Design strategies that provide a better environment for preterm infants

Preterm infants are born during the most crucial phase of brain development, meant to occur in utero in preparation for birth at term. Instead, with preterm birth, this complex developmental process occurs in a hospital setting that is far different from the expected environment in utero.

In this presentation I will talk about the many challenges the Newborn Intensive Care setting presents to normal brain development, and will suggest design strategies that provide a better environment for preterm infants. In particular, we will develop the case for encouraging family participation in the care of the preterm infant, and especially for prolonged and intimate maternal-infant interaction. Even the needs of the caregivers for an appropriate environment cannot be forgotten, so I will address these concepts and concerns as well, in an attempt to present a design strategy (utilizing the single family room concept) that meets the needs of the babies, families, and caregivers.

Robert White, MD is head of the Newborn ICU at Memorial Hospital, South Bend Indiana, USA.
Presentation at the Conference Child-Centred Care = Family-Centred Care, organised by Kind en Ziekenhuis , the Dutch member association of EACH.
Rotterdam, December 1, 2008.

Considering the child like a person, respecting his or her specific needs and his or her rights (in and outside the hospital) will bare importance on this child's future and on how, as an adult, he or she will behave towards his or her own health and will care for it.

Thus, the way children and their parents are welcomed in a hospital, for example, is the reflection of the consideration that a society has for its members, the place it keeps for its children, their needs, their rights, and specifically in a hospital setting, their right to health. Respecting children's rights to health goes beyond a moral and legal obligation.

Thus, respecting all children's rights in the field of health is a project for which positive effects will be seen in the long term. Caring for children's rights to health is not only a question of law and rules but also a question of acting to ensure that these rights are being implemented.

APACHE (Association Pour l'Amélioration des Conditions d'Hospitalisation des Enfants) in 2005 published a report on the subject of the health of the child in the hospital, the health of the child outside of the hospital and the ways the child’s interests are being represented in France.
This report is based on two surveys realized by the organization into the actual practices of hospitals, on a survey on the place for parents of hospitalized children, a review of current literature on the topic, on the mails and testimonies received by the organization (mails from parents, professionals, organizations), and on telephonic interviews with professionals working in the field of children’s health.

This report bases its findings on the EACH Charter on hospitalized children, and also on the International Children’s Rights Convention (ICRC) and criteria stipulated by a French accreditation agency.

You can download the complete report here:

la_sante_des_enfants_en_france-translation.pdf

Implementation of the ten points of the EACH Charter needs a new approach in the training of doctors and nurses involved in the care of sick children. They need to regard children and their families/ carers as a unit and accept children as equal partners in all areas of health care. Children must be treated with understanding and sensitivity and their developmental needs met. They must be cared for in an environment suited to their needs and by staff trained in children's care.

Institutions and individuals dedicated to the rights of children can help EACH by promoting the acceptance of the principles of the EACH Charter by health authorities and governments. This will ensure the best possible care for sick children.

Some of the goals of the EACH Charter are still not achieved in Europe. Goals such as:

• The right of children to have their parents with them in hospital is sometimes restricted and made subject to a particular age or illness of the child or to the social standing of the family.
• The special needs of adolescents in hospitals are often not sufficiently addressed.
• In the daily hospital routine little regard still is given to what we know today about the psychological, emotional and social needs of children of different ages and developmental stages, their origin or their social or cultural background.
• Pain control for children is still a neglected area.
• Guidance for staff on established practice for action when a sick child shows signs of abuse or maltreatment is often missing.
• Children are still being admitted to adult wards.

When implementing the Charter in all European countries it furthermore has to be considered that

• Health care is subject to varying economic conditions and constraints.
• Health services are organised differently from country to country.

We invite parents...

to provide or arrange to provide the support and care their children need.

We invite those in public office...

to create the framework within which the parents may become active in the care of their child in hospital.

We invite those involved in the care of sick children...

to get acquainted with the rights of children in hospital and to act in accordance with those rights.

Implementation of the ten points of the EACH Charter needs a new approach in the training of doctors and nurses involved in the care of sick children. They need to regard children and their families/ carers as a unit and accept children as equal partners in all areas of health care. Children must be treated with understanding and sensitivity and their developmental needs met. They must be cared for in an environment suited to their needs and by staff trained in children's care.

Institutions and individuals dedicated to the rights of children can help EACH by promoting the acceptance of the principles of the EACH Charter by health authorities and governments. This will ensure the best possible care for sick children.