Use of Single-Family Rooms Reduces Incidence of Neonatal Sepsis

Although there was no significant difference in long-term neurodevelopmental outcome in preterm infants hospitalized in single-family rooms compared with open bay units, the single-family room setting significantly reduced neonatal sepsis and improved rates of exclusively breastfeeding at discharge, according to a study recently published in the Lancet Child & Adolescent Health.¹

Unfavorable environmental factors during hospitalization may affect a range of morbidities in preterm infants, including infections, neurodevelopment, and psychosocial behaviors.^2-4 Evidence is scarce on whether single-family rooms improve infant outcomes in a neonatal setting. As such, researchers conducted a systematic review and meta-analysis and reported an analysis of 13 distinct study populations (n=4793), which aimed to show the benefits of single-family rooms over traditional open bay neonatal units.

The primary outcome was age-appropriate long-term neurodevelopment. Secondary outcomes were length of hospital stay, sepsis, breastfeeding, growth, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, and mortality.

No significant difference in cognitive neurodevelopment was found on the Bayley Scales of Infant and Toddler Development-III at the corrected age of 18 to 24 months (n=680; mean difference 1.42; 95% CI, −1.11 to 3.95; P=.27; I²=42%).

Compared with open bay units, single-family rooms showed a significantly reduced incidence of sepsis (n=4165; 108,035 hospitalization days; risk ratio 0.63; 95% CI, 0.50-0.78; P<.0001; I²=0%) and higher incidence of exclusive breastfeeding at discharge (n=484; risk ratio, 1.31; 95% CI, 1.07-1.61; P=.01; I²=0%).

No differences in length of hospital stay, growth, bronchopulmonary dysplasia, intraventricular hemorrhage, retinopathy of prematurity, and mortality were observed.

The study authors concluded that their “findings support future development towards building single family rooms and provide evidence for all players and stakeholders in the field of neonatal care.”

However, single-family rooms have some inherent disadvantages, as noted by Jayanta Banerjee, MBBS, of Imperial College Healthcare NHS Trust in London, United Kingdom, in a commentary.⁵ Dr Banerjee stated that “parents might feel more isolated from other parents and health-care professionals when caring for their infants in single family rooms.” In addition, single-family rooms would require a rearrangement of staffing and major restructuring of most neonatal units, which would have a significant economic effect on healthcare costs and resources. Thus, “when building new neonatal units or redeveloping existing units, single family rooms should be seriously considered,” wrote Dr Banerjee.

References

1. van Veenendaal NR, Heideman WH, Limpens J, et al. Hospitalising preterm infants in single family rooms versus open bay units: a systematic review and meta-analysis [published online January 7, 2019]. Lancet Child Adolesc Health. doi: 10.1016/S2352-4642(18)30375-4
2. Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern Heal Neonatol Perinatol. 2017;3:5.
3. Ranger M, Zwicker JG, Chau CMY, et al. Neonatal pain and infection relate to smaller cerebellum in very preterm children at school age. J Pediatr. 2015;167(2):292-298.
4. Provenzi L, Giusti L, Fumagalli M, et al. Pain-related stress in the neonatal intensive care unit and salivary cortisol reactivity to socio-emotional stress in 3-month-old very preterm infants. Psychoneuroendocrinology. 2016;72:161-165.
5. Banerjee J. Are single family rooms the future for neonatal units? [published online January 7, 2019]. Lancet Child Adolesc Health. doi: 10.1016/S2352-4642(18)30402-4