Parent involvement in Sickkids NICU remodelling

Today's Toronto Star included the article "Premature Babies Thrive in Cozier ICU" (thanks Janis for passing along) showing parent involvement by Gord and Stacey Archer in Sickkids NICU remodelling plan that will have "bright, noisy rooms replaced by womb-like conditions". The work includes use of sound-absorbent tiles, cushion flooring, task lighting to reduce bright overhead lights, sound monitors at each bed to alert staff if noise levels rise above 30 decibels (they can go as high as 120 db), white boards for pictures, comfortable rocking chairs, painting the room like a nursery; also, staff will be taught "how to spot signs of stress and how to handle the babies with slow and careful motions."

'Stacey and Gord Archer noticed a difference when their son Samuel was placed in a quiet, isolated room after undergoing heart surgery shortly after he was born, seven weeks early, in December 2006. They watched anxiously as their tiny baby grew slowly but steadily over the first several weeks. "Every calorie counted for the little guy," Gord says. "He needed to gain weight, which was only a half-a-pound every 10 days." With his recovery progressing well after a couple of months, Samuel was moved to one of the hospital's nine regular neonatal intensive care rooms, which can house four to six babies each. Located closer to the nursing station and with large windows, his new room was much brighter and noisier. Within days, his parents could see his health begin to deteriorate. "There were a lot of stressors in this room, which prevented Samuel from gaining weight," Stacey recalls. "As a parent, it's so stressful, because you know that every sound is affecting the baby, but there isn't anything you can do." When Samuel stopped gaining weight and developed high blood pressure, his parents asked that he be moved back into the quieter, isolated room. Within days, he began to improve. "He was sleeping better, digesting food better – it was a remarkable difference," Gord says. "It's so much common sense. All the rooms should be like this. They were good not only for Samuel, but for us, too. When the parents are less stressed out, they can connect with the baby better." Based on their experience, the Archers have been giving SickKids advice on how to create neonatal rooms that will help calm both the fragile patients and their frazzled parents.'

Having heard parts of Gord and Stacey and Sam's story from their thoughts and suggestions to the NICU family brainstorm last month, I am happy to see the NICU including them in environmental solutions. It makes sense that reduction of noise and noxious stimulation is very important for preterm children but would it not also help any kids in any ICU environment? While in CCCU I was very sensitive to Sasha's sleep, focusing on environmental noise, however a quick dive into the literature shows it is accepted that critically ill patients have very disrupted sleep patterns, missing certain types of sleep (including REM sleep) as opposed to sleeping little. Non-intuitively, a 2003 study thought environmental noise may account for less than 30% of poor sleep and a 2001 study thought that number might be as low as 10% of arousals from sleep with more disruption and waking up caused by mechanical ventilation, conversations and hands on check of vitals. Generally I found staff made an effort to keep things quiet, as did parents. Once I was irked by a loud TV movie when Sasha was restless but couldn't say anything when I looked over at the dad so happy to have his daughter awake and animated. Once in a CCCU room with only two other children on a quiet weekend morning I was enjoying the soft light and two nurses shared a joke and started laughing - I cannot say they were particularly loud, it simply bothered me and I asked them to please be quiet. Better sleep felt like a sign of recovery. Without doubt, poor sleep effects patients and is a recurring concern and focus for parents. One study suggested giving patients ear plugs.

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