Kimberli Johnson's baby was born much too soon, trading the serenity of the womb after 24 weeks of gestation for the chaotic world of a neonatal intensive care unit.
"Her head was the size of a kiwi fruit, and her legs were like index fingers," said Johnson, recalling the premature birth of her daughter, Ellie, about 10 years ago. "I heard a little mewing like a lamb before they intubated her."
In the six months that Johnson sat by Ellie's isolette, she began to understand firsthand the jarring discrepancy between the aquatic nest that her daughter had left too early and the new environment into which she had been thrust and was now expected to grow.
Parents of other babies stopped and gawked. Alarms went off at adjacent isolettes. Monitors beeped, instruments clattered and lights glared.
Sometimes, a wail of grief from parents learning of the death of their fragile baby added to the cacophony.
But after Ellie left the hospital, Johnson used her experiences to join what has become a growing trend in the care of premature babies by helping design private rooms in neonatal intensive care units, or NICUs, that strive to replicate the qualities of the womb: its darkness, relative quiet and full entanglement with the mother's biological rhythms.
The spaces, called "womb rooms" by some researchers, are predicated on the obvious notion that the best place for a premature baby would be the exquisitely complex environment where, in the last three months of gestation, the neural connections in the baby's brain grow exponentially as it curls up in amniotic fluid, listening to the mother's heartbeat, breathing, intestinal gurgling and pitch of her voice.
In premature births, however, the second-best place is one where the infant develops in a cocoonlike environment that mimics as many of the womb's qualities as possible, with uninterrupted sleep, indirect light, skin-to-skin contact and the assuring sound of parents' voices.
Private spaces
Hospitals are overhauling their neonatal intensive care units to transform open wards into private spaces that, in essence, restore the intimate relationship between the mother and child and allow the fragile infants to develop.
About 20 of the at least 800 neonatal intensive care units in the United States have completed projects through which most or all of the rooms are private.
A general model of a single room includes a place for the parents to sleep, noise kept below 45 decibels so babies can recognize parents' voices, and ambient lighting, according to recommended standards drawn up in February by neonatology experts.
In addition, the standards say the space, sealed off by dividers or walls, should be at least 150 square feet. Windows let nurses see in, and parents often decorate them.
"It is the trend of the future," said William E. Smalling, a neonatologist at Baptist Children's Hospital in Miami, where Amillia Taylor, who at slightly more than 21 weeks' gestation was one of the world's smallest premature babies, spent nearly four months in an open ward before being released last month.
CHRISTINE HAUSER
NYT News Service