How to use best practices to illuminate a NICU

NICU lighting insights

• Lighting design in a neonatal intensive care unit (NICU) has changed over the years, and now focuses on the newborns’ health and welfare.
• RP-29-22 Recommended Practice: Lighting Hospital and Healthcare Facilities, last updated in 2020, offers lighting designers and consulting engineers guidance for lighting in a NICU.

Advancements in standard care and technology options present lighting design teams with unique challenges.

Hospitals can now choose from a growing array of lighting equipment for maternal and newborn care units. Among these options, designers must find an ideal balance of intensity, color, direction and placement for different users who often have unique — sometimes competing — lighting preferences.

To assist hospitals with navigating these design decisions, the American National Standards Institute (ANSI)/Illuminating Engineering Society (IES) will soon be releasing RP-29-22 Recommended Practice: Lighting Hospital and Healthcare Facilities. RP-29-22 will include guidance to address the sensitive nature and complex lighting preferences of neonatal intensive care units (NICUs) and delivery units.

Figure 1: Ideal lighting conditions can promote newborn infants’ health and recovery. Courtesy: Burns Engineering

Lighting design and health impacts

At birth, newborns emerge to find a bright, noisy hospital environment. Lighting can be especially irritating for premature babies. Pupil responses do not fully develop until around the 35^th week of development. Many infants struggle to process blue light for weeks after.

Continuous bright light affects sleep cycles. Lighting levels can also undermine alertness, regulation of circadian rhythms and feeding patterns. Overstimulation may result in greater agitation, lower blood-oxygen levels and sub-optimal weight gain.

Lighting can have a major impact on labor and delivery as well. Birthing women thrive in relaxing environments. Dimmed lighting and changing colors can help to provide distraction and calm, potentially lowering heart rates for the woman and child, which may facilitate an unmedicated birth.

History of NICU lighting

NICU lighting design has changed significantly over the past century.

After World War II, evolving hospital standards led many NICUs to stop isolating premature infants, instead grouping them within large rooms. Bright overhead lights stayed on 24/7, enabling medical teams to tell if babies were turning pike or blue. At the time, it was one of the few ways to determine if infants needed oxygen.

In the 1980s, many hospitals applied research suggesting NICU environments should mimic conditions within the womb. Dim incandescent lighting replaced harsh fluorescent bulbs.

The shift away from bright lights improved conditions for infant development. Newborns and birthing women thrive within softly lit, calming environments. But darker rooms are not necessarily the best conditions for delivering medical care.

Continuous dark lighting creates new challenges:

• Sleeping newborns are often unintentionally jolted awake when lights are turned on during routine assessments.

• Insufficient daytime ambient light can disrupt infants’ sleep/wake cycle, affecting their mood and possibly diminishing weight gain.

• Constantly dim lighting can seriously disrupt daytime workers’ circadian rhythm, potentially contributing to serious health impairments.

Figure 2: Ambient lighting levels in infant spaces should be adjustable through a range of at least 10 lux (0.9 footcandles) to no more than 600 lux (185.8 footcandles). Courtesy: Burns Engineering

NICU and delivery unit lighting best practices

NICU design best practice currently is to use indirect, diffuse and adjustable lighting. NICUs are the only critical-care environment where indirect lighting is recommended to achieve ambient illuminance levels.

Control technologies make infinite lighting adjustments possible for NICU and delivery unit environments. Colors and intensity levels can gradually change over the course of the day, supporting the circadian system of infants, families and care providers.

To prevent light sources from shining directly into an infant’s sensitive eyes, LEDs can now be placed in seemingly every imaginable location — from the ceiling and walls to within side walls, headwalls, cabinets and beds. Light shields or diffusers can further reduce glare.

For procedural lighting, dedicated fixtures at the infant bed can aid health care providers’ abilities to perform assessments and critical tasks. Design standards suggest no more than 2% of light output should extend beyond the illumination field, ensuring task lights do not increase lighting levels for other babies located in the room.

Within delivery rooms, innovative lighting installations are going far beyond minimum standards. Multisensory rooms may twinkle like a night sky, cast patterns of a relaxing range of colors or feature sky-and-cloud panels that give the appearance of sunlight filling the room. More units are incorporating biophilic lighting that recreates natural elements to reduce stress and that supports the hospital’s healing environment.

Figure 3: Neonatal intensive care unit design best practice is to use indirect, diffuse and adjustable lighting. Courtesy: Brad Greenlee

Updated IES recommendations on lighting best practices

Release of new IES recommendations marks a significant step forward in promoting the health and well-being of newborn infants and birthing mothers. The revised guidelines acknowledge the sensitive nature of these environments, striking a balance between the needs and preferences of different users, including infants, family members and medical providers.

More specifically, the IES health care committee is revising ANSI/IES RP-29-20, Section 8.3.1.5 Nursery Units, to provide concise guidelines on color rendering metrics, lighting control application methods and ambient lighting practices.

Recommendations include, for example, deviation from the color rendering measures included in Facility Guidelines Institute Recommended Standards for Newborn ICU Design. It is now accepted that NICU color fidelity (Rf) should be greater than or equal to 80 — with a color gamut (Rg) between or equal to 97 and 110.

Adopting the new IES recommendations will ultimately support care delivery. When incorporated into hospital designs, restorative lighting conditions can promote newborn infants’ health, establish comforting environments for families and support the practical needs of care providers.

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