Reduction of high-risk neonates’ exposure to aversive light stimulation is an important component of developmentally supportive care. In neonatal intensive care unit (NICU), usually light is reduced by reducing the room’s light level or by using incubator covers. Many types of incubator covers are in use, including homemade and commercial covers. A comparative study was used to determine the light reducing capabilities of 19 homemade incubator covers, 2 commercial covers, and 1 receiving blanket. The covers were tested by covering and uncovering an incubator and an oxygen hood in the NICU during daytime and nighttime lightings. The light reducing capabilities value was determined for each cover using an Extech light dosimeter when the cover was placed over and removed from an oxyhood, and an incubator. The study showed that the light reducing capability of the commercial covers was 91.2%, the homemade covers capability was 72.1%, and the receiving blankets capability was 55.1%. A significant difference between the commercial and homemade covers was found ( , ). Commercial incubator covers are the most effective covers to achieve light reduction; homemade covers can be effective if made large enough so that they completely cover all sides of the incubator. 1. Introduction Reduction of the exposure of high-risk neonates to aversive light stimulation is an important component of developmentally supportive care [1–3]. Neonatal intensive care units (NICUs) usually reduce light by reducing the room’s light level or by using incubator covers [4, 5]. Many types of incubator covers are in use, including homemade and commercial covers. Homemade covers are not standardized, and only one report of their light reducing capability during daytime and evening time could be found [6], and that report was based on a simulated level of light created in a windowless nursing school skills because reports of light reduction capability of homemade incubator covers in an actual NICU could not be found. The lighting in nurseries is known to be relatively constant [1, 5, 7], but light levels really are quite variable [8]. Two measures of light are referenced in the study presented here. A footcandle (ftc) is defined as a unit of illumination on a surface that is one foot from a point source of one candle; lux is defined as a unit of illumination that is equal to the direct illumination on a surface that is one meter from a uniform point source of one candle intensity or equal to one lumen per square meter (lumen/m2). The amount of light received by any infant varies from 15 to
References
[1]
S. N. Graven, “Early neurosensory visual development of the fetus and newborn,” Clinics in Perinatology, vol. 31, no. 2, pp. 199–216, 2004.
[2]
T. T. Lai and C. F. Bearer, “Iatrogenic environmental hazards in the neonatal intensive care unit,” Clinics in Perinatology, vol. 35, no. 1, pp. 163–181, 2008.
[3]
A. Symington and J. Pinelli, “Developmental care for promoting development and preventing morbidity in preterm infants,” Cochrane Database of Systematic Reviews, no. 2, Article ID CD001814, 2006.
[4]
M.-S. Roy, C. Caramelli, J. Orquin, J. Uleckas, P. Hardy, and S. Chemtob, “Effects of early reduced light exposure on central visual development in preterm infants,” Acta Paediatrica, vol. 88, no. 4, pp. 459–461, 1999.
[5]
R. D. White, “Lighting design in the neonatal intensive care unit: practical applications of scientific principles,” Clinics in Perinatology, vol. 31, no. 2, pp. 323–330, 2004.
[6]
Y. L. Lee, N. Malakooti, and M. J. Lotas, “A comparison of the light-reduction capacity of commonly used incubator covers,” Neonatal Network, vol. 24, no. 2, pp. 37–44, 2005.
[7]
S. N. Graven, “Clinical research data illuminating the relationship between the physical environment and patient medical outcomes,” Journal of Healthcare Design, vol. 9, pp. 15–24, 1997.
[8]
D. C. Stevens, M. Akram Khan, D. P. Munson, E. J. Reid, C. C. Helseth, and J. Buggy, “The impact of architectural design upon the environmental sound and light exposure of neonates who require intensive care: an evaluation of the Boekelheide Neonatal Intensive Care Nursery,” Journal of Perinatology, vol. 27, supplement 2, pp. S20–S28, 2007.
[9]
P. Mac Leod and L. Stern, “Natural variations in environmental illumination in a newborn nursery,” Pediatrics, vol. 50, no. 1, pp. 131–133, 1972.
[10]
R. D. White, “Recommended standards for the newborn ICU,” Journal of Perinatology, vol. 27, supplement 2, pp. S4–S19, 2007.
[11]
R. D. White and G. I. Marin, “New standards for newborn intensive care unit (NICU) design,” Journal of Perinatology, vol. 26, pp. S2–S18, 2006.
[12]
M. Walsh-Sukys, A. Reitenbach, D. Hudson-Barr, and P. DePompei, “Reducing light and sound in the neonatal intensive care unit: an evaluation of patient safety, staff satisfaction and costs,” Journal of Perinatology, vol. 21, no. 4, pp. 230–235, 2001.
[13]
M. S. Rea, IESNA Lighting Handbook: Reference and Application, Illumination Engineering Society of North America, New York, NY, USA, 9th edition, 2000.
[14]
G. Sjors, K. Hammarlund, P.-A. Oberg, and G. Sedin, “An evaluation of environment and climate control in seven infant incubators. The investigated incubators differ sharply in their performance characteristics,” Biomedical Instrumentation and Technology, vol. 26, no. 4, pp. 294–301, 1992.
[15]
S. B？se-O'Reilly, U. Heudorf, T. Lob-Corzilius, K. E. V. Mühlendahl, M. Otto, and S. Schmidt, “Children's environment in Central Europe: threats and chances,” International Journal of Hygiene and Environmental Health, vol. 210, no. 5, pp. 503–507, 2007.
[16]
S. Blackburn, “Environmental impact of the NICU on developmental outcomes,” Journal of Pediatric Nursing, vol. 13, no. 5, pp. 279–289, 1998.
[17]
A. DiBiasie, “Evidence-based review of retinopathy of prematurity prevention in VLBW and ELBW infants,” Neonatal Network, vol. 25, no. 6, pp. 393–403, 2006.
[18]
M. J. Lotas and M. Walden, “Individualized developmental care for very low-birth-weight infants: a critical review,” Journal of Obstetrical and Neonatal Nursing, vol. 25, no. 8, pp. 681–687, 1996.
[19]
P. Glass, G. B. Avery, and K. N. Siva Subramanian, “Effect of bright light in the hospital nursery on the incidence of retinopathy of prematurity,” New England Journal of Medicine, vol. 313, no. 7, pp. 401–404, 1985.
[20]
B. Ackerman, E. Sherwonit, and J. Williams, “Reduced incidental light exposure: effect on the development of retinopathy of prematurity in low birth weight infants,” Pediatrics, vol. 83, no. 6, pp. 958–962, 1989.
[21]
A. R. Fielder and M. J. Moseley, “Environmental light and the preterm infant,” Seminars in Perinatology, vol. 24, no. 4, pp. 291–298, 2000.
[22]
M. T. O'Connor, B. R. Vohr, R. Tucker, and W. Cashore, “Is retinopathy of prematurity increasing among infants less than 1250 g birth weight?” Journal of Perinatology, vol. 23, no. 8, pp. 673–678, 2003.
[23]
M. Shogan and L. L. Schumann, “The effect of environmental lighting on the oxygen saturation of preterm infants in the NICU,” Neonatal Network, vol. 12, no. 5, pp. 7–13, 1993.
[24]
M. Slevin, N. Farrington, G. Duffy, L. Daly, and J. F. A. Murphy, “Altering the NICU and measuring infants' responses,” Acta Paediatrica, vol. 89, no. 5, pp. 577–581, 2000.
[25]
J. Bullough, M. S. Rea, and R. G. Stevens, “Light and magnetic fields in a neonatal intensive care unit,” Bioelectromagnetics, vol. 17, no. 5, pp. 396–405, 1996.
[26]
N. P. Mann, R. Haddow, and L. Stokes, “Effect of night and day on preterm infants in a newborn nursery: randomised trial,” British Medical Journal, vol. 293, no. 6557, pp. 1265–1267, 1986.
[27]
Y. Shiroiwa, Y. Kamiya, S. Uchiboi et al., “Activity, cardiac and respiratory responses of blindfold preterm infants in a neonatal intensive care unit,” Early Human Development, vol. 14, no. 3-4, pp. 259–265, 1986.
[28]
K. A. Kennedy, A. R. Fielder, R. J. Hardy, B. Tung, D. C. Gordon, and J. D. Reynolds, “Reduced lighting does not improve medical outcomes in very low birth weight infants,” Journal of Pediatrics, vol. 139, no. 4, pp. 527–531, 2001.
[29]
C. M. Maguire, F. J. Walther, P. H. T. Van Zwieten, S. Le Cessie, J. M. Wit, and S. Veen, “No change in developmental outcome with incubator covers and nesting for very preterm infants in a randomised controlled trial,” Archives of Disease in Childhood, vol. 94, no. 2, pp. F92–F97, 2009.
[30]
S. M. Ludington-Hoe, M. W. Johnson, K. Morgan et al., “Neurophysiologic assessment of neonatal sleep organization: preliminary results of a randomized, controlled trial of skin contact with preterm infants,” Pediatrics, vol. 117, no. 5, pp. e909–e923, 2006.
[31]
I. S. Jung, “Effects of cycled lighting on body weight, physiological variables and behavioral states in low birth weight infants,” Taehan Kanho Hakhoe chi, vol. 35, no. 1, pp. 143–153, 2005.
[32]
M. J. Lotas, “Effects of light and sound in the neonatal intensive care unit environment on the low-birth-weight infant,” NAACOG's Clinical Issues in Perinatal and Women's Health Nursing, vol. 3, no. 1, pp. 34–44, 1992.
[33]
D. H. Brandon, D. Holditch-Davis, and M. Belyea, “Preterm infants born at less than 31 weeks' gestation have improved growth in cycled light compared with continuous near darkness,” Journal of Pediatrics, vol. 140, no. 2, pp. 192–199, 2002.
[34]
A. W. Gottfried, P. Wallace-Lande, and S. Sherman-Brown, “Physical and social environment of newborn infants in special care units,” Science, vol. 214, no. 4521, pp. 673–675, 1981.
[35]
S. F. Glotzbach, E. A. Rowlett, D. M. Edgar, R. J. Moffat, and R. L. Ariagno, “Light variability in the modern neonatal nursery: chronobiologic issues,” Medical Hypotheses, vol. 41, no. 3, pp. 217–224, 1993.
[36]
J. Robinson, M. J. Mosely, and A. R. Fielder, “Illuminance of neonatal units,” Archives of Disease in Childhood, vol. 65, no. 7, pp. 679–682, 1990.
[37]
K. Gray, S. Dostal, C. Ternullo-Retta, and M. A. Armstrong, “Developmentally supportive care in a neonatal intensive care unit: a research utilization project,” Neonatal Network, vol. 17, no. 2, pp. 33–38, 1998.
[38]
American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, American Academy of Pediatrics, Elk Grove Village, Ill, USA, 5th edition, 2002.
[39]
L. S. Treas, “Incubator covers: health or hazard?” Neonatal Network, vol. 12, no. 8, pp. 50–51, 1993.
[40]
H. H. Seliger and W. D. Mc Elroy, Light: Physical and Biologic Action, Academic Press, New York, NY, USA, 1965.
[41]
D. L. Phelps and J. L. Watts, “Early light reduction for preventing retinopathy of prematurity in very low birth weight infants,” Cochrane Review, Issue 2, 2013, http://www.nichd.nih.gov/Cochrane/Phelps/Phelps.HTM.
[42]
E. Wesolowski and L. E. H. Smith, “Effect of light on oxygen-induced retinopathy in the mouse,” Investigative Ophthalmology and Visual Science, vol. 35, no. 1, pp. 112–119, 1994.
[43]
J. S. Penn, B. L. Tolman, L. A. Lowery, and C. A. Koutz, “Oxygen-induced retinopathy in the rat: hemorrhages and dysplasias may lead to retinal detachment,” Current Eye Research, vol. 11, no. 10, pp. 939–953, 1992.
[44]
S. Aucott, P. K. Donohue, E. Atkins, and M. C. Allen, “Neurodevelopmental care in the NICU,” Mental Retardation and Developmental Disabilities Research Reviews, vol. 8, no. 4, pp. 298–308, 2002.
[45]
K. A. VandenBerg, “Individualized developmental care for high risk newborns in the NICU: a practice guideline,” Early Human Development, vol. 83, no. 7, pp. 433–442, 2007.
