1. Single-family room (SFR) model of care in the NICU improved medical and neurodevelopmental outcomes in infants.
2. Increased developmental support and maternal support in the SFR model were identified as mediating factors for improved outcomes.
Evidence Rating Level: 2 (Good)
Study Rundown: Single-family rooms (SFR) have increasingly replaced the traditional open-bay model of care in the neonatal ICU (NICU). This study examined neurodevelopmental outcomes for infants in the open-bay vs. SFR NICU model and factors that mediated observed differences. Statistically significant, superior medical outcomes for infants in the SFR NICU included greater rate of weight gain, fewer medical procedures, lower gestational age at full enteral feeds, and less sepsis. Neurodevelopmental outcomes included increased attention and decreased physiologic stress, hypertonicity, lethargy, and pain. The SFR model had increased developmental and maternal support. Developmental support, including number of occupational therapy days, mediated weight and attention differences. Maternal support, including number of days per week of parental presence, maternal care, kangaroo care and feeding, mediated the observed decrease in medical procedures, stress, and pain. Though this study may have limited generalizability due to variations among SFR models at different institutions, it emphasizes the benefits associated in models of care that increase maternal involvement and developmental support that physicians should be aware of.
Relevant Reading: The single-patient room in the NICU: maternal and family effects
In-Depth [prospective cohort study]: Infants less than 1500 grams and born to English-speaking mothers at least 18-years-old at the Women & Infants Hospital of Rhode Island were enrolled into the study before and after transition from an open-bay to SFR NICU model. A total of 151 infants in the open-bay NICU and 252 infants in the SFR NICU participated in the study. There were no differences between infants in the open-bay vs. SFR models at enrollment. Neurobehavioral outcomes were measured using a NICU Network Neurobehavioral Scale. Maternal involvement was assessed by questionnaires administered 3-4 days prior to discharge. Statistically significant differences between the open-bay vs. SFR cohort existed in discharge weight (2657 g vs. 2890 g; p=0.005), rate of weight gain (22.7 g/day vs. 23.8 g/day; p=0.017), gestational age at full enteral feeding (32.0 weeks vs. 31.4 weeks; p=0.015), and sepsis (20% vs. 12.7%; p=0.050). Developmental support was increased in the SFR cohort and mediated improvement in weight (p=0.012) and attention (p=0.052). Maternal involvement was increased in the SFR cohort and mediated decreased medical procedures (p <0.000), stress (p <0.000) and pain (p <0.014).
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