Determining space requirements for small and sick newborns and their mothers in health facilities: a systematic review.

Background: There are currently no World Health Organization and United Nations Children Fund benchmarks or 'norms' for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Specifically, there is limited evidence on optimal bed space requirements in SSN units such as special care nurseries and neonatal intensive care units (NICUs). Through this systematic review, we aimed to gather evidence on the optimal space requirements needed for SSNs and their mothers in health facilities, particularly at level 2 district hospitals. Methods: We included simulation, experimental, and observational studies, as well as guidelines and formal expert opinion processes that described the optimal bed space for SSN units within any health facility. We searched Medline (via Ovid), EMBASE (via Ovid), CENTRAL (via the Cochrane Library), CINAHL (via EBSCO), and LILACS from inception to October 2023. We assessed the quality of included studies using the RoB 2, ROBINS I, ROBINS E, and AGREE-II tools. We narratively described and synthesised all data. Results: We identified 10 574 studies and, after deduplication, screened 8453 titles and abstracts and assessed, followed by the full texts of 125 studies for eligibility. We included 12 reports which discussed three guidelines and one simulation-based study. All four came from high-income countries. Only one guideline specified the required bed space and floor space to be 2.8 m2 and 14 m2 per bed in an open bay unit, respectively. One study defined the mother-NICU bed space requirements for a mother and her infant as 20 m2 (inclusive of the bathroom), while another stated it to be 28 m2 (exclusive of the bathroom). Conclusions: We found no studies describing space requirements for SSN units in LMICs and limited evidence for the optimal space requirements for open bay and mother-NICU beds in high-income countries. Much of the data reported was too heterogeneous to combine. More research, especially simulation studies, is needed to establish optimal space requirements for SSN units, including benchmarks that demonstrate functionality and the impact on infection control. Registration: PROSPERO: CRD42022378329.