The creation of formal planning guidelines for newborn intensive care units (NICUs) first occurred when Toward Improving the Outcome of Pregnancy was published in 19761.

This landmark publication, written by a multidisciplinary committee and published by the March of Dimes, provided a rationale for planning and policy for regionalized perinatal care and details of roles and facility design. Since then, the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) have published several editions of their comprehensive Guidelines for Perinatal Care2, and The American Institute of Architects has likewise published several editions of their Guidelines for Construction of Hospital and Healthcare Facilities3.

The purpose of this committee is to complement the above documents by providing healthcare professionals, architects, interior designers, state healthcare facility regulators, and others involved in the planning of NICUs with a comprehensive set of standards based on clinical experience and an evolving scientific database.

With the support of Ross Products Division / Abbott Laboratories, a multidisciplinary team of physicians, nurses, state health planning officials, consultants, and architects reached a consensus on the first edition of these recommendations in January 1992. The document was sent to all members of the American Academy of Pediatrics Section on Perinatal Pediatrics to solicit their comments, and we also sought input from participants at the 1993 Parent Care Conference and an open, multidisciplinary conference on newborn ICU design held in Orlando in 1993. Subsequent editions of these recommended standards were then developed by consensus committees in 1993, 1996, 1999, 2002, 2006, 2007, 2012, and 2019 under the auspices of the Gravens Conference.

Various portions of these recommended standards have been adopted by the American Institute of Architects/Facilities Guidelines Institute Guidelines3, the AAP/ACOG Guidelines2, and by standards documents in several other countries. In the future, we will continue to update these recommendations regularly, incorporating new research findings, experience, and suggestions. We hope this document will continue to provide the basis for a consistent set of standards that can be used by all states and endorsed by appropriate national organizations and that it will also continue to be useful in the international arena.

While many of these standards are minimums, the intent is to optimize design within the constraints of available resources and to facilitate excellent health care for the infant in a setting that supports the family's central role and the staff's needs. Decision makers may find these standards do not go far enough, and resources may be available to push further toward the ideal.


Leslie Altimier DNP, RNC, NE-BC

Chief Editor Journal of Neonatal Nursing(JNN)

Regional Director - Neonatal Services

SSM Health - Cardinal Glennon Children's Hospital

1465 S Grand Blvd

St. Louis, MO 63104


Sue Ann Barton AIA, LEED AP, EDAC


ZGF Architects LLP

1223 SW Washington Street

Suite 200

Portland, Oregon 97205


Jesse Bender, MD

NICU Medical Director

Mission Health System

509 Biltmore Ave

Asheville NC 28801

Cell: (828) 778-0374

Joy Browne, PhD

Associate Professor, University of

Colorado School of Medicine

Department of Pediatrics at the

Children's Hospital

1056 E19th Ave

Denver, CO 80218


Debra Harris, PhD

Associate Professor

Family & Consumer Sciences, Interior Design

Robbins College of Health and Human Sciences

Baylor University

One Bear Place #97346

Waco, TX 76798

Office Location: Goebel 103.01

Office Tel: 254.710.7255

Carol B. Jaeger, DNP, RN, NNP-BC

Associate Professor of Clinical Practice

The Ohio State University College of Nursing

Columbus, OH 43210


Carol B Jaeger Consulting, LLC

3143 Cranston Drive

Dublin, OH 43017

P: 614-581-3647

Beverley H. Johnson, FAAN

Institute for Patient- and

Family-Centered Care

6917 Arlington Road, Suite 309

Bethesda, MD 20814


Carole Kenner, PhD, RN, FAAN, FNAP, ANEF

CEO Council of International Neonatal Nurses, Inc. (COINN)

Carol Kuser Loser Dean and Professor

The College of New Jersey School of Nursing, Health, & Exercise Science

206 Trenton Hall

2000 Pennington Road

Ewing, NJ 08628

P: 609-771-2541

Kathleen J. S. Kolberg, PhD

Associate Dean of Science

Asst. Director of the Center for Health Sciences Advising

219 Jordan Hall of Science

University of Notre Dame

Notre Dame, IN 46556


Angela Loder, Ph.D., WELL AP

WELL Faculty

Vice President, Research

International WELL Building Institute

220 Fifth Avenue, 8th Floor

New York, NY 10001

Phone: 773-803-0164

Gilbert L. Martin, MD

Pediatrix Medical Group Director, NICU

Citrus Valley Medical Center 1135 S. Sunset, Suite 406 West Covina, CA 91719

P: 626-813-3716

Sabah Mohammed MS, B.Arch

Healthcare Designer, Planning + Strategies,

Perkins & Will

1315 Peachtree St NE

Atlanta, GA 30309

P: 209-407-8942

Teri Oelrich MBA, BSN, FNIHD

Consulting Partner/Healthcare NBBJ

310 SW 4th

Portland OR 97204


Lynne Wilson Orr, BID, March, OAA, MRAIC, NCARB, ARIDO, IDC

Principal, Parkin Architects Limited 1 Valleybrook Drive

Toronto, ON M3B 2S7

Canada P: 416-467-8000

M. Kathleen Philbin, RN, PhD

Independent Researcher 43 Foxwood Dr.

Moorestown, NJ 08057

P: 856-912-3197

Mardelle McCuskey Shepley, D.Arch., FAIA


Human Centered Design

Cornell University

3250C MVR Hall

Ithaca, NY 14850-4401

P: 607.255-3165

Jonas Shultz MSc EDAC CRP

Human Factors Specialist,

Health Quality Council of Alberta

Adjunct Lecturer, Cumming School of Medicine, University of Calgary

210, 811 – 14 Street NW

Calgary, AB T2N 2A4

P: 403-355-4440

Judith A. Smith, MHA

Principal, Smith Hager Bajo, Inc.

10947 E Cannon Dr

Scottsdale, AZ 85259


Tammy S. Thompson, EdD, RA, RID, CPXP, EDAC

Director of Experience Engagement, Education & Design; ECU Health

Assistant Professor

College of Engineering

NC A&T State University

1601 East Market Street

Greensboro, NC 27411

Robert D. White, MD


Director, Regional Newborn Program

Beacon Children’s Hospital

615 N. Michigan Street

South Bend, IN 46601

P: 574-647-7141


Mark Rea, Ph.D., and Jack Evans, PE, provided valuable technical assistance to the committee.

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