A Case Study of the Environmental Experience of a Hospitalized Newborn Infant with a Complex Congenital Heart Defect
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Date
2014-12
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The Ohio State University
Abstract
Background: Cognitive, social, emotional, behavioral, and motor delays pose a significant concern for infants born with complex congenital heart defects (CCHD). Although the etiology of these delays is multifactorial (e.g. surgery, cerebral injury, parental distress), the physical environment may also contribute to these adverse outcomes. Extensive studies have been conducted in the neonatal intensive care units (NICU) measuring environmental influences on development and resulting in policy and practice changes to support improved infant outcomes. Cardiothoracic intensive care units (CTICU) and cardiac step-down units (SDU) are new environments in which newborns with CCHD receive care. No environmental studies have been conducted in these cardiac specialty units for full-term, newborn infants recovering from cardiac surgery. The purpose of this case study was to examine the environmental experience of a newborn infant with CCHD undergoing an invasive surgical procedure within the first month of life.
Methods: Measurements of illumination, sound levels, and interrupted sleep were recorded on one newborn infant, immediately following cardiac surgery, for two consecutive post-operative days in the CTICU and two consecutive days in the SDU.
Results: Although average daily noise exposure remained below recommended guidelines, the infant experienced significant intermittent periods of excessive noise (≥ 55dBA) during 59 of 87 hours and 110 episodes of acute noise events greater than 70 dBA. Average daily light exposure was below the recommended guidelines. However, maximum levels of light levels were at least 2.2 times higher than the recommended levels at multiple points daily. For each of the 4 observation days, the infant experienced 104 to 184 awakenings during expected sleep times. The highest percentage of time spent sleeping in a 24 hour day was 59%.
Conclusion: This study provides the first report of potential environmental stressors in newborn infants cared for in cardiac specialty units. Excessive levels of light and noise as well as frequent interruptions for intensive medical and nursing care contribute to disorganized sleep and increased patient distress, and have the potential to impact subsequent neurodevelopment. This case study provides critical information for designing a future, larger study focused on identifying potentially adverse aspects of the intensive caregiving environment for newborn infants who have undergone neonatal cardiac surgery.
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Keywords
intensive care unit, hospital environment, neonate, infant development