Women & Infants: Single-room NICU can have positive impact on preterm infants

PROVIDENCE – While the Centers for Disease Control and Prevention estimate that some 500,000 babies are born prematurely each year – representing one of every eight live births in the United States – data from the March of Dimes indicate some 380,000 babies – or about one in 10 – are born prematurely each year. Rhode Island’s preterm birth rate was 8.6 percent last year, Dr. James F. Padbury, pediatrician-in-chief and chief of neonatal/perinatal medicine at Women & Infants Hospital, told Providence Business News. “RIte Care does a good job.”

Nevertheless, preterm births (infants born before the 37th week of pregnancy) remain a major health problem, and one that has increased in the past 20 years, according to Women & Infants Hospital, the 12th largest stand-alone obstetrical service in the country and the largest in New England. Women & Infants data is based primarily on a baby’s birthweight, rather than gestational age; however, of the 8,500 babies born there in 2014, 760 were born before 37 weeks, the hospital reported.

“Born Too Soon: The Global Action Report on Preterm Birth” – published in 2012 by the March of Dimes Foundation; The Partnership for Maternal, Newborn & Child Health, Save the Children and the World Health Organization – represents almost 50 United Nations agencies, universities and organizations. The report, which contains the first-ever estimates of preterm birth rates by country, ranked the United States 131st in the world in terms of its preterm birth rate.

Survival rates for preterm infants have improved, but researchers continue to analyze what can positively impact their neurodevelopment. Research conducted at Women & Infants Hospital, a Care New England facility, suggests that the environment in a neonatal intensive care unit can positively impact preterm infants’ short- and long-term neurobehavioral development.

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Barry M. Lester, director of the Brown Center for the Study of Children at Risk at Women & Infants Hospital, led research that determined that ta mother’s involvement is the single greatest contributor to long-term neurobehavioral development in a preterm infant. Further, they found that a single-family room NICU affords mothers the ideal opportunities to connect with their newborns. The research, entitled “18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit,” was published in the current issue of The Journal of Pediatrics.

“We found that the amount of maternal involvement was greater shortly after birth, increased rapidly, peaked within the first two weeks and was then sustained in the single-family room NICU, in contrast to a more gradual increase in maternal involvement in an open bay NICU,” Lester, who is also a professor of psychiatry and pediatrics at The Warren Alpert Medical School of Brown University, explained in a hospital statement. “In other words, the single-family room NICU appears to ‘jump start’ high maternal involvement.”

Lester and his colleague, Padbury and Elsa Zopfi, professor of pediatrics for perinatal research at the Alpert Medical School, published research in September 2014 in Pediatrics. That research discovered that a single-family room NICU environment provides appropriate levels of maternal involvement, developmental support and staff involvement, deemed essential to provide care that optimizes a preterm infant’s medical and neurodevelopmental outcomes and contributes to developing preventive interventions to minimize impairments in the future.

The hospital researchers conducted an 18-month follow-up, which compared infants born at Women & Infants Hospital earlier than 30 weeks’ gestation – 93 were cared for in an open-bay NICU and 123 were cared for in the single-family room NICU. Infants were divided into high versus low maternal involvement based on days per week of kangaroo care (where a preterm infant is held skin-to-skin with a parent, generally the mother, for as many hours as possible each day), breastfeeding, bottle feeding and maternal care. Infants with high versus low maternal involvement in the single-family room and open bay NICUs were compared on the Bayley Cognitive, Language and Motor scores and Pervasive Developmental Disorders autism screen. Since September 2009, when the new NICU was opened, all of its rooms are single-family rooms.

“What we learned is that of the four components of maternal involvement, kangaroo care … was the most important contributor, followed by maternal care,” Lester said. “It is likely that kangaroo care, when started early, triggers a cascade of maternal care, breastfeeding and bottle feeding.

“In the original study, we found that the single-family room model of care facilitated maternal involvement, and that more maternal involvement was related to better neurobehavioral outcomes at NICU discharge,” said Lester. “For this most recent study, we hypothesized that maternal involvement would be associated with improved neurodevelopmental outcome at 18 months, especially in infants cared for in a single-family room NICU. Our study results suggest, as hypothesized, that the improvements are sustained through 18 months. The fact that the early findings were maintained through 18 months suggests that the improvements could be permanent. Notably, infants in a single-family room NICU also had fewer symptoms of autism spectrum disorder, so that model of care might also help combat autism spectrum disorder in preterm infants.”

Women & Infants/Brown University colleagues Amy L. Salisbury, Katheleen Hawes, Lynne M. Danserreau, Rosemary Bigsby, Dr. Abbot Laptook, Marybeth Taub, Linda Lagasse, Padbury and Dr. Betty R. Vohr were research team members.

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