This document provides an overview of lighting design considerations for neonatal intensive care units (NICUs). It discusses the biological and developmental impacts of light on newborns, including their developing eyes and circadian rhythms. Specific lighting zones and objectives are outlined for infant patients, families, and nurses. Design recommendations include using indirect, dimmable lighting and amber wavelengths at night while allowing for brighter exam lighting. Finishes, fixtures, and controls must also support infection control and the unique needs of the NICU environment.

1. NICU Lighting:
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NICU LIGHTING: SUPPORTING HEALTH, COMFORT
AND WELL-BEING FOR NEWBORNS, FAMILY AND
STAFF THROUGH LIGHTING DESIGN.
Lighting Design Content by Visa Lighting

2. 2
NICU Lighting:
Description
Course Description
The growth and development of our children is extremely
important at any age. At birth our eyes are still developing
and will continue to change throughout our lives. Special
care to lighting and the surrounding environment is an
essential part of a NICU design. This course will go over the
needs of an appropriate NICU lighting design as well as
future design trends. We’ll review the body’s photo
biological response to daylight and our 24 hour clocks as
well as the visual lighting spectrum and how to apply it.

3. Learning Objectives
At the end of this course participants will be able to:
1. Discuss the body’s biological and psychological
responses to light.
2. Analyze a neonate’s eye development and the
importance of a responsive lighting design.
3. Identify key lighting sources and how to apply them
when designing.
4. Review NICU lighting design trends, zones and
controls.
3
NICU Lighting:
Objectives

4. NICU LIGHTING:
PHOTOBIOLOGY OVERVIEW
4
Circadian Rhythm
What is it and what does it mean to us?
•24 Hour Cycle that is built in to any living being –
plants & animals
•The cycle can be modulated by external cues such as
sunlight and temperature
•Determines sleep and feeding patterns
•Brain wave activity and Hormone production
•Cell Regeneration and other Biological activities

5. 5
NICU Lighting:
Photobiology Overview

6. 6
NICU Lighting:
Photobiology Overview
Circadian Rhythms & Lighting
How can lighting support a 24 hour routine?
•Electric light should mimic the outdoors and a
typical day
•Brighter lighting during the day to keep us awake
•Dimmer lighting at night that will promote normal
sleep
Where this gets hard
•Shift Workers
•Nurse Stations
•Seasonal Changes

7. 7
NICU Lighting:
Photobiology Overview
Circadian Rhythms & Lighting
NICU Lighting
•Day/Night cycled lighting in NICUs - Increased
weight gain, earlier initiation of oral feedings,
decreased number of days on the ventilator and
under phototherapy, and enhanced motor
condition
•Reducing light levels in NICUs – leads to lower
respiratory rates, reduced time on mechanical
ventilation and oxygen support and lower activity
levels

8. 8
Daylighting
•Rooms with windows when possible to have views
to nature
•Daylighting should be readily accessible to all
patients, families and staff in a healthcare setting
•Sunlight gives Vitamin D which supports our bodily
functions and bone structure
•Glare and heat gain need to be considered
•Reflections from windows or skylights can be
uncomfortable and harmful if not designed correctly
•Utilize shades and controls when possible
NICU LIGHTING:
PHOTOBIOLOGY OVERVIEW

9. NICU LIGHTING:
INFANT EYE DEVELOPMENT AND
LIGHTING CONSIDERATIONS
9
Parts of The Eye

10. NICU LIGHTING:
INFANT EYE DEVELOPMENT AND
LIGHTING CONSIDERATIONS
10
The Developing Eye
•Pupil – Controls the amount of Light entering the eye
•It takes two weeks for the pupils to enlarge and
start to see a range of light and dark images in a
newborn
•Retina –Light sensitive tissue that converts light into
electric impulses
•As this develops the ability to see and recognize
pattern improves
•Macula– Area of the Retina used for central vision
•Not fully developed until Age 4
•Eyelids – Can be thin in premature Infants
•Decreased ability to constrict and control light
exposure

11. NICU LIGHTING:
INFANT EYE DEVELOPMENT AND
LIGHTING CONSIDERATIONS
11
Eye Development Process
A baby's First year of life
•0-3 Months
•Babies can not focus more than 8-10 inches from their
face, sensitive to bright light
•High Contrast Images like their mothers eyes/face
begin to attract attention in the early weeks
•Eyes may wander or look crossed as they learn
how to coordinate and focus
•Eye hand coordination begins and they start
reaching out towards objects

12. 12
Eye Development Process
A baby's First year of life
•5-8 Months
•Control of eye movement and eye-body coordination
skills improve
•Eyes begin to see depth and are working together
•Begin to have good color vision, will see red first
•Crawling begins, aids in eye-hand-foot body
coordination
NICU Lighting:
Infant Eye Development and
Lighting Considerations

13. 13
Eye Development Process
A baby's First year of life
•9-12 Months
•Babies should be using their eyes and hands together
•They will begin to pull themselves up to a standing
position
•Should be able to grasp objects with their thumb and
forefinger
•Crawling before walking encourages eye-hand
coordination
•Babies can now judge distances fairly well and throw
NICU Lighting:
Infant Eye Development and
Lighting Considerations

14. NICU LIGHTING:
INFANT EYE DEVELOPMENT AND
LIGHTING CONSIDERATIONS
14
Damaging Effects of Bright Light
•Excessive Stimulation – Amount and sudden change of
light can be stressful
•Bright light can increase heart and respiratory rates and
decrease oxygen saturations
•Eye exams with opthalmoscopes as well as pupil dilatation
increases sensitivity to light
•Retinopathy of Prematurity (ROP) – Occurs in premature
infants when there is abnormal blood vessel development
in the Retina
•Lighting should accommodate for sensitive eyes in
this case, especially in ROP patients

15. 15
NICU Lighting:
Lighting Overview

16. NICU LIGHTING:
LIGHTING OVERVIEW
16
Electromagnetic Spectrum
Lighting
• Surfaces are properly perceived only when they reflect specific
amounts of light of certain wavelengths
• Correct color information will reach the observer only if the
illuminance is balanced (i.e. sufficient blue, green, and red
components)
• It is important to use sources with adequate blue-to-yellow
spectral power in spaces where patients are being observed

17. 17
Visual Spectrum
NICU Lighting:
Lighting Overview

18. NICU LIGHTING:
LIGHTING OVERVIEW
18
Visual Spectrum
How could this affect newborns?
• Cyanosis – The appearance of blue or purple coloration of
the skin or mucous membranes due to the tissues near the
skin surface having low oxygen saturation
• Jaundice – A yellowish pigmentaion of the skin and whites
of the eyes caused by excess bilirubin in the blood. Occurs
when bilirubin(breakdown of red blood cells) builds up
faster than a newborn’s liver can break it down and pass
through the body.

19. NICU LIGHTING:
LIGHTING OVERVIEW
19
CRI
(Color Rendering Index)
•A light sources ability to accurately
render all colors of their spectrum, in a
scale from 0-100. Daylight = CRI 100

20. NICU LIGHTING:
LIGHTING OVERVIEW
20
Color Temperature
•A method of describing the color characteristics of
light, usually either warm or cool and measuring in
degrees of Kelvin (°K)

21. NICU LIGHTING:
LIGHTING OVERVIEW
21
Lamp types
•Incandescent – Warm inviting quality. High CRI so
complimenting to skin tones and is psychologically
appealing.
•Halogen – A variation of incandescent. More energy
efficient, cooler light. Renders colors well
•Fluorescent – Multiple color temperatures, good for
lighting large spaces. Longer lasting than incandescent.
Color rendering not as good as incandescent.
•LED – Light Emitting Diode. Longest lamp life of any source.
Energy efficient. Can come in multiple color temperatures
and CRI levels.

22. NICU LIGHTING:
LIGHTING OVERVIEW
22
Amber/Red Wavelengths
•Gives enough light to see and is comparable to
incandescent lighting.

23. NICU LIGHTING:
LIGHTING OVERVIEW
23
Blue Light
•Keeps us awake and alert by suppressing the
production of melatonin, the hormone needed for
sleep

24. NICU LIGHTING:
LIGHTING OVERVIEW
24
Phototherapy
•The process of using light to eliminate bilirubin in the
blood (in the case of Jaundice treatment). A baby’s skin
and blood absorb the light waves. Then changes
bilirubin into products instead of pigment, that can be
eliminated.
•Phototherapy light emits in the 430-490 nm spectrum

25. NICU LIGHTING:
LIGHTING OVERVIEW
25
Ultraviolet
•Short-wave ultraviolet radiation can be
used to kill bacteria and control the spread
of infection in a healthcare environment.

26. NICU LIGHTING:
LIGHTING OVERVIEW
26
Finishes
•Room finishes will absorb or impact light levels
•An intended amount of light level in a room with darker
finishes will not produce the same as a room with lighter/cooler
finishes
•Interior Designers and Lighting Designers need to work
together to achieve the correct balance
•Reduce glossiness when specifying finishes, pay close attention
to room reflectance's and glare control

27. NICU LIGHTING:
DESIGN
27
NICU: Neonatal Intensive Care Unit
Areas of a hospital specializing in the care of ill or
premature newborn infants
Lighting Zones
“Three layers of lights”
• Patient
• Family
• Nurse/Caregiver

28. NICU LIGHTING:
DESIGN
28
Infant Patient Lighting
•Separate procedure lighting of 200FC needed for exam
•Indirect ambient lighting in patient area, dimmable (3500K)
•1-60 FC as needed measured at bedside for general lighting
•FLR or LED sources with CRI of 80+
•Controls that allow immediate darkening at any bed position
for transillumination
•Amber nightlight

29. NICU LIGHTING:
DESIGN
29
Family
•Warm, comforting light that resembles home (3000K)
•Task lighting for reading during the day or night
•Dimmable lighting for night time and sleep
•Amber room nightlight for night time observation and trips
to the restroom
•Shade and window controls can tie into lighting

30. NICU LIGHTING:
DESIGN
30
Nurse
•Controls at room entry and bedside. Should allow for
immediate on/off as needed
•Separate procedure lighting of 200FC needed for exam
•Task Lighting at 35FC<
•Nurse Stations should have dimmable light to maintain
circadian rhythms and help with adaptation

31. NICU LIGHTING:
DESIGN
31
Clean and Accessible Surfaces
•Lighting Fixtures shall not promote dust collection
•Materials should permit cleaning without the use of chemicals
that may be hazardous, as it may not be possible to vacate the
space during cleaning
•Fixtures should be sealed with no areas for dust collection and
be able to be easily wiped down
•Ceiling/Lighting access from
below the plenum
•Hospital Acquired Infection is the greatest
cause of death and sickness in the NICU

32. NICU LIGHTING:
DESIGN
32
Lighting Power Density and Codes
ASHRAE 90.1 2010
•Building Area Method
•Hospitals – 1.21 W/SqFt
•Space by Space Method
•Exam/Treatment – 1.66 W/SqFt
•Nursery – .88 W/SqFt
•Patient Room - .62 W/SqFt
•Exceptions
•Patient care areas do not require an automatic control
device or Procedure lighting to be accounted for in LPD

33. Questions:
Please contact Visa Lighting with questions.
Visa Lighting
(201) 245-5500
Lauren Roberts, LC, IES
Healthcare Development
Manager
lroberts@visalighting.com
Visa Lighting
(801) 448-2126
Kathleen Packard, LC, EDAC
Healthcare Development
Manager
kpackard@visalighting.com