The importance of parent presence and involvement in the single‐family room and open‐bay NICU

Abstract

It is remarkable how the perception of an optimal environment for preterm infants has evolved since Dr. Julius Hess opened the first premature unit at Sarah Morris Hospital in Chicago in 1914 (1). With the introduction of the incubator and gavage feeding, Dr. Martin Couney first introduced care of the preterm to the public in an exhibit at the 1939 New York Words Fair where visitors paid a fee to view preterm infants in incubators. Wet nurses provided breast milk, and infants were separated from their mothers. In 1960, Dr. Louis Gluck established the first ‘modern’ intensive care unit for high-risk infants at Yale New Haven Hospital, which resulted in the rapid expansion of NICUs in the US and internationally (2). The early premature nurseries and NICUs had an open-bay design, and infants in bays of 12– 20 infants were often separated from their mothers for an extended time. As awareness gradually shifted to the importance of developmental care (3), the design concept shifted to fewer infants in a care area. The option of parent rooming-in became available in a limited fashion in the 1980s, and recommendations of a single room design first appeared in the 1990s (4). The stark differences between the environments of the crowded open-bay NICU from 1986 to 2009 and the current 80 bed single-family room NICU at Women & Infants Hospital are clearly seen in Figures 1 and 2. With the spread of the single-family room nursery design, multiple studies reported a spectrum of benefits including increased rates of breastfeeding (5), decreased mortality, decreased rates of infection, apnoea, length of initial hospitalisation and readmissions (5–8), and improved developmental outcomes (9,10). A meta-analysis published by van Veenendaal et al. (11) in 2019 reported significantly lower rates of sepsis and higher rates of exclusive breastfeeding at discharge but no differences in growth or length of stay. Lester et al. (8,10) noted that mothers in a single-family room nursery were more involved in their infant’s care, including skin-to-skin care compared to open-bay NICU mothers, and that improved infant growth and developmental outcomes were mediated by increased developmental support and maternal involvement. In a multicenter clinical trial (12) (Canada, Australia and New Zealand) of Family Integrated Care in the NICU for infants <34 weeks, infants in the intervention arm had higher daily weight gain and were more likely to be