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Many neonatologists have assumed that the optimal design for a neonatal intensive care unit (NICU) is one that successfully merges high technology with a supportive “womb-like” environment. In the 1970s, NICUs were sterile, technology-filled dormitories with bombarding visual and auditory stimuli. From the late 1980s forward, efforts have focused on reducing stimulation. Initial attempts led to reduced-light environments, which were thought to simulate the in utero environment. Subsequent randomized trials failed to confirm the protective effects of reduced light on retinopathy of prematurity.1 Other studies demonstrated the importance of cycled lighting on the development of circadian rhythms.2 The application of studies to health care design has been termed evidence-based design. This process, led by architects at the Center for Health Design, has strengthened the evidence base for architectural practices. The field of neonatology has been an early adopter of this principle, with a robust and enthusiastic team that has contributed to ongoing innovations.3,4

When the NICU is appreciated as a place where crucial brain growth and development occur over a period of weeks or months, it becomes apparent that the sensory environment has comparable importance to the provision of direct medical care. This is even more evident when one realizes that the physical environment can affect the physical and mental health and performance of the caregivers as well as parental involvement and satisfaction. Thus, proper design should provide the best technological and environmental support possible to three constituencies: infants, families, and caregivers. The goal is difficult to achieve, not only because of space and financial limitations common to almost all construction projects, but also because some of these needs are in conflict with one another, as illustrated briefly in the previous discussion of circadian biology.


In an ideal setting, the NICU is located in close proximity to the high-risk delivery rooms—in some NICUs, close enough to use a pass-through window. In hospitals with large maternity services or in children’s hospitals, however, the NICU may be on a separate floor or in a different building. In this case, a stabilization area must be provided within or adjacent to the high-risk delivery area where the infant can be stabilized before transfer to the NICU. Transfer should be on a neonatal transport device with appropriate monitoring and respiratory support, proceed through nonpublic areas as much as possible, and use dedicated or controlled-access elevators.

Adjacencies to other support services in the hospital, including operating rooms, imaging, laboratories, and pharmacies, should be carefully considered. One must carefully evaluate traffic patterns for families to reach the NICU and the areas they need to use for eating, sleeping, personal needs, and interacting with other families. While making access convenient for families, good design also minimizes traffic congestion of NICU visitors or staff for both safety and aesthetic reasons. Public access should be limited to provide infant safety and ...

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