Recommended standards for the newborn ICU.

The creation of formal planning guidelines for newborn intensive care units (NICUs) first occurred when Toward Improving the Outcome of Pregnancy was published in 1976. This landmark publication, written by a multidisciplinary committee and published by the March of Dimes, provided a rationale for planning and policy for regionalized perinatal care, as well as details of roles and facility design. Since then, the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) have published several editions of their comprehensive Guidelines for Perinatal Care, and the American Institute of Architects has likewise published several editions of their Guidelines for Construction of Hospital and Healthcare Facilities. In 1993, Toward Improving the Outcome of Pregnancy was revised. The second Toward Improving the Outcome of Pregnancy reviewed medical and societal changes since the original document and formulated new recommendations in recognition of these developments, particularly the ascendance of managed care. The purpose of this committee is to complement the above documents by providing health-care professionals, architects, interior designers, state health-care facility regulators and others involved in the planning of NICUs with a comprehensive set of standards based on clinical experience and an evolving scientific database. With the support of Ross Products Division/Abbott Laboratories, a multidisciplinary team of physicians, nurses, state health planning officials, consultants and architects reached consensus on the first edition of these recommendations in January 1992. The document was then sent to all members of the American Academy of Pediatrics Section on Perinatal Pediatrics to solicit their comments, and we also sought input from participants at the 1993 Parent Care Conference and at an open, multidisciplinary conference on newborn ICU design held in Orlando in 1993. Subsequent editions of these recommended standards were then developed by the consensus committees in 1993, 1996, 1999, 2002 and 2006 under the auspices of the Physical and Developmental Environment of the High-Risk Infant Project. Various portions of these recommended standards have now been adopted by the American Institute of Architects’ Guidelines, the AAP/ACOG Guidelines and by standards documents in several other countries. In the future, we will continue to update these recommendations on a regular basis, incorporating new research findings, experiences and suggestions. It is our hope that this document will continue to provide the basis for a consistent set of standards that can be used by all states and endorsed by appropriate national organizations, and that it will also continue to be useful in the international arena. While many of these standards are minimums, the intent is to optimize design within the constraints of available resources, and to facilitate excellent health care for the infant in a setting that supports the central role of the family and the needs of the staff. Decision makers may find that these standards do not go far enough and resources may be available to push further toward the ideal.