts may have multiple causes interfering with their routine use as an inflammatory marker. Nonetheless, low neutrophil count has consistent independent associations with outcomes.Journal of Perinatology (2008) 28, 604–610; doi:10.1038/jp.2008.65; published online 19 June 2008 [ABSTRACT FROM AUTHOR]

Objective:To identify and quantify airborne volatile organic compounds (VOCs) inside neonatal incubators during various modes of operation within the neonatal intensive care unit (NICU) environment.Study Design:Air samples were taken from 10 unoccupied incubators in four operational settings along with ambient air samples using air sampling canisters. The samples were analyzed following EPA TO-15 using a Tekmar AutoCan interfaced to Agilent 6890 Gas Chromatograph with a 5973 Mass Spectrometer calibrated for 60 EPA TO-15 method target compounds. Non-target compounds were tentatively identified using mass spectral interpretation and with a mass spectral library created by National Institute for Standards and Technology.Result:Two non-target compounds, 2-heptanone and n-butyl acetate, were found at elevated concentrations inside the incubators compared with ambient room air samples. Increase in temperature and addition of humidity produced further increased concentrations of these compounds. Their identities were verified by mass spectra and relative retention times using authentic standards. They were quantified using vinyl acetate and 2-hexanone as surrogate standards.Conclusion:The emission pattern of these two compounds and background measurements indicate that they originate inside the incubator. There is evidence that exposure to some VOCs may adversely impact the fetal and developing infants’ health. Currently, as there is no definitive information available on the effects of acute or chronic low-level exposure to these compounds in neonates, future studies evaluating the health effects of neonatal exposure to these VOCs are needed.Journal of Perinatology (2008) 28, 534–540; doi:10.1038/jp.2008.75; published online 19 June 2008 [ABSTRACT FROM AUTHOR]

Objective:We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of non-compliance that could be addressed by quality improvement measures.Study Design:A detailed review was made of every transfusion administered to patients with a date of birth of 1 January 2006 through 31 December 2006, in any of three level III, perinatal-center-associated NICUs within Intermountain Healthcare.Result:During 2006 the three NICUs cared for 1759 neonates. Seventeen percent of these received one or more (median 3) erythrocyte transfusions, 4% received one or more (median 3) platelet transfusions, 6% received one or more (median 1) FP infusions and 2% received cryoprecipitate (median 1 dose). Seventy percent of the erythrocyte transfusions were given in compliance with the guidelines, as were 69% of the platelet transfusions, 65% of the FP transfusions and 94% of the cryoprecipitate administrations. Patients who received large numbers of transfusions were more likely to receive transfusion that violated the guidelines. Forty-five percent of patients who received 1 to 3 transfusions received all transfusions within guidelines. However, only 18% of patients who received 4 to 10 transfusions received all within guidelines. No patient who received >10 transfusions received all within the guidelines. Erythrocyte transfusions given early in the hospital course were likely to be within guidelines; 72% (588/818) in the first 29 days were compliant with guidelines, but compliance fell to 61% (144/237) for transfusions administered after 29 days (P=0.002). About half of the platelet transfusions given early in the hospital course were in violation of guidelines, but after day 9, 83% of platelet transfusions were compliant with guidelines (P=0.000).Conclusion:Opportunities exist in our healthcare system to improve compliance with our transfusion guidelines. Such opportunities are greatest among neonates receiving multiple transfusions, among those receiving erythrocyte transfusions late in their NICU course and among those receiving platelet transfusions early in their NICU course.Journal of Perinatology (2008) 28, 492–497; doi:10.1038/jp.2008.23; published online 13 March 2008 [ABSTRACT FROM AUTHOR]

Objective:We hypothesized that neonatal intensive care unit (NICU) admission reduces breastfeeding in a recent population of US infants, adjusting for confounding factors.Study Design:Using pregnancy risk assessment monitoring system data from 27 states for the years 2000 to 2003, we determined the relationship between breastfeeding and gestational age (GA) stratified by NICU status. We fitted a proportional odds model for breastfeeding duration as a function of NICU status adjusted for other covariates. SAS 9.1.3 and SUDAAN 9.0 were used for the weighted analyses.Result:In total 138 359 surveys, including 29 940 NICU-admitted infants, were analyzed. A total of 73% of mothers of nonadmitted infants initiated breastfeeding vs 70% of mothers of NICU-admitted infants. Mothers of GA <38 weeks NICU-admitted infants were 34% more likely to initiate breastfeeding and 21% more likely to breastfeed for 4 weeks than were mothers of nonadmitted preterm infants (P<0.001). However, mothers of term NICU-admitted infants were less likely to initiate and continue breastfeeding to 4 weeks than were mothers of term nonadmitted infants (P<0.001). Adjusting for GA, race, maternal age, maternal education, mode of delivery and Medicaid status, NICU admission was associated with increasing duration of breastfeeding (OR 1.10, CI 1.03, 1.17). Compared with mothers of term infants, mothers of <32-week infants were 40% more likely to continue breastfeeding for 4 weeks, mothers of 32 to 34 week infants were 13% less likely to continue and mothers of 35–37 week infants were 22% less likely to continue for at least 4 weeks (P<0.001).Conclusion:NICU admission is now a positive influence on breastfeeding continuation, improving the overall likelihood by 10%. Mothers of preterm NICU-admitted infants were more likely than mothers of nonadmitted infants to continue breastfeeding for 4 weeks, while mothers of term NICU-admitted infants were less likely to continue. Breastfeeding support should be enhanced for term and late preterm infants.Journal of Perinatology (2008) 28, 505–510; doi:10.1038/jp.2008.32; published online 27 March 2008 [ABSTRACT FROM AUTHOR]

Objective:To review the literature on respiratory syncytial virus (RSV) as a cause of nosocomial infections (NI) on neonatal intensive care units (NICUs) and pediatric wards, and the effectiveness of various containment strategies.Study Design:We conducted a literature review to define characteristics of RSV NI, and to evaluate the relative effectiveness of various infection containment programs, including the use of palivizumab on the reported incidence of RSV NI on NICUs and pediatric wards.Result:Highly variable rates of RSV NI have not significantly changed since RSV was first identified. The evaluation of the effectiveness of containment strategies has relied on before/after study designs. Focus on rapid patient diagnosis, compliance of acceptable handwashing techniques and cohorting of patients and staff appears to form the backbone of most prevention and containment programs. When these or other measures have failed, the administration of palivizumab has been useful in halting the spread of RSV NI in children.Conclusion:RSV NI continues to be prevalent in the NICU despite adoption of infection control programs. Preventive measures should be employed to lower the risk of RSV NI and, if identified, appropriate containment strategies should be rapidly implemented.Journal of Perinatology (2008) 28, 319–323; doi:10.1038/jp.2008.37; published online 27 March 2008 [ABSTRACT FROM AUTHOR]

Objective:Neonatal intensive care units (NICUs) impose stressors on development. Comparative studies have focused mostly on the units’ medical qualities and less on their developmental ‘ecology’. The aim of the study was to develop a tool for measuring the various domains of a developmentally appropriate practice in the NICU environment, and to assess its implementation in Israel.Study Design:A questionnaire, designed for NICU senior staff members, was completed by 76 respondents representing 24 NICUs in Israel. The tool that measures developmentally appropriate practice as applied in the NICU environment includes the following three domains: (a) parental and family involvement, (b) environmental control and (c) individualized care and assessment. These measures jointly produce the developmentally appropriate neonatal intensive-care practice (DANIP) index.Result:High variability was found in the application of procedures and programs considered developmentally appropriate. Units with a relatively large multidisciplinary team scored high. Overall, the NICUs in Israel did not consistently follow an integrated form of the developmental care as provided by the Neonatal Individualized Developmental Care and Assessment Program. It was found that individualized care and assessment was significantly and positively linked to control of the environment (r=0.53, P<0.01) and to parental and family involvement (r=0.76, P<0.01); the latter two scales were not associated. Of the three DANIP domains, parental involvement was salient. Although the staff highly appreciated the importance of environmental control and individualized care, application was limited.Conclusion:The DANIP index provides a good starting point for comparative studies.Journal of Perinatology (2008) 28, 218–225; doi:10.1038/sj.jp.7211908; published online 13 December 2007 [ABSTRACT FROM AUTHOR]

Objective:To determine the effect of a dedicated lactation consultant (LC) on the percentage of neonates receiving any human milk in the neonatal intensive care unit (NICU) and at discharge over time.Study Design:Retrospective chart review of three time periods of 3 months each; Time period 1 (before LC hire), Time period 2 (T2; after LC arrival) and Time period 3 (subsequent period after T2).Result:Percentage of infants receiving any HM during hospital stay and at discharge increased significantly over time after LC hire and with LC experience. Outborn (OB) infants receiving any HM in the NICU and at discharge increased over time, but there was no significant change for inborn infants, as the proportion receiving any HM remained consistently high over time.Conclusion:Addition of a dedicated LC to the NICU increased the percentage of neonates receiving any HM, specifically in the OB population.Journal of Perinatology (2008) 28, 136–140; doi:10.1038/sj.jp.7211888; published online 20 December 2007 [ABSTRACT FROM AUTHOR]

Objective:Although our knowledge about how to care for high-risk neonates who require intensive care is continually improving, disparities in health outcomes among various ethnic groups living in developed countries are becoming more evident. The purpose of this study was to identify the risk factors for neonatal intensive care unit (NICU) mortality among Canadian-born minority infants and, furthermore, to determine whether ethnicity was in itself an independent predictor of mortality or major morbidity in the NICU.Study design:Data were prospectively gathered on 6528 infants admitted to nine regionally located NICUs across Canada. Multiple logistic regressions were used to develop risk-adjusted models for NICU mortality and major morbidity.Result:Despite adjusting for differences in small for gestational age (SGA), outborn status and gestational age less than or equal to 28 weeks, South Asian infants still had significantly greater odds of mortality in the NICU. Neonatal sepsis was the strongest predictor of mortality among African infants, even greater than birth at 28 weeks or less. At significantly greater odds of survival with major morbidity were Aboriginal males and East Asian females.Conclusion:There are ethnic disparities in the risks of neonatal mortality and morbidity in the NICU. Understanding these differences is important to be able to determine specific areas to target in improving healthcare delivery and reducing disparities in health outcomes among Canada's diverse population.Journal of Perinatology (2007) 27, 448–452; doi:10.1038/sj.jp.7211766; published online 7 June 2007 [ABSTRACT FROM AUTHOR]

Objective:To determine whether an association exists between either fungal or bacterial sepsis and retinopathy of prematurity (ROP).Study Design:Retrospective cohort study on all neonates with birth weight <1500 g admitted to a large Italian third Level Neonatal Intensive Care Unit in the years 1997–2001 and screened for ROP. Univariate analysis and multiple logistic regression were used to detect significant associations with ROP (all grades and threshold) in neonates with birth weight <1000 g (extremely low birth weight (ELBW)) and 1000–1500 g.Results:Among 301 enrolled neonates, ROP (all grades), threshold ROP, fungal and bacterial sepsis occurred in 31.9, 12.9, 11.6 and 40.5% of the infants, respectively. At multivariate analysis, only gestational age (P=0.03), colonization by Candida non-albicans spp (P=0.03) and fungal sepsis (P=0.03) were independent predictors of threshold ROP, and only in ELBW neonates.Conclusions:Fungal (but not bacterial) sepsis is significantly and independently associated with ROP, but only in ELBW neonates and only with threshold ROP.Journal of Perinatology (2006) 26, 23–30. doi:10.1038/sj.jp.7211420; published online 1 December 2005 [ABSTRACT FROM AUTHOR]

Inconsistency of care in the Neonatal Intensive Care Unit is a common complaint amongst caregivers. This paper discusses evidence-based medicine and standards of care in relation to personal preference where care-giving choices are concerned. It is suggested that moral distress may be diminished by consistently applying evidence-based practice, adhering to standards of care and optimizing the team dynamic by engaging in consensus-based collaboration. [ABSTRACT FROM AUTHOR]

Recommended standards for the acoustic environment of the newborn intensive care unit (NICU) have become more protective over time based on research about the deleterious effects of noise and distraction on infants and adults, and on experience in successfully designing and building quiet hospital nurseries. The 2006 Recommended Standards for Newborn ICU Design include an operating, hourly Leq of 45 dBA, hourly L10 of 50 dBA and Lmax of 65 dBA. Rationales are presented for supporting these levels with noise criterion NC-25 for mechanical systems and thorough use of sound containment and absorption strategies. Involvement of an acoustical engineer throughout the design, build and post-construction validation process will help to ensure that objectives are met. Clinicians are reminded that conscientious self-management in maintaining quiet and acoustic privacy continues to be necessary even in NICUs built for quiet. [ABSTRACT FROM AUTHOR]

Objective: To explore the implications of the single family room (SFR) care environment of neonatal intensive care units (NICU) compared to Open-bay, Combination and Double-occupancy configurations, focusing on family experience, neonate outcomes, staff perceptions, cost and environmental design. Study design: This study uses a multimethod design with 11 Level III NICUs. Space allocations, construction costs, staff preferences and perceptions, and occupant behaviors were evaluated. Results: SFR NICU design provides solutions for increasing parent privacy and presence, supporting Health Insurance Portability and Accountability Act compliance, minimizing the number of undesirable beds, increasing staff satisfaction and reducing staff stress. Conclusion: The analysis of this study suggests that there are benefits to SFR NICU. This study is an initial, comprehensive effort, the purpose of which is to spawn future, narrower, in-depth studies focused on SFR NICU design. [ABSTRACT FROM AUTHOR]

The neonatal intensive care unit (NICU) is a stressful environment for both families and caregivers. Positive distraction is a means of mitigating stress. A review of research reveals that several factors in the physical environment can contribute to positive distraction, the most prominent of which are nature, art and music. Design interventions that provide positive distraction and can be introduced into the NICU setting are window views of pleasant outside vistas, soothing artwork and the ability to listen to music. [ABSTRACT FROM AUTHOR]