Shanna Batchelor didn't have to leave her baby behind when he needed intensive care after being born a few weeks premature in St. Paul, Minn. She stayed right with him, in the neonatal intensive care unit of Children's Hospitals and Clinics of Minnesota.

Her baby, Aiden, had his own spacious, private room in the St. Paul NICU. On the couch in the back of the room, Batchelor could sit and crochet -- and spend the night, too, if she chose.

Journal photo / Kathy Borchers Shanna Batchelor comforts her son, Aiden, in their room in the neonatal intensive care unit at Children's Hospitals and Clinics of Minnesota. The St. Paul NICU allows families more privacy and comfort, especially if parents want to stay overnight. At top, Leah Ennin snuggles with her baby, Madelyn, in their private room there.

"If I don't feel like I need to go home, I can actually stay here and sleep here with him," said Batchelor, of Hugo, Minn. "I changed his diaper. I get to hold him skin-to-skin -- babies really like that. … It just makes you feel better that you can be here."

If it makes the mother feel better, think what this environment does for the baby, gaining strength in a peaceful space that, in spite of the heavy-duty medical equipment, can feel almost like home.

Pretty soon, parents and babies in Rhode Island will enjoy the same advantages when a baby is born needing intensive care.

The St. Paul hospital served as the model for the new neonatal intensive care unit that will open at Women & Infants Hospital in the fall. The NICU will occupy two floors of the $76.8-million, five-story building now under construction at the corner of Dudley and Gay streets in Providence. (The other stories will house beds for obstetrical patients, conference rooms and utilities.)

The new unit will be five times larger than today's noisy, frenetic NICU, where bassinets, ventilators and other bulky equipment are crowded into five open rooms. As in St. Paul, each child will get a private room (and there are big double rooms for twins). Hospital leaders hope the transformation will benefit babies, parents and caregivers -- enough to justify the enormous cost.

When Women & Infants' current home was built in 1986, no one foresaw the magnitude of the changes that were coming in newborn care. The NICU, built for 41, licensed for 60, was overcrowded almost from the day it opened. On an average day, about 66 babies stay there. But there can be as many as 80, and the hospital has had to turn away some 30 babies a year, forcing parents to travel to Boston or New Haven.

What happened? Women & Infants established itself at the regional nexus for newborn care. Any woman in southern New England at risk of delivering extremely early is transferred there, as is any baby born before 32 weeks' gestation. Women & Infants has the region's only Level III NICU, able to provide the most advanced care a newborn could need, except for cardiac surgery. (Kent Hospital, in Warwick, and St. Luke's Hospital, in New Bedford, have Level II NICUs for less severely ill babies.)

So the hospital was getting more babies. But the bigger factor, says pediatrician-in-chief James F. Padbury, was its success at saving them, especially the tiniest. By 2004, Women & Infants' survival rate had reached nearly 90 percent for babies born weighing between 1 pound, 10 ounces and 2 pounds, 3 ounces (750 to 1,000 grams). Babies so tiny, however, typically spend weeks to months in the hospital, so they were also filling the beds for longer periods of time.

Then, the number of babies born prematurely -- the majority of NICU babies -- has been increasing steadily since the '80s, in Rhode Island and around the country. Some 11 percent of babies born at Women & Infants end up in the NICU.

BUT CROWDING was only part of the worry. The NICU is a noisy place, where activity never stops. Adults who spend long periods in brightly lit, ever-active intensive care units sometimes develop temporary psychosis. What does all that racket do to the immature nervous systems of babies? Loud noises have been shown to increase pressure in the skull and decrease oxygen levels in the blood, not to mention interfering with the baby's ability to establish sleep patterns, Padbury says. Infections travel more easily in open rooms, and preemies are especially vulnerable.

In 2003, the hospital convened a task force that included doctors, nurses, parents and others to research the design of the new unit. They visited newly built NICUs around the country, considering every configuration, from arranging the bassinets in "pinwheels," to mixtures of private rooms and open bays, to the all-private-room approach. Every place they saw had something missing -- until they visited Children's in St. Paul.

The Minnesota hospital had gone through a similar process a few years earlier when its NICU needed to expand. Officials there concluded that the only way to go was to build private family rooms for every baby. Such rooms are quieter and make it easier for parents to learn how to take care of their babies.

Journal photo / Kathy Borchers In the NICU of the St. Paul hospital, nurses work with “buddies” and the rooms, while private, have glass doors and windows to allow the nurses to better monitor the infants inside. The rooms also have curtains to allow for privacy.

There were some reservations. "The nurses were extremely concerned about their isolation from each other," says Kathy Schoenbeck, director of neonatal services in St. Paul. "They were used to being in a big room where they could just yell at each other if they needed each other."

That concern, she said, was universal among the staffs of hospitals that sent delegations to inspect the private-room model, and nurses interviewed at Women & Infants expressed the same worry. All alone in their rooms, would the babies be safe?

The question was put to the test within the first 24 hours of opening the new unit in St. Paul: two babies went into cardiac arrest. The hospital has an electronic communications system involving handheld devices, and the system worked perfectly. Everyone responded smoothly; the babies survived. And everyone worried less after that.

Private rooms also brought a big change for families, who often develop a sense of community and form lasting friendships when they meet in an open unit. The closeness of families, however, is a double-edged sword. In an open unit, parents have no choice but to share their traumas and endure those of other families.

"In the old environment, there was just no privacy whatsoever," says Schoenbeck. "So when a baby was dying, or died, all the families around knew that that was going on. So the other families would be scared: ‘When is this going to happen to my baby?' or they'd feel bad if their baby was doing well. …

"For the people who lost the baby, right after the baby died, they'd leave the unit as quickly as possible. … In this environment they can stay for hours, bathe the baby, dress the baby … then leave when they're ready."

Once the new NICU opened, Schoenbeck says, "it took no time at all for the staff and the families to realize this is a better world, for everyone -- for the babies, for the family, for the staff."

Babies can be left in peace, without constant fussing and handling, without other infants' alarms upsetting them. The lights can be kept dim at night and lighter in the day, to ease the baby into a normal sleep-wake cycle.

Another key change was an increase in breastfeeding. Studies -- including research by Dr. Betty Vohr of Women & Infants -- have shown that premature babies have fewer complications in the NICU and afterward if they receive breast milk. Most preemies cannot suck, so mothers must pump. But where? With the new private rooms, where a curtain can shield the family area, mothers are much better able to accomplish this, and then move on to breastfeeding when the baby is strong enough. At St. Paul, 95 percent of NICU mothers learn to breastfeed.

AFTER VISITING St. Paul, Padbury says, the choice was clear. "We saw no other model of care that was reasonable," he said.

Journal photo / Kathy Borchers The St. Paul NICU of Children's Hospitals and Clinics of Minnesota served as the model for the new NICU that Women & Infants, in Providence, plans to open this fall.

When Women & Infants brought its building proposal to the state Department of Health in 2005, even the state's health insurers did not object, despite the heavy cost. The new unit is expected to consume $11.6 million in patient-care-related costs during its first year of operation.

Because the work done in NICUs involves a lot of well-reimbursed procedures, these units are money-makers for hospitals. Women & Infants made nearly $14 million in profits from the NICU in 2004. With the new NICU, the hospital expects its profits to drop by about a third because of added costs -- repayment of the building debt as well as additional staff and equipment. When it applied for approval in 2005, the hospital projected that the expenses for one day of NICU care would increase from $1,686 in 2004 to $1,908 in the new NICU's first year of operation, while the average reimbursement would stay nearly the same at about $2,300. (The hospital declined to provide its updated figures on expectations for expenses and reimbursement.)

No one denied the need for more space, and the hospital was allowed to increase the licensed bassinets from 60 to 80. In approving the new building, however, Health Director David R. Gifford required Women & Infants to spend some of the NICU bounty on addressing related problems outside the hospital -- improving prenatal health care for women, providing in-home support to families when their babies leave the NICU and working with community pediatricians who take care of them.

The new NICU will occupy two floors -- to maximize the number of rooms with windows to the outside. Each room will have "zones" designated for the family, the baby and the staff. The family space includes sleeper couch, desk and storage area, with a privacy curtain. When nurses are not taking care of the baby, they can sit in a nook outside with windows that allow views of two rooms at once. A communications system, using hand-held devices, will also keep nurses in touch with every nuance of the baby's condition.

Ample sunny spaces have been set aside for families to gather, in the hope of fostering the kind of fellowship that developed in the old NICU. There will be play areas for siblings and fish tanks visible from all sides.

Will the new NICU be a better environment for babies? As much as it makes intuitive sense, only anecdotal evidence supports the notion that babies will have fewer complications in private family rooms.

Women & Infants hopes to answer the question definitively. In a project paid for by the hospital, researchers from the Brown University Center for the Study of Children at Risk have been cataloging and measuring every aspect of care in the old NICU, such as decibel levels and nurse interactions with babies. Identical data will be gathered in the new NICU. Then they will compare how the babies fared.

Great strides have been made in improving the survival rates of premature babies, but many still go home with physical and mental impairments. As Padbury sees it, efforts to reduce the ill effects of prematurity represent the new frontier of newborn care. He's hoping Women & Infants' NICU will show the way to healthier preemies.