18-Month Follow-Up of Infants Cared for in a Single-Family Room Neonatal Intensive Care Unit

  • Barry M. Lester
    Correspondence
    Reprint requests: Center for the Study of Children at Risk, Women & Infants Hospital of Rhode Island, 101 Dudley St, Providence, RI 02905.
    Affiliations
    Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI

    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Departments of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Amy L. Salisbury
    Affiliations
    Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI

    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Katheleen Hawes
    Affiliations
    Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI

    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Lynne M. Dansereau
    Affiliations
    Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Rosemarie Bigsby
    Affiliations
    Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI

    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Abbot Laptook
    Affiliations
    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Marybeth Taub
    Affiliations
    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Linda L. Lagasse
    Affiliations
    Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Providence, RI

    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • Betty R. Vohr
    Affiliations
    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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  • James F. Padbury
    Affiliations
    Departments of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI

    Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI
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      Objectives

      To determine whether the single-family room (SFR)-neonatal intensive care unit (NICU) is associated with improved 18-month neurodevelopmental outcome, especially in infants of mothers with high maternal involvement.

      Study Design

      An 18-month follow-up was undertaken that compared infants born <30 weeks gestational age; 123 from a SFR-NICU vs 93 from an open-bay NICU. Infants were divided into high vs low maternal involvement based on days/week of kangaroo care, breast/bottle feeding, and maternal care. Infants with high vs low maternal involvement in the SFR and open-bay NICUs were compared on the Bayley Cognitive, Language, and Motor scores and Pervasive Developmental Disorders autism screen.

      Results

      There were more mothers in the high maternal involvement SFR than in the high maternal involvement open-bay group ( P = .002). Infants with high maternal involvement in both NICUs had greater Cognitive ( P = .029) and Language ( P < .000) scores than infants with low maternal involvement. Effect sizes within NICU were moderate to large in the SFR-NICU for Language scores and moderate for the Language composite in the open-bay NICU. The number of days of maternal involvement was greater in the SFR than open-bay NICU ( P < .000), and length of stay was shorter in the high maternal involvement SFR than high maternal involvement open-bay NICU ( P = .024). Kangaroo and maternal care predicted Cognitive (kangaroo, P = .003) and Language scores ( P = .015, P = .032, respectively). Infants with ≥1 symptom of autism were more likely to be in the open-bay low maternal involvement group vs the SFR high maternal involvement group (OR = 4.91, 95% CI = 2.2-11.1).

      Conclusions

      High maternal involvement is associated with improved 18-month neurodevelopmental outcome, especially in infants cared for in a SFR-NICU.

      Keywords

      Abbreviations:

      ASD ( Autism spectrum disorder), Bayley-III ( Bayley Scales of Infant and Toddler Development, Third Edition), LOS ( Length of stay), NICU ( Neonatal intensive care unit), PDDST-II ( Pervasive Developmental Disorders Screening Test, 2nd edition Stage 2), SFR ( Single-family room)
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      References

        • Lester B.M.
        • Hawes K.
        • Abar B.
        • Sullivan M.
        • Miller R.
        • Bigsby R.
        • et al.
        Single-family room care and neurobehavioral and medical outcomes in preterm infants.
        Pediatrics. 2014; 134: 754-760
        • Domanico R.
        • Davis D.K.
        • Coleman F.
        • Davis B.O.
        Documenting the NICU design dilemma: comparative patient progress in open-ward and single family room units.
        J Perinatol. 2011; 31: 281-288
        • Carter B.S.
        • Carter A.
        • Bennett S.
        Families' views upon experiencing change in the neonatal intensive care unit environment: from the ‘baby barn’ to the private room.
        J Perinatol. 2008; 28: 827-829
        • Erdeve O.
        • Arsan S.
        • Yigit S.
        • Armangil D.
        • Atasay B.
        • Korkmaz A.
        The impact of individual room on rehospitalization and health service utilization in preterms after discharge.
        Acta Paediatr. 2008; 97: 1351-1357
        • Ortenstrand A.
        • Westrup B.
        • Brostrom E.B.
        • Sarman I.
        • Akerstrom S.
        • Brune T.
        • et al.
        The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity.
        Pediatrics. 2010; 125: e278-85
        • Stevens D.C.
        • Helseth C.C.
        • Khan M.A.
        • Munson D.P.
        • Reid E.J.
        A comparison of parent satisfaction in an open-bay and single-family room neonatal intensive care unit.
        HERD. 2011; 4: 110-123
        • Carlson B.
        • Walsh S.
        • Wergin T.
        • Schwarzkopf K.
        • Ecklund S.
        Challenges in design and transition to a private room model in the neonatal intensive care unit.
        Adv Neonatal Care. 2006; 6: 271-280
        • Stevens D.C.
        • Helseth C.C.
        • Khan M.A.
        • Munson D.P.
        • Smith T.J.
        Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design.
        J Perinatol. 2010; 30: 352-358
        • Stevens D.C.
        • Helseth C.C.
        • Thompson P.A.
        • Pottala J.V.
        • Khan M.A.
        • Munson D.P.
        A comprehensive comparison of open-bay and single-family-room neonatal intensive care units at Sanford Children's Hospital.
        HERD. 2012; 5: 23-39
        • Walsh W.F.
        • McCullough K.L.
        • White R.D.
        Room for improvement: nurses' perceptions of providing care in a single room newborn intensive care setting.
        Adv Neonatal Care. 2006; 6: 261-270
        • Pineda R.G.
        • Stransky K.E.
        • Rogers C.
        • Duncan M.H.
        • Smith G.C.
        • Neil J.
        • et al.
        The single-patient room in the NICU: maternal and family effects.
        J Perinatol. 2012; 32: 545-551
        • Pineda R.G.
        • Neil J.
        • Dierker D.
        • Smyser C.D.
        • Wallendorf M.
        • Kidokoro H.
        • et al.
        Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments.
        J Pediatr. 2014; 164 (e2): 52-60
        • Vohr B.R.
        • Wright L.L.
        • Poole W.K.
        • McDonald S.A.
        Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks' gestation between 1993 and 1998.
        Pediatrics. 2005; 116: 635-643
        • Vohr B.R.
        Neurodevelopmental outcomes of extremely preterm infants.
        Clin Perinatol. 2014; 41: 241-255
        • O'Shea T.M.
        • Allred E.N.
        • Dammann O.
        • Hirtz D.
        • Kuban K.C.
        • Paneth N.
        • et al.
        The ELGAN study of the brain and related disorders in extremely low gestational age newborns.
        Early Hum Dev. 2009; 85: 719-725
        • Wilson-Costello D.
        • Friedman H.
        • Minich N.
        • Fanaroff A.A.
        • Hack M.
        Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s.
        Pediatrics. 2005; 115: 997-1003
        • Siegel B.
        Pervasive developmental disorders screening test-II.
        Harcourt Assessment, San Antonio (TX)2004
        • Montgomery J.M.
        • Duncan C.R.
        • Francis G.C.
        Test Review: Siegel, B. (2004). Pervasive Developmental Disorder Screening Test—II (PDDST-II). San Antonio, TX: Harcourt.
        J Psychoeduc Assess. 2007; 25: 299-306https://doi.org/10.1177/0734282906298469
        • Miles M.S.
        • Funk S.G.
        • Carlson J.
        Parental Stressor Scale: neonatal intensive care unit.
        Nurs Res. 1993; 42: 148-152
        • Beck A.
        Beck depression inventory.
        The Psychological Corporation, San Antonio (CA)1996
        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Davis P.
        • Rabinowitz P.
        Methods of numerical integration.
        2nd ed. Academic Press, San Diego (CA)1984
        • Quach J.
        • Hiscock H.
        • Ukoumunne O.C.
        • Wake M.
        A brief sleep intervention improves outcomes in the school entry year: a randomized controlled trial.
        Pediatrics. 2011; 128: 692-701
        • Chwo M.J.
        • Anderson G.C.
        • Good M.
        • Dowling D.A.
        • Shiau S.H.
        • Chu D.M.
        A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity.
        J Nurs Res. 2002; 10: 129-142
        • Feldman R.
        • Eidelman A.I.
        • Sirota L.
        • Weller A.
        Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development.
        Pediatrics. 2002; 110: 16-26
        • Baley J.
        • Committee On Fetus and Newborn
        Skin-to-skin care for term and preterm infants in the neonatal ICU.
        Pediatrics. 2015; 136: 596-599
        • Stephens B.E.
        • Bann C.M.
        • Watson V.E.
        • Sheinkopf S.J.
        • Peralta-Carcelen M.
        • Bodnar A.
        • et al.
        Screening for autism spectrum disorders in extremely preterm infants.
        J Dev Behav Pediatr. 2012; 33: 535-541
        • Limperopoulos C.
        • Bassan H.
        • Sullivan N.R.
        • Soul J.S.
        • Robertson Jr, R.L.
        • Moore M.
        • et al.
        Positive screening for autism in ex-preterm infants: prevalence and risk factors.
        Pediatrics. 2008; 121: 758-765
        • Kuban K.C.
        • O'Shea T.M.
        • Allred E.N.
        • Tager-Flusberg H.
        • Goldstein D.J.
        • Leviton A.
        Positive screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in extremely low gestational age newborns.
        J Pediatr. 2009; 154 (e1): 535-540
        • Fanaroff A.A.
        • Stoll B.J.
        • Wright L.L.
        • Carlo W.A.
        • Ehrenkranz R.A.
        • Stark A.R.
        • et al.
        Trends in neonatal morbidity and mortality for very low birthweight infants.
        Am J Obstet Gynecol. 2007; 196 (e1-8): 147