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Report of the Eighth Census Conference on Newborn ICU Design
Committee to Establish Recommended Standards for Newborn ICU Design
Robert D. White, MD, Chair
January 26, 2012 Clearwater Beach, FL
 
   September 18, 2012
 
 
 
Delivery Room Standards

Infant Resuscitation/Stabilization Areas

Space for infant resuscitation/stabilization shall be provided within operative delivery rooms and within Labor/Delivery/Recovery (LDR), Labor/Delivery/Recovery/Post-partum (LDRP) rooms, and other non-operative delivery rooms. Delivery rooms may directly connect to nursery or Newborn ICU (NICU) space via pass-through windows or doors. The ventilation system for each delivery and resuscitation room shall be designed to control the ambient temperature between 72-78 degrees Fahrenheit (22-26 degrees Centigrade) during the delivery, resuscitation, and stabilization of a newborn.

Specific recommendations for each location where infant resuscitation or stabilization occurs are as follows:

Operative Delivery Rooms

Recommendations for operating rooms intended for use by NICU patients (Standard 8) shall be followed with these exceptions:

  • A minimum clear floor area of 80 square feet (7.5 square meters) for the infant shall be provided in addition to the area required for other functions.
  • 3 oxygen, 3 air, 3 vacuum and 12 simultaneously-accessible electrical outlets shall be provided for the infant and shall comply with all specifications for these outlets described in NICU Standard 9.
  • The infant space may not be omitted from the operative delivery room(s) when a separate infant resuscitation/stabilization room is provided.

LDR, LDRP or other Non-operative Delivery Rooms

  • A minimum clear floor area of 40 square feet (3.7 square meters) shall be provided for infant space. This space may be used for multiple purposes including resuscitation, stabilization, observation, exam, sleep or other infant needs.
  • 1 oxygen, 1 air, 1 vacuum and 6 simultaneously-accessible electrical outlets shall be provided for the infant in addition to the facilities required for the mother.
  • The infant space may not be omitted from the LDR, LDRP or non-operative delivery room when a separate infant resuscitation/stabilization room is provided.

Pass-Through Windows and Doors

  • Windows and doors shall be designed for visual and acoustical privacy and shall allow easy exchange of an infant between personnel.
  • When an operative delivery room is equipped with a pass-through window or door, it shall have positive pressure so that air flows out to the infant room when the window or door is opened.

Interpretation: Today's delivery rooms (operative and non-operative) are required to have separate resuscitation space and outlets for infants. This space includes an acceptable environment for most uncomplicated term infants, but may not support the optimal management of infants who will become NICU patients.

Some term infants and most preterm infants are at greater thermal risk and often require additional personnel, equipment and time to optimize resuscitation and stabilization. They are essentially NICU patients from the time of delivery and would therefore be optimally managed in space designed to NICU standards. The appropriate resuscitation/stabilization environment should be provided. Providing it in each delivery room allows parents to be aware of staff's efforts to revive and care for their infant before transport to the NICU. Providing ongoing support in a designated admission room or within the NICU with infant transfer via pass-through windows or doors offers efficiencies for staff, an environment designed for infants, and immediate access to all necessary equipment and supplies. Infectious concerns for an opening into an operative room from a non-sterile (NICU) area are addressed by designing airflow out of the sterile room when windows and doors are opened.

Provision of appropriate temperature for delivery room resuscitation of high-risk preterm infants is vital to their stabilization. While lower temperatures are often more comfortable for gowned attendants, the needs of the high-risk infant must take priority. It is also essential that these appropriate ambient temperatures can be achieved within a short time frame, since many high-risk deliveries occur with little warning.

Since many of the higher risk patients are delivered in operative delivery rooms, the operative room minimums should be greater than the minimum standards for LDRs or LDRPs. If a hospital serves a predominantly high-risk perinatal population, the hospital is encouraged to exceed the minimum standards.

Equipment storage may be best provided by a wall-hung board or other suitable technique to allow ready visibility and access to all needed resuscitation equipment.


 
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last updated September 19, 2012  Kathleen Kolberg, University of Notre Dame