Anyone who has awakened to an emergency knows the feeling of being forced alert before you're ready. The phone rings, you fumble. Someone snaps on a light, you shudder.
Imagine, then, the shock to a premature infant who is denied not hours but months of rest.
The stunned baby is rushed from a dim, muffled womb to a ward lit up day and night like an automobile showroom. Here the infant will remain anywhere from several weeks to more than three months while alarms clang, monitors beep, nurses jabber and ventilators hiss--continually. The baby's sleep will be interrupted for various procedures an average of 40 to 132 times a day.
To the infant who has no defenses to ward off this onslaught, the neonatal intensive care unit is "basically a torture chamber," concludes Sandra Gardner, a nurse and co-editor of the "Handbook of Neonatal Intensive Care."
The frantic, high-tech surroundings of the neonatal nursery have, until recently, been thought necessary to saving lives. But some health care workers now argue that the environment is actually harming babies, and that infants who start their lives in neonatal intensive care may be handicapped by the experience. They may encounter feeding difficulties, inability to gain weight, disturbed sleep-wake cycles, impaired motor skills, mental disabilities and emotional problems, including lack of ability to form loving attachments.
Recent research in the new field of "environmental neonatology" found the sensory bombardment of infants may lead to hearing and vision deficits. A study published in the New England Journal of Medicine showed a link between the blazing lights used in intensive care nurseries and an illness called retinopathy of prematurity, which blinds about 500 babies annually in this country and leaves 1,500 more with some vision loss.
A New Jersey father, Peter Aleff, who believes his 4-year-old son's blindness is due to light exposure in a neonatal intensive care unit, is currently waging a national campaign to have the lights reduced. But, most neonatal specialists say more study must be done before they are convinced nursery lights play a role in the disease.
Studies performed on animals also suggest that the extreme noise levels in intensive care nurseries are at least partly responsible for the high incidence of hearing loss among its graduates. Routine sounds--such as the clink of a bottle set atop the Plexiglass lid of an isolette--can register noise levels above 80 decibels inside the isolette. Levels above 80 decibels have been shown to produce hearing loss in adults.
Still other studies indicate intensive care babies may later avoid physical contact because they associate human touch with traumatic medical procedures. During their stay in intensive care, infants are handled by many different caretakers.
One neonatal specialist estimated that less than 5% of the nation's intensive care nurseries have made substantial environmental changes on the basis of these concerns. But, in some units, nurses have taken it upon themselves to dim the lights for at least an hour or two each day to create a semblance of nighttime. And speakers that used to pump rock music to the staff are disconnected now in many nurseries in a bow to the babies' need for quiet.
At Brigham and Women's Hospital in Boston, a state-of-the-art environmental unit, preterm infants sleep in waterbeds and hammocks designed to simulate the contours and motion of the womb.
In this unit, alarms are set to ring at the lowest possible volumes; there are no overhead lights; and each isolette is covered with a blanket so that only about one-third of the lower porthole is exposed to light.
"We are very sensitive to having restful babies here," said psychologist Heidelise Als, a research associate at the hospital.
Preliminary studies by Als, who is an associate professor of psychology at Harvard Medical School, show that the altered intensive care environment may reduce the amount of time an infant needs to be on an oxygen ventilator or be fed by stomach tube. She has also noted improved sleep patterns, motor functioning and attention spans in children who began life on this unit as opposed to more traditional intensive care nurseries.
Another environmentally advanced unit, the neonatal intensive care ward at Children's National Medical Center in Washington, reflects "high-touch" as well as "high-tech values," said Dr. Gordon Avery, chairman of the neonatology department. The hospital recently spent $150,000 to install individual dimmer switches by each isolette. (Because preemie care is already enormously costly, the expense of such alterations is often mentioned as a disincentive to environmental change.) The staff has experimented with filters that protect the isolettes from glare. And they have even tried fitting babies with special preemie sunglasses, Avery said.