Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study

Authors: Gianluca Terrin, Francesca Conte, Antonella Scipione, Vincenzo Aleandri, Maria Di Chiara, Erica Bacchio, Francesco Messina, Mario De Curtis

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Login to get access

Abstract

Background

A multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected. We aimed to investigate the impact of the architectural design of the DR and the NICU on neonatal outcome.

Methods

Two cohorts of preterm neonates born at < 32 weeks of gestational age, consecutively observed during 2 years, were compared prospectively before (Cohort 1: “conventional DR”) and after architectural renovation of the DR realized in accordance with specific standards (Cohort 2: “new concept of DR”). In Cohort 1, neonates were initially cared for a conventional resuscitation area, situated in the DR, and then transferred to the NICU, located on a separate floor of the same hospital. In Cohort 2 neonates were assisted at birth directly in the NICU room, which was directly connected to the DR via a pass-through door. The primary outcome of the study was morbidity, defined by the proportion of neonates with at least one complication of prematurity (i.e., late-onset sepsis, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis). Secondary outcomes were mortality and duration of hospitalization. Statistical analysis was performed using standard methods by SPSS software.

Results

We enrolled 106 neonates (56 in Cohort 1 and 50 in Cohort 2). The main clinical and demographic characteristics of the 2cohorts were similar. Moderate hypothermia (body temperature ≤ 35.9 ° C) was more frequent in Cohort 1 (57 %) compared with Cohort 2 (24 %, p = 0.001). Morbidity was increased in Cohort 1 (73 %) compared with Cohort 2 (44 %, p = 0.002). No statistically significant differences in mortality and median duration of hospitalization were observed between the 2 cohorts of the study.

Conclusions

If realized according to the proposed architectural standards, renovation of DR and NICU may represent an opportunity to reduce morbidity in preterm neonates.
Literature
1.
American Academy of Pediatrics/American College of Obstetricians and Gynecologists: Guidelines for Perinatal Care. 6th edn. Elk Grove Village: IL/Washington, DC, 2007.
2.
The American Institute of Architects Academy of Architecture for Health. Guidelines for Design and Construction of Hospital and Health Care Facilities. Washington: The American Institute of Architects Academy of Architecture for Health; 2006.
3.
4.
Leone TA, Rich W, Finer NN. A survey of delivery room resuscitation practices in the United States. Pediatrics. 2006;117:164–75.CrossRef
5.
Rich WD, Leone T, Finer NN. Delivery room intervention: improving the outcome. Clin Perinatol. 2010;37(1):189–202.CrossRefPubMed
6.
Vento M, Aguar M, Leone TA, Finer NN, Gimeno A, Rich W, Escrig R, Brugada M. Using Intensive Care Technology in the Delivery Room. A New Concept for the Resuscitation of Extremely Preterm Neonates. Pediatrics. 2008;122(5):1113–6.CrossRefPubMed
7.
Vandenberg KA. Individualized developmental care for high risk newborns in the NICU: A practice guideline. Early Hum Dev. 2007;83(7):433–42.CrossRefPubMed
8.
Woodward GA, Kirsch R, Stone Trautman M, Kleinman ME, Wernovsky G, Marino BS. Stabilization and transport of the high-risk infant. In: Gleason CA, Devaskar SU, editors. Avery’s Diseases of the Newborn. 9th ed. Philadelphia: Elsevier; 2012. p. 341–56.CrossRef
9.
Finer NN, Rich W, Halamek LP, Leone TA. The delivery room of the future: the fetal and neonatal resuscitation and transition suite. Clin Perinatol. 2012;39(4):931–9.CrossRefPubMed
10.
Terrin G, Passariello A, Manguso F, Salvia G, Rapacciuolo L, Messina F, et al. Serum calprotectin: An antimicrobial peptide as a new marker for the diagnosis of sepsis in very low birth weight newborns. Clin Dev Immunol. 2011;2011:291085.CrossRefPubMedPubMedCentral
11.
Terrin G, Conte F, Oncel MY, Scipione A, McNamara PJ, Simons S, et al. Paracetamol for the treatment of patent ductus arteriosus in preterm neonates: a systematic review and meta- analysis. Arch Dis Child Fetal Neonatal Ed 2015, fetalneonatal-2014-307312
12.
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrage: a study of infants with birth weight less than 1500 gm. J Pediatr. 1978;92(4):529–34.CrossRefPubMed
13.
Chao CP, Zaleski CG, Patton AC. Neonatal hypoxic-ischemic encephalopathy: multimodality imaging findings. Radiographics. 2006;26(1):S159–72.CrossRefPubMed
14.
Bancalari E. Changes in the pathogenesis and prevention of chronic lung disease of prematurity. Am J Perinatol. 2001;18:1–9.CrossRefPubMed
15.
International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity Revisited. Arch Ophtalmol. 2005;123(7):991–9.CrossRef
16.
Terrin G, Passariello A, Canani RB, Manguso F, Paludetto R, Cascioli C. Minimal enteral feeding reduces the risk of sepsis in feed-intolerant very low birth weight newborns. Acta Paediatr. 2009;98(1):31–5.CrossRefPubMed
17.
Soll RF. Heat loss prevention in neonates. J Perinatol. 2008; Suppl 1:S57-9.
18.
Leone TA, Finer NN. Resuscitation in the Delivery Room. In: Gleason CA, Devaskar SU, editors. Avery’s Diseases of the Newborn. 9th ed. Philadelphia: Elsevier; 2012.
19.
Mitchell A, Niday P, Boulton J, Chance G, Dulberq C. A prospective clinical audit of neonatal resuscitation practices in Canada. Adv Neonatal Care. 2002;2(6):316–26.CrossRefPubMed
20.
El-Naggar W, McNamara PJ. Delivery room resuscitation of preterm infants in Canada current practice and views of neonatologists at level III centers. J Perinatol. 2012;32:491–7.CrossRefPubMed
21.
Mann C, Ward C, Grubb M, Hayes-Gill B, Crowe J, Marlow N, Sharkey D. Marked variation in newborn resuscitation practice: a national survey in the UK. Resuscitation. 2012;83(5):607–11.CrossRefPubMedPubMedCentral
22.
Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very low-birth-weight infants. N Engl J Med. 2007;356(21):2165–75.CrossRefPubMed
23.
Tracy M, Downe L, Holberton J. How safe is intermittent positive pressure ventilation in preterm babies ventilated from delivery to newborn intensive care unit? Arch Dis Child Fetal Neonatal Ed. 2004;89(1):F84–7.CrossRefPubMedPubMedCentral
24.
Lee SK, McMillan DD, Ohlsson A, Boulton J, Lee DS, Ting S, Liston R. The benefit of preterm birth at tertiary care centers is related to gestational age. Am J Obstet Gynecol. 2003;188(3):617–22.CrossRefPubMed
25.
Mohamed MA, Aly H. Transport of premature infants is associated with increased risk for intraventricular haemorrhage. Arch Dis Child Fetal Neonatal Ed. 2010;95(6):F403–7.CrossRefPubMed
26.
Thorp JA, Jones PG, Clark RH, Knox E, Peabody JL. Perinatal factors associated with severe intracranial hemorrhage. Am J Obstet Gynecol. 2001;185(4):859–62.CrossRefPubMed
27.
Chitty H, Wyllie J. Importance of maintaining the newly born temperature in the normal range from delivery to admission. Semin Fetal Neonatal Med. 2013;18(6):362–8.CrossRefPubMed
28.
Costeloe K, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPIcure studies). BMJ. 2012;345:e7976e89.CrossRef
29.
Laptook AR, Salhab W, Bhaskar B. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007;119:e643e9.CrossRef
30.
Ogunlesi TA, Ogunfowora OB, Adekanmbi FA, Fetuga BM, Olanrewaju DM. Point-of-admission hypothermia among high-risk Nigerian newborns. BMC Pediatr. 2008;8:40.CrossRefPubMedPubMedCentral
31.
Mullany LC, Katz J, Khatry SK, LeClerq SC, Darmstadt GL, Tielsch JM. Risk of mortality associated with neonatal hypothermia in southern Nepal. Arch Pediatr Adolesc Med. 2010;64(7):650e6.
32.
de Almeida MF, Guinsburg R, Sancho GA, Rosa IR, Lamy ZC, Martinez FE, da Silva RP, Ferrari LS, de Souza Rugolo LM, Abdallah VO, Silveira Rde C. Brazilian Network on Neonatal Research: Hypothermia and early neonatal mortality in preterm infants. J Pediatr. 2014;164(2):271–5.CrossRefPubMed
33.
Miller SS, Lee HC, Gould JB. Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol. 2011;31 Suppl 1:49–56.CrossRef
34.
Clyman RI. Patent ductus arteriosus in the preterm infant. In: Gleason CA, Devaskar SU, editors. Avery’s Diseases of the Newborn. 9th ed. Philadelphia: Elsevier; 2012. p. 751–61.CrossRef
35.
Evora PR, Cable DG, Chua YL, Rodrigues AJ, Pearson PJ, Schaff HV. Nitric oxide and prostacyclin-dependent pathways involvement on in vitro induced hypothermia. Cryobiology. 2007;54(1):106–13.CrossRefPubMed
36.
te Pas AB, Lopriore E, Dito I, Morley CJ, Walther FJ. Humidified and heated air during stabilization at birth improves temperature in preterm infants. Pediatrics. 2010;125(6):e1427–32.CrossRef
37.
Bhatt DR, White R, Martin G, Van Marter LJ, Finer N, Goldsmith JP, Ramos C, Kukreja S, Ramanathan R. Transitional hypothermia in preterm newborns. J Perinatol. 2007;27 Suppl 2:S45–7.CrossRefPubMed
38.
Schmölzer GM, Kumar M, Pichler G, Aziz K, O’Reilly M, Cheung PY. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ. 2013;347:f5980.CrossRefPubMedPubMedCentral
39.
Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Vento M, Halliday HL. European Association of Perinatal Medicine: European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-- 2013 update. Neonatology. 2013;103(4):353–68.CrossRefPubMed
40.
Committee on Fetus and Newborn; American Academy of Pediatrics. Respiratory support in preterm infants at birth. Pediatrics. 2014;133(1):171–4.CrossRef
41.
Schmolzer GM, Te Pas AB, Davis PG, Morley CJ. Reducing lung injury during neonatal resuscitation of preterm infants. J Pediatr. 2008;153:741–5.CrossRefPubMed
42.
Metadata
Title
New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study
Authors
Gianluca Terrin
Francesca Conte
Antonella Scipione
Vincenzo Aleandri
Maria Di Chiara
Erica Bacchio
Francesco Messina
Mario De Curtis
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-0849-4

Other articles of this Issue 1/2016

BMC Pregnancy and Childbirth 1/2016 Go to the issue

Research article

Pre-induction translabial ultrasound measurements in predicting mode of delivery compared to bishop score: a cross-sectional study

Research article

Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study

Study protocol

Metformin in women with type 2 diabetes in pregnancy (MiTy): a multi-center randomized controlled trial

Research article

Women’s birth place preferences in the United Kingdom: a systematic review and narrative synthesis of the quantitative literature

Research article

A discriminant analysis prediction model of non-syndromic cleft lip with or without cleft palate based on risk factors

Research Article

Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans