From walls to warmth: How room design shapes parent-infant closeness in the NICU

When newborns require intensive care, closeness between parents and infants can be difficult to maintain—especially in traditional open bay units. Research has long suggested that skin-to-skin contact and physical presence are vital for a newborn’s development and for fostering the emotional bond with their parents. A recent Dutch cohort study explored whether switching from an open bay unit to single-family rooms could support more parent-infant closeness. Based on observations from over 800 families, the results show that architectural changes led to longer daily presence of both mothers and partners, and increased physical contact with their infants. While the transition had measurable benefits, the study also emphasizes that further improvements are needed to meet current care standards.

When a newborn is admitted to a neonatal intensive care unit (NICU), the environment can either support or limit the connection between infants and their parents. In open bay units (OBUs), care is often efficient for staff but leaves little space for privacy, intimacy, or prolonged parental involvement. Emotional and physical closeness—like skin-to-skin care or holding—are essential to reduce stress, strengthen attachment, and promote healthy development in preterm or critically ill infants.

To investigate how architecture influences this closeness, researchers followed families before and after a Dutch NICU transitioned from OBUs to single-family rooms (SFRs). These rooms allow parents to stay with their child throughout the day and night, offering more privacy and comfort. The study measured how often parents were present, how long they held their infants, and how much skin-to-skin contact occurred.

More time, more contact: A space that fosters bonding

The results were clear: SFRs significantly increased parent-infant closeness. Mothers’ daily presence doubled, from about 3.5 hours in OBUs to 7 hours in SFRs. Partners showed a similar pattern, with their presence rising from 3 to 6 hours per day. Skin-to-skin care also improved—mothers increased from 2 to nearly 3 hours a day, and partners from under 2 to more than 2 hours. Lap holding saw smaller gains, mostly for mothers. These increases were consistent across all gestational age groups and started as early as the first day of life.

The study highlights that while SFRs support stronger bonds, even with this improvement, parental presence fell short of WHO and GFCNI (former: EFCNI) recommendations. This suggests that room design alone is not enough—staff encouragement, flexible routines, and family-integrated care also matter.

Designing care that includes families

For parents, these findings offer hope: the environment can support their presence and involvement, even in the stressful NICU setting. For hospitals and care teams, the study reinforces that investing in SFRs can enhance emotional and developmental outcomes. However, to fully support closeness, physical changes should be paired with cultural shifts that truly integrate parents into the care team.

Encouraging closeness isn’t just about architecture—it’s about prioritizing family-centered care. This study adds to the growing evidence that where infants heal can shape how they connect.

Paper available at: Effect of Shifting From Open Bay to Single-Family Rooms on Closeness in a NICU – PubMed

Full list of authors: Wielenga, J.M.; Pascual, A.; Ruhe, K.; Aarnoudse, C.; van Kaam, A.H.

DOI: https://doi.org/10.1111/apa.70108