title: New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study.
abstract: BACKGROUND
  A multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected. We aimed to investigate the impact of the architectural design of the DR and the NICU on neonatal outcome.
  
  
  METHODS
  Two cohorts of preterm neonates born at < 32 weeks of gestational age, consecutively observed during 2 years, were compared prospectively before (Cohort 1: "conventional DR") and after architectural renovation of the DR realized in accordance with specific standards (Cohort 2: "new concept of DR"). In Cohort 1, neonates were initially cared for a conventional resuscitation area, situated in the DR, and then transferred to the NICU, located on a separate floor of the same hospital. In Cohort 2 neonates were assisted at birth directly in the NICU room, which was directly connected to the DR via a pass-through door. The primary outcome of the study was morbidity, defined by the proportion of neonates with at least one complication of prematurity (i.e., late-onset sepsis, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis). Secondary outcomes were mortality and duration of hospitalization. Statistical analysis was performed using standard methods by SPSS software.
  
  
  RESULTS
  We enrolled 106 neonates (56 in Cohort 1 and 50 in Cohort 2). The main clinical and demographic characteristics of the 2 cohorts were similar. Moderate hypothermia (body temperature ≤ 35.9 °C) was more frequent in Cohort 1 (57%) compared with Cohort 2 (24%, p = 0.001). Morbidity was increased in Cohort 1 (73%) compared with Cohort 2 (44%, p = 0.002). No statistically significant differences in mortality and median duration of hospitalization were observed between the 2 cohorts of the study.
  
  
  CONCLUSIONS
  If realized according to the proposed architectural standards, renovation of DR and NICU may represent an opportunity to reduce morbidity in preterm neonates.
authors.affiliation: Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. gianluca.terrin@uniroma1.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Terrin
authors.affiliation: Department of Pediatrics, "Sapienza" University of Rome, Viale del Policlinico 155, Rome, 00161, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Conte
authors.affiliation: Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Scipione
authors.affiliation: Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.|Research Center on Evaluation of Quality in Medicine - CEQUAM, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Aleandri
authors.affiliation: Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Di Chiara
authors.affiliation: Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Bacchio
authors.affiliation: Department of Perinatal Medicine, Evangelical Hospital "V. Betania", Via Argine 604, Naples, 80147, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Messina
authors.affiliation: Department of Pediatrics, "Sapienza" University of Rome, Viale del Policlinico 155, Rome, 00161, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: De Curtis
mesh_terms: D003696:Delivery Rooms; D036861:Delivery, Obstetric / Q000451:nursing; D005260:Female; D005865:Gestational Age; D006749:Hospital Design and Construction / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000209:etiology / Q000451:nursing; D007363:Intensive Care Units, Neonatal; D009017:Morbidity; D011247:Pregnancy; D011446:Prospective Studies
keywords: Delivery room; Early nasal-CPAP; Hypothermia; Intraventricular hemorrhage; Morbidity; Neonatal intensive care unit; Patent ductus arteriosus; Resuscitation; Sepsis