NICU Standard 7: Couplet Care Rooms

Any hospital that offers both an obstetrical delivery service and neonatal intensive care shall include an adequate number of couplet care rooms equipped to provide both intensive care for the newborn and postpartum care for the mother in the same room or suite. This requirement does not apply to mothers who require specialized care after delivery such as treatment for unstable hypertension or respiratory failure, or to infants who require care such as ECMO or isolation that cannot be provided in a conventional NICU room. An assessment of the appropriate quantity of couplet care rooms shall be conducted to identify an adequate number.

When a room is provided in the NICU, postpartum, or LDRP Unit that allows a hospitalized mother and NICU patient to be care for in the same room, the room shall have the following:

Couplet Care Room in the NICU or Postpartum Unit: Minimum clear floor area of 150 square feet (14 square meters) for the NICU infant and 150 square feet for the mother.

LDRP Room: 405 square feet 37.6 square meters) for combined mother and NICU patient.

Minimum clearances shall be provided as follows:

    • Postpartum patient rooms: 4 feet (1.2 meters) at the foot of the bed.
    • NICU Couplet Care Rooms: 1 foot (0.3 meters) at the head of the bed to the wall, 4 feet from the foot of the bed to the wall or other obstruction, and 8 feet (2.4 meters) between beds.
    • LDRP Clearances: Six feet (1.8 meters) at the foot of the bed, 5 feet (1.5 meters) on the transfer side of the bed to a wall or fixed obstruction, and 4 feet on the non-transfer side.

Family and staff space shall be provided as specified in Standard 6 (Single-Family rooms).

Each patient room with a hospitalized adult patient shall be provided with natural light by means of a window to the outside. In new construction, windowsill height in the patient rooms shall be a maximum of 36 inches (0.9 meters) above the finished floor.

Each patient room with a hospitalized adult patient shall have direct access to an enclosed toilet room with a shower and handwashing station.

There shall be a handwashing station in the patient room in addition to that in the toilet room.

Each patient room shall have a separate lockable wardrobe, closet, or locker suitable for garments and for storing personal effects.

Interpretation: Infants born with medical problems have historically been separated from their mothers after birth. This model provides integrated hospitalized mother and neonate care. The benefits include early maternal attachment, skin-to-skin care, access to breast milk, and participation in care, among others4.

This model provides a platform for staff to consider the interdependent needs of the mother and infant(s) as a couplet in addition to each patient’s individual needs. The Standard maintains the square feet for each patient type with a neutral impact on minimum space and clearances.

The required assessment of the adequate quantity of couplet care rooms for the hospitalized mother and NICU patient should include collection of information that identifies the eligible patient population, lengths of stay, required staff and other relevant factors to project future room needs and support the building design.

Other facility considerations include providing access to clean supply, linen, medication, and equipment storage for both adult and neonatal patients.

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