Private NICU Rooms May Alter Brain Development in Preemies

Jenni Laidman

October 21, 2013

Although current recommendations for the design of neonatal intensive care units (NICUs) call for private rooms for premature infants, a longitudinal cohort study showed that at age 2 years, children who had stayed in private NICU rooms as premature infants scored lower on language acquisition tests, showed more externalizing behavior, and trended toward lower motor scores compared with children who had stayed in an open NICU ward as preemies.

The study, published online October 13 in the Journal of Pediatrics, was conducted in a hospital with low levels of parental visitation and holding.

Roberta G. Pineda, PhD, research assistant professor of occupational therapy and pediatrics in the Program in Occupational Therapy and the Department of Pediatrics at Washington University School of Medicine, St. Louis, Missouri, and colleagues enrolled 136 infants born before 30 weeks' gestation from 2007 to 2010. The infants, who had no congenital anomalies, were in a 75-bed urban level 3 NICU. Infants were assigned either to a private room or to an open ward (1 of 4 rooms with 8 - 12 beds, each about 2 m apart) on the basis of space and available staffing. The open ward was lit by dimmed fluorescent overhead light, and incubators were covered. There was also an effort to minimize noise.

The researchers assessed the infants throughout their NICU stay. The assessments included amplitude integrated electroencephalography recordings 4 times during the NICU stay, and magnetic resonance imaging at 37 to 41 weeks' postmenstrual age. The investigators performed follow-up assessments on 86 of the infants at age 2 years (83% of the survivors) and plan to test them again at age 5 years.

The researchers report no differences in medical factors between the 2 groups, although more infants with Medicaid insurance were placed in private rooms (P = .004). Parental visitation ranged from 1.8 hours to 104 hours per week, with a mean of 19 ± 19 hours. Infants were held an average of 0 to 6 days per week for a mean of 2.4 ±1.5 days.

At 34 weeks' postmenstrual age, infants in private rooms showed higher arousal levels on the NICU Network Neurobehavioral Scale, showing more irritability during testing with more associated motor activity, with a mean score of 3.4 ± 0.8 (P = .0004; β, 0.5; CI, 0.9 - 0.2) for infants in private rooms. The mean score for infants in an open ward was 2.9 ± 0.7. The association remained significant even after controlling for infant score on the Critical Risk Index for Babies, insurance type, and cerebral injury (P = .008; β, 0.5; CI, 0.9 - 0.1).

The researchers found that at term equivalent age, infants kept in private rooms had reduced normal hemispheric asymmetry, as well as a trend toward lower amplitude integrated electroencephalography cerebral maturation scores (P = .04).

At age 2 years, infants who had stayed in private rooms as preemies scored lower on language assessments (P = .006; β, −8.3; confidence interval [CI], −14.2 to −2.4) compared with those who had stayed in the ward. The private room group also showed a trend toward lower motor scores (P = .02; β, −6.3; CI, −11.7 to −0.99) on the Bayley Scales of Infant and Toddler Development, third edition, than the ward group. The infants kept in private rooms showed more externalizing behavior at age 2 years (P = .04) on the Infant Toddler Social Emotional Assessment, after controlling for confounders including scores on the Critical Risk Index for Babies, cerebral injury, social risk score, and family functioning.

"This finding challenges previous reports on the positive benefits of the NICU private room," the authors write.

"The differences in outcomes may relate to the relative sensory deprivation associated with private rooms, particularly in an urban American NICU setting with low parental visitation," the authors write.

"Although a noisy NICU environment might well be detrimental to brain development, a lack of voice and auditory exposure with long periods of silence may also be detrimental," Dr. Pineda noted in a journal news release.

The authors have disclosed no relevant financial relationships.

J Pediatrics. Published online October 17, 2013. Abstract

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