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Family Rooms in Neonatal Intensive Care Units and Neonatal Outcomes: An International Survey and Linked Cohort Study
Liisa Lehtonen1, Shoo K Lee2, Satoshi Kusuda3
1Department of Pediatrics and Adolescent Medicine, Turku University Hospital; and Department of Clinical Medicine, University of Turku, Turku, Finland.
Insights
Most neonatal intensive care units lack 24-hour infant-parent rooms. However, units with these rooms showed improved outcomes for extremely preterm infants, including lower mortality and shorter hospital stays.
Area of Science:
- Neonatal care
- Pediatric intensive care
- Healthcare facility design
Background:
- Parental presence in neonatal intensive care units (NICUs) is increasingly recognized as vital for infant well-being.
- Facilities supporting 24-hour parental presence, termed infant-parent rooms, are not universally available in high-income countries.
- The impact of infant-parent rooms on clinical outcomes for extremely preterm infants requires further investigation.
Purpose of the Study:
- To determine the prevalence of infant-parent rooms in high-income countries.
- To analyze the association between the availability of infant-parent rooms and the outcomes of extremely preterm infants.
Main Methods:
- A survey of 331 neonatal units across 11 countries identified facilities for parental presence.
- A linked cohort study analyzed patient data from 4662 infants (gestation < 29 weeks) admitted to 159 units.
- Outcomes compared included mortality, major morbidity (sepsis, bronchopulmonary dysplasia), and length of stay.
Main Results:
- Only 13.3% of surveyed units offered infant-parent rooms.
- Infants in units with infant-parent rooms had significantly lower odds of mortality or major morbidity (adjusted odds ratio 0.76).
- These infants also experienced lower rates of sepsis and bronchopulmonary dysplasia and a shorter length of stay (3.4 days shorter).
Conclusions:
- The majority of neonatal intensive care units in high-income nations do not provide 24-hour infant-parent rooms.
- The presence of infant-parent rooms is associated with improved clinical outcomes for extremely preterm infants.
- Implementing infant-parent rooms may enhance care quality and reduce adverse outcomes in neonatal intensive care.
Objectives:
To evaluate the proportion of neonatal intensive care units with facilities supporting parental presence in their infants' rooms throughout the 24-hour day (ie, infant-parent rooms) in high-income countries and to analyze the association of this with outcomes of extremely preterm infants.
Study Design:
In this survey and linked cohort study, we analyzed unit design and facilities for parents in 10 neonatal networks of 11 countries. We compared the composite outcome of mortality or major morbidity, length of stay, and individual morbidities between neonates admitted to units with and without infant-parent rooms by linking survey responses to patient data from 2015 for neonates of less than 29 weeks of gestation.
Results:
Of 331 units, 13.3% (44/331) provided infant-parent rooms. Patient-level data were available for 4662 infants admitted to 159 units in 7 networks; 28% of the infants were cared for in units with infant-parent rooms. Neonates from units with infant-parent rooms had lower odds of mortality or major morbidity (aOR, 0.76; 95% CI, 0.64-0.89), including lower odds of sepsis and bronchopulmonary dysplasia, than those from units without infant-parent rooms. The adjusted mean length of stay was 3.4 days shorter (95%, CI -4.7 to -3.1) in the units with infant-parent rooms.
Conclusions:
The majority of units in high-income countries lack facilities to support parents' presence in their infants' rooms 24 hours per day. The availability vs absence of infant-parent rooms was associated with lower odds of composite outcome of mortality or major morbidity and a shorter length of stay.
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