The Impact of Neonatal Intensive Care Unit Design on Neurodevelopmental Outcomes of Premature Neonates: Single Rooms vs. Multi-bed Wards An Integrated Literature Review

Background: Preterm birth is a significant cause of infant death and disability, including impaired neurodevelopmental functioning. Many recent studies report beneficial effects of single-family room (SFR) versus multi-bed-ward design in NICUs, however few studies focus on the neurodevelopmental-associated outcomes. Identification of positive and negative neurodevelopment in each environment will allow nurses and other healthcare providers to strategize patient placement and moderate environmental stimuli to maximize neurodevelopmental outcomes in both settings. Objectives: The purpose of this literature review was to explore current research to evaluate whether neurodevelopmental outcome (including cognitive delay, hearing deficit or loss, and visual impairment) differs between preterm infants treated in NICUs with a multi-bed ward versus a single-family room design and to recommend nursing interventions that can be taken to minimize factors that prompt negative neurological outcome in each environment. Method: An integrative literature review was performed using PubMed, Cumulative Index to Nursing and Health Literature (CINAHL), and PsychInfo databases to gather articles from the past ten years focused on neurodevelopmental outcomes in NICUs with multi-bed wards and single-family rooms. Results: Infants in SFR and OPEN units demonstrated similar visual and auditory neurological outcomes; both environments may have negative implications for language development related to limited exposure to meaningful language while in each setting. SFR rooms demonstrate an increased proportion of parental support and developmental care. Conclusions: NICU patient room design does affect neurodevelopmental outcome in premature infants, however more research is needed to better understand the short and long-term neurologic implications of each environment. Keywords: neonatal intensive care unit, environment, patients’ rooms, infant development, brai

Exercise intensities as factors of metabolic outcomes in type 2 diabetes: A systematic review.

Review ArticleExercise is effective to prevent and treat type 2 diabetes, although currently underutilized. This review analyzes the metabolic response to exercise performance at various intensities in individuals with type 2 diabetes. These findings provide insight into the development of safe and efficacious exercise prescriptions and education. We conducted a systemic review of the literature to examine the association of various exercise protocols with metabolic outcomes in type 2 diabetes. Between 1984 and 2018, 29 studies were categorized per exercise mode and intensity levels according to the American College of Sports Medicine standards. The most consistent improvement was found in HbA1c following moderate- to high-intensity exercise—post-exercise fasting glucose improved to a lesser extent. Low-intensity exercise improved HOMA-IR (homeostasis model assessment for insulin resistance) levels. Glucose and HbA1c improved most following interval compared with continuous exercise, irrespective of intensity. A comparison of high-intensity exercise with moderate-intensity exercise demonstrated few differences in HbA1c, fasting glucose, fasting insulin, and HOMA-IR. Irrespective of exercise intensity, HbA1c improvements were observed, suggesting a delayed progression to diabetes-related complications. Initial low-intensity exercise, with increased quantities when feasible, will contribute to metabolic improvements. The variability in methodology and measurement contributed to inconsistent outcomes; additional research with larger samples sizes is warranted