Last month, I wrote my thoughts on Sunnybrook Hospital’s new NICU parent coordinator. Kate Robson, the Sunnybrook Neonatal Intensive Care Unit Parent Coordinator, responded to my question:

… is there a way of minimizing the feel of the breathing machines and tubes, and interjecting some life from outside those stabilizing entities?

She gave me a link (Thank You!!!) to a PDF presentation by Dr. Robert White on The NICU Environment of Care, given at the Millennium Neonatology Symposium on April 29, 2010.

Dr. White’s presentation looks at the NICU care environment in terms of patients (babies), families, and staff members. He explains some common myths about the pre-term infant brain and illustrates why it matters: brain weight alone increases 400% in the last 3 months of pregnancy. An environment that fosters brain, lung, heart, growth etc, is incredibly important.

Circadian rhythms (the body’s 24 hour biochemical, physiological and psychological cycles) are very important in a baby’s development. Babies can see light and hear sounds within the womb, however they also receive zeitgebers (external circadian rhythm triggers) from the mother’s body based on her physical activity, eating and sleeping habits throughout the day.

New moms realize their milk supply changes as they breast feed a child: the visual chart showing how much cortisol and melatonin are found in breast milk at various times of day is a good reminder that a mother’s body generally knows what her child needs. This is an important point by Dr. White. Traditional incubators cannot replace the intimacy of the infant in the womb. NICU units that group multiple pre-term babies with different needs is appropriate for staff member access, but doesn’t satisfy the holistic healing of both the vulnerable newborns, nor the emotional needs of the families, who desire connection with their child. As Dr. White puts it:

A design that is optimal from a functional standpoint but does not nourish the spirit treats patients, families, and caregivers as less than fully human. (Dr. White, The NICU Environment of Care.)

In the presentation, Dr. White gives some examples of a new trend. Hospitals started modifying patient suites for more individual rooms with exterior views, recognizing faster patient improvement from Evidence-Based Design (EBD). These “step-down” rooms take a patient down through care levels without taking them from room to room and unit to unit. Infant patients should be treated the same. Individual provide access for the whole family and remove the beeps and noises of other machines and babies. Natural light creates a nicer environment for patients and boosts circadian rhythms. Windows from the corridor allow staff members important views.

The presentation doesn’t articulate how to mediate between staff work lighting and patient sleep cycles but that is a common problem every where. Staff members must see what they are doing clearly.

I found the PDF very informative, but didn’t see the actual presentation. I am curious about the examples of supporting spaces: an outdoor space, an informal gathering space, and a “Neonatal Village.” The “village” picture offers a sense of the layout: a central gathering space with private NICU rooms on the exterior with the windows. I welcome the space for family members to remain outside the NICU rooms so they can rest themselves and get to know other families. However, I wonder: Is the space used frequently? Does the requirement for staff views of the NICU rooms mean that the remainder of the central space has to feel open and institutional? Are parents sleeping in the NICU rooms or do they have their own space to rest?  How does the architecture of the central gathering and nursing station nourish the spirit?

The patient rooms are getting better, though I would love to know how nursing staff feel about the spaces. Thank you for the link, it was inspiring!