Friday, July 27, 2018

Light and Acoustic Environment In NICU

Planning appropriate lighting for the NICU requires consideration of the disparate needs of both the babies and staff. In general, babies need very little light, but exposure to moderate levels of   illumination during part of the day may help establish circadian rhythmicity.

The lighting will be different in many areas in the NICU as illumination of a procedure area will vary from other ambient lighting situations. Flexibility in lighting levels is required as infants' needs change at different stages of development. Control of illumination should be accessible to both staff and families, and the design should include multiple light switches. If linear fluorescent lamps are used, the color designation should be “RE80.” All fixtures should have filters or shields that block ultraviolet radiation and minimize the risk to babies and staff if a bulb should shatter.

Staff need moderate levels of illumination at the bedside to evaluate babies and to perform charting and manual tasks.
At times, intense levels of illumination are necessary to perform procedures and for phototherapy of hyperbilirubinemia. 
It is doubtful that babies need natural lighting, but studies of adult office workers and hospital patients document the benefit of windows for staff and families. A multilevel lighting scheme should be considered by the design team:

1. Ambient lighting in infant care areas.
Lighting levels are adjustable through a range of 10 to 600 lx (1 to 60 foot-candles) as measured on a
horizontal plane. A control thermistor should allow for immediate darkening if necessary. Electric light sources should have a color rendering index (CRI) of no less than 80 and a gamut area index (GA) of no less than 80 and no greater than 100. The optical reflectors in the light fixture shall have a neutral finish  and unnecessary ultraviolet or infrared radiation shall be avoided. Any ambient lighting utilized should avoid the infant's direct line of sight.

2. Procedure lighting in infant care areas.
Separate procedure lighting should be present at each infant bed and be capable of providing no less
than 2,000 lx. In addition, the light output must be framed to exclude extension beyond its illumination field. Temporary increases in illumination may be necessary for clinical evaluation or performing a procedure. It is important not to increase lighting levels for adjacent babies. Intense light may be harmful to the developing retina. It is best to permanently mount a procedure light than to have a free-standing floor light, so that space can be maximized and accidents avoided.