Effects of NICU Environmental Characteristics on Preterm Infant Oral Feeding

Pickler, Rita H.

Monday, June 25, 2012 : 3:15 PM

Title: Effects of NICU Environmental Characteristics on Preterm Infant Oral Feeding

Baltimore 3-5 (Gaylord National Harbor)

Rita H. Pickler, PhD, RN, PNP-BC, FAAN , Center for Professional Excellence and Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Barbara Reyna, PhD, RN, NNP-BC , Newborn Intensive Care Unit, VCU Health System, Children's Hospital of Richmond, Richmond, VA

Marty Lewis, BS, RN , VCU Health System, Virginia Commonwealth University, Richmond, VA

Al Best, PhD , School of Dentistry, Virginia Commonwealth University, Richmond, VA

Paul Wetzel, PhD , School of Engineering, Virginia Commowealth University, Richmond, VA

Jacqueline McGrath, PhD, RN, FNAP, F , Department of Family and Community Health Nurisng, Virginia Commonwealth University, School of Nursing, Richmond, VA

Sharon Cone, MS, RN, NNP , VCU Health System, Virginia Commonwealth University, Richmond, VA

Heather Tubbs-Cooley, PhD, RN , Center for Professional Excellence and Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Audio File

Discipline: Professional Issues (PI), Newborn Care (N)

Learning Objectives:

Identify changes in environmental light, sound, and activity associated with ward design and single family room design NICUs.
Describe effects of environmental light, sound, and activity on preterm infant oral feeding outcomes.
Identify other environmental factors in the NICU amenable to change that affect preterm infant oral feeding.

Submission Description:

Objective:

Many NICUs have been redesigned from multi-patient (wards) to single family room (SFR) design with the expectation of improved patient outcomes. This study examined the effect of NICU environmental characteristics (light, sound, activity) associated with wards and SFRs on preterm infant oral feeding outcomes.

Design:

This descriptive analysis was part of a larger RCT of preterm infant feeding. The study had IRB approval.

Setting:

Data were collected in a Level 3 NICU that moved from a single 32-bed ward to a 30-SFR design midway through the study.

Patients/Participants:

The observations involved 87 preterm infants (43 males; mean BW 1.4 kg; 70% Black, non-Hispanic).

Methods:

Light, sound, and activity were recorded at every feeding over 14 days for 87 preterm infants resulting in 10,913 observations (5111 ward, 5802 SFR). A rating scale (1-5; 1=lowest level) was used to record light, sound and activity. Oral feeding outcome was the proportion of prescribed breastmilk or formula consumed by nipple at each scheduled feeding. Data were analyzed with descriptive statistics and Chi square analysis.

Results:

Light, sound, and activity were rated significantly lower in the SFRs versus the ward (p<0.0001 for all measures). Feeding times of 9 am, 12 noon, 3 pm were associated with the highest levels of light, sound, and activity in both unit designs, with the ward design significantly higher (p<0.001). Infant oral feeding was significantly affected by infant post-conceptual age, morbidity, light, and time of feeding.

Conclusion/Implications for nursing practice:

Preterm infant feeding is affected by many things, including characteristics of the infant that may not be amenable to intervention. However, oral feeding is also influenced by environmental characteristics that can be changed. This analysis found that infant oral feeding was significantly improved by lower light levels. Although it is acknowledged that unit design may affect caregivers’ ability to alter light levels, a variety of strategies do exist, including feeding infants in specially designated feeding rooms, retrofitting units with bedside task lighting, and using overhead shields to reduce light exposure during the feeding. Time of feeding also affected outcome with the busiest daytime hours have a significantly negative impact on oral consumption. Some unit practices may contribute to this environmental characteristic, including bedside rounds, clustering of care, and multiple assessments conducted within a short time interval. These activities need further study to determine their impact on important health outcomes.

Keywords: NICU design, preterm infant feeding, caregiving environment