I met Joan and Christine about five years ago, when we worked tougher to design a new Neonatal Intensive Care Unit for University of Maryland Medical Center. After many delays, it opened last fall. I appreciated a tour of the new facility.
You can walk through a NICU and hardly see a baby. Neonates are so tiny, and the equipment that keeps them alive so large. Western medicine has made extraordinary strides in helping babies born as early as 22 weeks gestation to develop on par with their full-term peers. Premies can spend weeks, even months, in the NICU to ensure that their heart, lungs, and other vital organs achieve full function.
A generation ago, NICUs were large open spaces where six or eight babies could be taken care of by multiple staff within arms reach. During the 1990’s a major shift in adult inpatient design favored giving each patient his or her own room, thus reducing infection and improving medical outcomes. The benefits of adult private rooms influenced NICU design, and most NICU’s today have private rooms for each infant. The change in care can require units to be three times larger for the same number of patients.
UMMC NICU has 52 private rooms, each of which can accommodate a parent rooming in. The unit is much quieter than their previous space; parents have more opportunity to hold and bond with their baby. Staff and families agree that the unit is a huge improvement over their former space.
Joan explains how every advantage has its costs. “There’s a huge NICU in St. Louis that has half private rooms and half babies in open areas. Babies are assigned randomly. They follow their babies for three years, as do we. Three years later they’ve found that the babies in the open area are developmentally ahead of the ones in private rooms.” All that noise, all that chaos that present medical and infection challenges, also provides stimulation that gave the babies who survive a leg up in life.
“We’ve gotten so good at teaching parents to put their babies on their backs to avoid SIDS, babies are developing ‘flat heads’ from laying on their backs. Now we have to guide them to tummy time, while watching the baby.”
This is not to say that private rooms are not a good idea or you should let your baby sleep on her stomach. It’s just another lesson that the more we think we know, there’s always another level of refinement.
How will we live tomorrow?
“When I go into the staff lounge, I always sit next to the oldest nurse there; she’s less likely to be on her phone and we can talk. I have one son that just graduated college and another who just finished high school. I think about their future. I hope its good, but I have my doubts.” – Christine Byerly