Royal Free London NHS Foundation Trust
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Paediatrics / Neonatal: the NICU environment

The neonatal intensive care unit can initially be a frightening place for the families of sick infants. They have to cope with the physical and emotional stress of knowing that their baby is receiving very specialised and intensive care. Their baby is also surrounded by bright lights and numerous equipment which makes constant noise, with frequent alarms sounding. There appear to be a lot of people bustling about, who add to the noise level. All this can be stressful to us as adults, but we can take time away from the unit in order to cope with this, and "re-charge our batteries".

For the sick neonate, they too are surrounded by noise and lighting levels which can be very distressing. In addition, they have frequent handling which at times can be painful. They get very little sleep, especially deep sleep, which is needed for recovery and growth. They sometimes find it difficult to get into comfortable positions, which can further stress them and make them feel insecure.

At the Royal Free Hospital we recognise the importance of reducing these environmental stimuli and have introduced a programme of developmentally supportive care.

Developmental care means looking at the infant as an individual and applying an appropriate holistic approach to care in order to protect the pre-term infant's brain and central nervous system. This is aimed at helping them to develop as normally as possible while they are in hospital, and it provides on-going support for those that have gone home but still need further help.

We can do this by assessing the immediate environment and by reducing the levels of noise and lighting as much as possible.


Studies have shown that loud noise is a concern because it can be stressful to the baby and may affect his/her heart rate or breathing patterns. It also affects the length and quality of sleep. Excessive noise levels may be a factor for hearing problems later in life.


Bright light has been shown to have an effect on the baby as it interferes with normal body rhythms and may also cause damage to the eye. Babies are unable to open their eyes for a long period, and this can prevent them from interacting with their families and carers. Bright light also affects the quality of sleep.


We also recognise the importance of ensuring that the baby is nursed in a comfortable, flexed position, which not only makes him/her feel secure, but also helps physiological stability (heart rate and oxygenation), and prevents him/her wasting energy.

The pre-term infant does not always have the muscle strength to control arm, leg and head movements, which means that he or she may have to lie in an "extended position" for long periods. This can lead to stiffness and delay in motor development.


Research has shown that pre-term infants do not cope well with excessive handling. They can show this by "stress signs", such as changes in their heart rate, colour and breathing patterns. Sometimes they show other signs such as yawning, hiccoughing, grimacing or squirming.

Not all handling is negative, and we encourage parents to use positive touch, such as "kangaroo care", as one of the ways in which we can achieve this.

We actively support parental involvement in all aspects of care. Our role is to help parents get to know their baby and to feel comfortable in caring for them, even while in the intensive care setting. By recognising their baby's behaviour, we believe that not only will parents get to know their baby better, but they will understand what he or she likes and dislikes, and be able to decide how best to care for their baby.

page last reviewed: 03 June 2010