Premature babies often spend their first months of life in neonatal intensive care units (NICUs) — environments that, in recent years, have seen transformations, with hospitals adding private rooms to NICUs in place of open wards. Such renovations are due in large part to concerns that excessive stimulation from noise and lights – and not medical conditions alone — may negatively impact a preemie’s neurodevelopmental outcome.
But research at Washington University School of Medicine in St. Louis adds new information to the discussion over what is the optimal setting for infants in the NICU.
“We had expected that babies in private rooms would do better than babies in the open ward,” said the study’s first author, Bobbi Pineda, PhD, assistant professor in occupational therapy and in pediatrics at Washington University. “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.”
The research is available online in The Journal of Pediatrics.
The observational study involved 136 premature infants who were born at less than 30 weeks gestation — at least 2 ½ months early — and were admitted to the NICU at St. Louis Children’s Hospital. Half of the hospital’s NICU beds are in private rooms, and the other half are in open wards, in which babies are kept together in groups. Infants were assigned to beds in the open wards or private rooms, based on space and staffing levels. The babies remained in the same room type for the duration of their hospitalization in the NICU.
Close to their due dates and before they were discharged from the NICU, each infant underwent comprehensive neurobehavioral testing and brain imaging with MRI.
Using advanced imaging techniques, the researchers found that by the time the babies were discharged from the NICU (on average, three months after birth), infants in the private rooms showed abnormalities in the structure of the brain’s language area compared with infants who were cared for in open wards.
At age 2, 86 of the preemies (83 percent of the survivors) returned for developmental testing, which included standardized assessments of motor, language and cognitive outcomes, as well as social-emotional development.
To their surprise, the researchers found that the children who had stayed in private rooms had poorer language skills. The investigators attempted to account for the many factors that contribute to development of language skills, but the link between the type of room a baby was assigned to in the NICU and the infant’s neurodevelopmental outcome persisted.
“This preliminary finding raises questions about the amount of sensory exposure and other characteristics of different NICU room types,” Pineda said. “More research is needed to examine the best ways to support development in the NICU environment.”
She cautions that the findings of this study 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.
Pineda doesn’t see abandoning private NICU rooms as the only answer.
“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. “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.”
Irrespective of the type of room a preemie is in, developmentally appropriate sensory stimulation can be integrated into care, and families can be empowered to interact and engage with their infants during the NICU stay, Pineda stressed.
“Further research should be directed at determining the optimal environment and types of stimulation that are appropriate for promoting better outcomes in vulnerable preterm infants,” Pineda said.
Current work is underway to examine the differences in language and sound exposure in the two room types. The next step, Pineda said, is to repeat the investigation of relationships between room type and neurodevelopmental outcome using a rigorous randomized clinical trial, while also relating the amount of language and sound exposure to brain development.
Pineda R, Neil J, Dierker D, Smyser C, Wallendorf M, Kidokoro H, Reynolds L, Walker S, Rogers C, Mathur A, Van Essen D, Inder T. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. The Journal of Pediatrics, published Oct. 17, 2013.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.