The NICU shall be a distinct area within the facility and if possible in close proximity to the labor and delivery unit. If the services are on separate floors, there needs to be an elevator adjacent to the
units that is only utilized for service between labor and delivery and the NICU. A separate fully equipped resuscitation room or a resuscitation area in each delivery room is necessary.

Many NICUs, particularly in small or medium-sized hospitals, share staff and responsibilities with the well-baby nursery or pediatric ICU. When these areas are contiguous, much of the support space (e.g., family lounge, staff lockers, equipment storage) can be shared, and the opportunities for staff to assist one another are enhanced.

Traffic patterns for infants who leave the NICU for procedures should be identified and private hallways created wherever possible, so that ill infants and their attendants do not have to use public areas.

The NICU should be designed as a component of an overall security program that will protect the physical safety of infants, families, and staff and minimize the risk of infant abductions. The number of entrances and exits should be limited, and control station(s) should allow for direct visualization of all visitors. The need for security must be balanced with the need for comfort and privacy. New technology, including cameras and other electronic detection systems, will allow for a safe yet intimate NICU experience.

Fire exits should be carefully planned in the initial design, and clearly marked, as should the location of fire extinguishers. The fire marshal should be given the first draft of the design documents so that any problems can be corrected early.

With the additional emphasis on family-centered care, the reception area will introduce the first impression of the NICU for the family. The size and layout of this space is often dependent on not only the size of the NICU but its own individual culture. The means to communicate with an NICU staff member should be provided in the reception area. If possible, there should be a hospital-based individual in charge of this reception desk. In addition to the reception area, a family lounge should be designed that provides comfortable seating but is not conducive to overnight sleeping. This lounge area should have a television set, reading material for families, and a toy box for children. Access to the Internet can be provided via a computer station in the family lounge area, and there should be space for families to secure valuables. Public restrooms and telephones should be available nearby.

In addition to generous provision of space at the bedside and in the family lounge, parents need space to stay overnight, to meet in private with staff to discuss their baby or to grieve, and to breastfeed. Depending on the size of the NICU and its local practices, some of these functions can be combined, but none can be ignored.

Breastfeeding of premature or ill infants is poorly accommodated in many existing NICUs. Mothers should be able to breastfeed babies at the bedside without compromising their privacy. A single-family room design alleviates the need for additional breast-feeding rooms. However, if the design is not a single-family room model, private breast pumping areas are required.

The location and content of signs are often overlooked when planning an NICU. Some thought should be given to traffic patterns for families and the public from the hospital entrance(s) and how signage will be used to direct them clearly to the NICU. Information on signs should be phrased warmly, in a way that will make families feel welcome, rather than sternly, in a way that could make them feel like outsiders and intruders.

NICUs have changed from “wardlike” configurations to specialized “pods,” two-bedded rooms, and now to the individual “single bed” patient room. This design is now most popular since families want continuous access to their babies and desire to stay at the bedside, but it raises the potential for isolation of both families and caregivers. Rooms must be large enough to allow parents the ability to “sleep in.” Storage and communication capabilities must be upgraded so that each room is self-sufficient. The family space area should include a reclining chair suitable for kangaroo/skin-to-skin care, a parent bed, enough outlets for electronic devices, and adequate storage space.

Certain principles can be established for all direct patient care area plans, regardless of whether a large multi-bed room, multiple smaller rooms, or private rooms are chosen as the model. First, each patient bed position must have sufficient space for families to stay for extended periods without interfering with staff duties. Second, each patient bed position must have individualized lighting, data entry, and communications systems. Third, traffic patterns must be well planned, with sufficient aisle widths to accommodate diagnostic equipment and personnel. Nursing functions should be separated from the bedside whenever possible. There should be adequate space for both direct patient care and nondirect patient care (charting, giving reports, telephone calls).

The complete infant space includes clear floor space, aisle space, storage space, and available areas that allow for necessary furnishings. NICUs have historically been undersized, but now horizons are expanding to accommodate new practices (especially increased parental access).

There are two methods of defining floor space/bed. The first method recommends a minimum of 120 square feet for multi-bed rooms and 165 square feet for single-bed rooms, excluding hand-washing stations, columns and aisles. There shall be an aisle adjacent to each infant space with a minimum width of 4 feet. In addition, an adjacent aisle of at least 8 feet will allow for passage of equipment and personnel. The second method utilizes square footage per bed. In the past, 150 to 200 departmental (complete) gross square feet per bed were recommended. At present, the recommendation has increased to 600 to 800 departmental gross square feet per bed, which includes patient care areas, office space, support space and space required for restrooms.

General support space includes clean and soiled utility areas, medical equipment storage and unit management services. The soiled utility area stores used and contaminated material prior to removal. This room shall contain a counter and hands-free hand-washing station separate from any utility sinks. The hand-washing station is controlled by a hands-free mechanism. The soiled utility area should be situated to allow removal of materials without passing through the infant care area. This soiled room shall have a ventilation system with negative air pressure. Provision for charting space is also included in general support space. The technology in this area must be upgraded to allow for electronic medical records and maintain patient confidentiality. Storage areas should have a generous supply of electrical outlets and shelving so that battery-powered devices can be recharged. Additional specific considerations are outlined in each state’s code documents.

A three-zone storage system is required. The first storage area is the central supply department. The second storage area is the clean utility room described above. Routinely used supplies (diapers, formula, linen, cover gowns, information booklets) are stored in this
space. The space allocated for each infant’s equipment should be 18 square feet per infant in intermediate care and 30 square feet per infant in critical or intensive care. The third storage zone is for items frequently used at the infant’s bedside. In addition, cabinet storage should be 16 cubic feet per infant intermediate care and 24 cubic feet per infant in critical or intensive care.

It is best to include a separate laundry room where infant clothing, cloth covers, and toys utilized in the NICU can be cleaned. Space for a commercial-grade washer and dryer should be provided, with the dryer vented through an outside wall.

Space for preparation of specialized formulas and additives to breast milk and formula should be in a separate area. This room should allow for storage for supplies, formulas, and refrigerated and frozen breast milk. To minimize contamination the ventilation system should have a minimum filtration of 90% based on the American Society of Heating, Ventilation, and Air Conditioning Engineers standards or have a high-efficiency particulate air (HEPA) forced air filtration system. All water supplied for feeding preparation should meet Federal Standards and be commercially sterile.

Other areas for ancillary services such as respiratory therapy, laboratory, pharmacy, radiology, and developmental therapy should be provided. Although pharmacies are not required to use a laminar flow hood to prepare oral medication, it is preferable to include one when choosing equipment. The laminar flow hood prevents contamination of biologic samples. Equipment should include an UV-C germicidal lamp to sterilize the shell and contents when not in use.

Family-infant room(s) shall be provided adjacent to the NICU that allows families and infants extended private time together. The room(s) shall have a sink, toilet, shower, emergency call, and linkage with the NICU staff. Sleeping facilities should include at least one parent bed and sufficient space for the infant and all necessary equipment. Provision of family-infant rooms encourages overnight stays by parents and allows for better transition to home. If the unit configuration includes only single-patient rooms, family transition rooms may not be necessary.

Staff support space should meet their professional, personal, and administrative needs efficiently. Lockers, a lounge, toilet facilities, and on-call rooms are necessary. Some charting space, especially for the nursing and respiratory therapy staff, should be allocated within this area. Additional space, especially for physician and nurse practitioner charting and discussion, should be provided adjacent to the patient care area. The communications systems (phone, computer terminal, printer) that link the NICU with the hospital laboratory, pharmacy, and central supply generally will also be situated in this area.