In 1992, Robert White and Thomas Whitman (1) asked whether individual rooms in the neonatal intensive care unit might benefit infants by reducing high levels of noise and bright lighting. In 2009, at Dr. White’s suggestion, Vermont Oxford Network added a question about single family rooms to the annual membership survey. The question asks what proportion of VLBW infants are cared for in single family rooms, defined as rooms with at least three full walls and a single patient or siblings, for any or all of the initial hospital stay. The response categories are: 10% or less; 11-50%; 51-90%; 91% or more.

The proportion of hospitals reporting that 91% or more of infants are cared for in single family rooms increased from 13% in 2009 to 20% in 2016, while the proportion of hospitals reporting that no more than 10% of infants are cared for in single family rooms decreased from 77% to 67%. These changes are true for the entire Network as well as among hospitals that have been members since 2009. Centers more likely to increase the percent of infants cared for in single family rooms from 2009 to 2016 were Type C centers, centers located in the United States, non-profit centers, and centers that had a formal NICU family advisory council.

The inclusion of single family rooms in construction of new NICUs is clearly trending upward, supported by data indicating improved infant outcomes (2,3) and satisfaction scores from families and staff (4-7) in a cost-effective manner (8).

It appears from these data that for most units, the decision for single family rooms is still “all-or-none,” though it is likely that a large number of the units with <10% SFRs were built more than a decade ago. A case can be made for “hybrid” units (9).

Our new unit has only ~60% of its beds as single family rooms with the rest as two-bed (“NIC2”) rooms, largely to provide for couplet care beginning immediately after delivery, but also for twins and for some unrelated babies whose families are rarely present. Indeed, even before single-family rooms have fully penetrated the NICU culture, couplet care has arrived, with approximately 10 such units already completed in the US, Canada, and Europe. An even newer concept is that of Neonatal Intensive Parenting Units (10), which began in the “We Are Family” homeroom of Vermont Oxford Network’s Newborn Improvement Collaborative for Quality (NICQ) and is as much an operational concept as a structural one.

The take-away is that we should design and operate our NICUs in a manner that fully integrates families into the day-to-day care of their infants. One only gets a chance to remove structural barriers every 20-30 years, so that opportunity should be used to foresee the needs of the next generation as much as for the current one. In the meantime, many operational barriers can be removed. In this respect, Vermont Oxford Network continues to inspire and lead by example.

1. White R, Whitman T. Design of ICUs. Pediatrics. 1992;89(6 Pt 2):1267.
2. Ortenstrand A, Westrup B, Brostrom EB, et al. The Stockholm Neonatal Family Centered Care Study: effects on length of stay and infant morbidity. Pediatrics. 2010;125(2):e278-285.
3. Lester BM, Hawes K, Abar B, et al. Single-family room care and neurobehavioral and medical outcomes in preterm infants. Pediatrics. 2014;134(4):754-760.
4. Walsh WF, McCullough KL, White RD. Room for improvement: nurses’ perceptions of providing care in a single room newborn intensive care setting. Adv Neonatal Care. 2006;6(5):261-270.
5. Stevens DC, Helseth CC, Khan MA, Munson DP, Reid EJ. A comparison of parent satisfaction in an open-bay and single-family room neonatal intensive care unit. HERD. 2011;4(3):110-123.
6. Stevens DC, Helseth CC, Khan MA, Munson DP, Smith TJ. Neonatal intensive care nursery staff perceive enhanced workplace quality with the single-family room design. J Perinatol. 2010;30(5):352-358.
7. Schulman J, Stricof R, Stevens TP, et al. Statewide NICU central-line associated bloodstream infection rates decline after bundles and checklists. Pediatrics. 2011;127(3):436-444.
8. Shepley MM, Smith JA, Sadler BL, White RD. The business case for building better neonatal intensive care units. J Perinatol. 2014;34(11):811-815.
9. White RD. The next big ideas in NICU design. J Perinatol. 2016;36(4):259-262.
10. Hall SL, Hynan MT, Phillips R, et al. The neonatal intensive parenting unit: an introduction. J Perinatol. 2017;37(12):1259-1264.

This report is made possible by Vermont Oxford Network members who voluntarily contribute data in a global effort to improve the care of high-risk newborns. VON members can view center-specific data by logging on to Nightingale and benchmark against this NICU by the Numbers report.

Editors: Erika Edwards, PhD, MPH; Roger Soll, MD

Analyst: Lucy Greenberg, MS