Preterm babies fare better in single family rooms, not hospital wards

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Premature babies
Premature babies

Lancet study examines breastfeeding rates and incidence of sepsis in preterm babies who are cared for in single rooms and hospital wards

 

Caring for preterm babies in single family rooms appears to reduce the incidence of sepsis and improve exclusive breastfeeding rates. compared with traditional open ward neonatal units this leads to better outcomes, according to a systematic review and meta-analysis published in The Lancet Child & Adolescent Health journal.

However, extremely preterm babies (<28 weeks gestation) in intensive care looked after in single family rooms do not appear to have better neurodevelopmental outcomes at 18–24 months.

The authors say that the findings support the growing trend towards building more single family rooms in neonatal units. Sepsis (which affects around a quarter of babies born extremely preterm) and establishing breastfeeding during hospital stay are major challenges for preterm infants, and both are associated with cognitive outcomes in the long term. However, they caution that the true effect of single family rooms on long-term cognitive outcomes remains unclear because of the small number and short follow-up of studies assessing neurodevelopment, and the lack of randomised controlled trials.

Prematurity is the main complication of pregnancy, and 14.9 million babies are born preterm (delivery before 37 weeks of gestation) worldwide every year. Delivery at any gestation other than full term can impair brain development

“Our findings support future development of single family rooms in neonatal units to reduce sepsis and improve breastfeeding rates during hospital stay. But to establish whether single rooms have an impact on long-term neurodevelopment we also need well-designed studies to examine the vast majority of preterm infants who are born after 32 weeks gestation, in whom no follow-up studies have been done”, says Dr Sophie van der Schoor from OLVG (a teaching hospital in Amsterdam), Netherlands, who led the study.

Prematurity is the main complication of pregnancy, and 14.9 million babies are born preterm (delivery before 37 weeks of gestation) worldwide every year. Delivery at any gestation other than full term can impair brain development, increasing the risk of poor neurocognitive outcomes.

Preterm babies often spend their first months after birth in neonatal intensive care units and are usually cared for communally in open bay units. Nurses provide routine care and parents are welcome in most units at any time. Concerns that unfavourable environmental factors including excessive stimulation from noise and lights, separation from parents, and infections may jeopardise neurodevelopmental outcomes and survival have contributed to a rise in hospitals building private rooms instead of open bay units. However, the potential benefits and harms that the hospital environment has on the health, particularly neurodevelopment, of preterm babies is hotly debated. Research so far has produced conflicting results.

“Although our study is based on all available data in the public domain, we did not find clear evidence of benefit of single family rooms on neurodevelopment. However, in all studies, outcomes were only assessed up to 2 years old, and some children who experience cognitive difficulties at school are classified as having normal neurodevelopmental function at 2 years of age. Even for cases of severe cognitive deficit at later ages in childhood the accuracy of early detection is low. As neuro-cognitive deficits often take a long time to develop, more and longer follow-up studies are needed”, says van der Schoor.

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