Neonatal Outcomes in a Modified NICU Environment


Name: Michelle Renaud

Rank: LTC (ret), USA

Organization: Madigan Army Medical Center

Performance Site: Madigan Army Medical Center, Tacoma, WA

Year Published: 1993

Abstract Status: Completed


Approximately 6% of newborns are admitted to neonatal intensive care units (NICUs) each year in the United States. We studied the effects of a modified NICU physicalenvironment on high-risk infants using a two-group experimental design with repeated measures.The study site was MAMC in Tacoma, Washington, where 126 subjects were consented, enrolled, randomized to groups, and stratified by gestational age. Experimental subjectswere placed in a modified nursery with reduced sound and lighting levels, noise control, and diurnally cycled lighting. Controls received routine care in a standard environment.Entry data were collected on all infants. Variables were recorded daily or at preset intervals. Outcome measures were assessed at discharge and at 1-2 weeks post-discharge.A continuation study expanded the follow-up data collected and added a home visit (8-10 weeks post-discharge) at which parental stress and parent-infant interaction were rated.No statistical differences were found on the Nursing Child Assessment Sleep-Activity Record (NCAFS) and no correlation seen between it and the Parenting Stress Index score.No significant relationships were found between NCAFS parent, infant, or total scores and postnatal or gestational age.No significant differences were seen in feeding progression, length of stay, weight gain, hearing abnormalities, or ROP diagnosis. No differences were seen between groups inmotor tone, reflexes, responses, total examination score, or age at examination. Experimental infants progressed to nipple feeding somewhat faster than controls and hadsomewhat shorter hospital stays. The control group had fewer referrals for hearing examinations.At follow-up, controls spent significantly more daytime hours crying with more nighttime feedings. At home visit, the experimental group slept more and cried less at night; control infants were awake more in the 24-hour day.These results show slight improvement of neonatal outcomes in the modified environment. Further research and increased caregiver training are needed.


Final Report available on NTRL: