Indoor Climate and Air Quality in a Neonatal Intensive Care Unit

The skin and respiratory system of premature neonates are in permanent contact with indoor room air. We longitudinally analyzed the room air climate and quality in neonatal intensive care inside and outside an incubator.

Sampling was performed in 2 patient rooms and inside a neonatal incubator (Caleo, Draeger Medical, Lübeck, Germany) over 6 weeks with 5-min resolution resulting in 12,090 samples (U-Monitor, U-Earth Biotech, London, UK). Temperature, humidity, and air pollutants, including particulate matter (<1 μm [PM1] and <2.5 μm [PM2.5]), volatile organic compounds (VOC), and odorous gases (OG), were recorded. Room air parameters were analyzed using time series analysis. A linear regression model was used to check for statistically significant linear trends. Statistical analysis was performed using decompensation of time series analysis and spectral analysis by fast Fourier transformation.

The indoor climate target values of the ward's central ventilation system for temperature and humidity were not always met. Room air parameters (PM, VOC, and OG) showed significant daytime-dependent fluctuations with different oscillation frequencies per day. The daily mean (first quartile - third quartile) concentrations of PM2.5 were significantly higher inside the incubator compared to the surrounding ambient air (2,158 [1,948-2,298] pcs/L vs. 2,018 [1,852-2,058] pcs/L; p < 0.001). OG were significantly lower inside the incubator compared to ambient air. VOC levels inside the incubator were substantially higher during the first 5 days of the observation period compared to VOC levels in the surrounding ambient air.

The indoor climate of neonatal intensive care units should be monitored in real time to detect deviations from target parameters quickly. In our neonatal intensive care unit, indoor air quality fluctuated significantly depending on the time of day. We highly suspect that air pollutants are carried into the direct patient environment by visitors and medical staff. The incubator does not protect against PM and VOC exposure but reduces exposure to OG. Cleaning procedures may lead to substantially higher concentrations of VOC inside the incubator and may represent a potentially harmful factor for premature infants.