Improving Outcomes for Cincinnati's Tiniest Patients
By Marty Brennan, AIA, WELL AP, and Zining Cheng
Cutting edge clinical research is being implemented in the Newborn Intensive Care Unit (NICU) of Cincinnati Children’s Critical Care Building, where a unique spectral lighting system builds upon recent discoveries about how light affects human development.
During those delicate days in the NICU, hospitals have traditionally striven to maintain environments believed to mimic conditions in the mother’s womb: Sterile. Quiet. Dark. Newer research into human light-sensitive opsins, however, is challenging these long-held assumptions about what the developing fetus experiences. Now Cincinnati Children’s is investing in the world’s first full-spectrum NICU lighting system to put those learnings into action.
The special light fixtures—which were custom designed, tested, and built for the new NICU—represent one of the boldest technical advances in the Critical Care Building. Specifically, the project represents a groundbreaking innovation in neuropic light design, a timed exposure of visible light between 380 and 460 nanometers.
It all started with a question from the client, Dr. James Greenberg, co-director of the Perinatal Institute for Cincinnati Children’s: How can we mimic daylight in the NICU? Simply placing newborns next to a window isn’t sufficient because hospital windows have coatings that block crucial wavelengths. This sparked the idea, and an active research collaboration with Cincinnati Children’s faculty colleague and discovery biologist Dr. Richard Lang, to install special lights that could provide the full range of wavelengths found in sunlight.
This opsin lighting framework illustrates how different color wavelengths support different aspects of human life, such as vision, circadian rhythm, growth and development. Cincinnati Children’s is using the spectral lighting system to study how the 405-450 nanometer range, or violet light, affects growth and development in babies.
Does violet light support newborn growth and development? We're working with Cincinnati Children's to find out.
In 2016, ZGF led the development of a circadian lighting system for the Medical Behavioral Unit at Children’s Hospital of Philadelphia. The lighting system complements daylight from windows in patient rooms, providing blue-rich light during the day to stimulate melanopsin, a light sensitive protein in the retina. The light fades to amber and then darkness at night to reinforce circadian rhythms.
During the design of the new Critical Care Building, Cincinnati Children’s was researching circadian medicine and other light-sensitive opsins and asked if we could mimic daylight that included violet wavelengths. It would need to be programmable for any latitude or season. With our combined in-house expertise in NICU design, daylighting, and medical planning, ZGF was able to assemble the team* of doctors, lighting designers, manufacturers, and other stakeholders, to develop the spectral lighting system—bridging the gap between design, medicine, and biology.
A life-size mock-up of the new NICU allowed the project team to test, measure, and evaluate the color quality and intensity of neuropic light, which is rich in violet wavelengths to simulate dusk.
The first-of-its-kind programmable and tunable LED lighting system optimizes the quantity and quality of light newborns receive during key periods of development. The system augments the typical patient room lighting that includes exam, task, and night lighting to support standard patient care and was designed to meet specific color quality requirements.
Drawing from spectral data being collected right on the roof the Critical Care Building, a custom software interface allows Cincinnati Children’s researchers, including discovery biologist Dr. Richard Lang of the acclaimed Lang Lab, to develop light “recipes” that mimic real day-night cycles while operating within the hospital’s required lighting metrics except for short transitions at the beginning and end of each day. The recipes are pre-programmed into the NICU spectral lighting system.
The daytime light recipe includes visible light to activate opsins 3, 4 and 5, photoreceptors in the brain that work together to regulate our circadian rhythms and support healthy development. The dusk recipe includes a bump in 405 nanometer violet light to activate opsin 5, which plays a role in eye growth and development. (Courtesy of the Lang Lab)
One goal of the lighting system is to specifically manage the quality of light newborns receive during twilight hours, which the researchers say is important for maintaining a stable circadian rhythm. A smooth-running internal clock supports better sleep, which in turn supports healthy growth and development.
The spectral lighting system is programmed to run continuously through the day-night cycle. While there is an override function for nursing staff, it’s important for the system to operate continuously so the research results in sufficient and accurate data that can be related to patient outcomes.
A brighter path forward
This type of cross-disciplinary integration is key to ZGF’s delivery process and innovation. We’ve partnered with Cincinnati Children’s and the University of Washington’s Applied Research Consortium (ARC) to continue collecting spectral sky data, developing simulation methods for prediction and recommendations for practitioners.
Dome light sensors, mounted on the roofs of the Critical Care Building in Cincinnati and Gould Hall in Seattle, are actively measuring the spectrum of daylight in both cities—with more locations to come in the future. The goal is to develop design guidelines for daylighting and electric lighting (e.g. tunable light fixtures) for NICUs that can be understood and used by lighting designers and medical planners.
Looking to the future, the spectral lighting system has the potential to not only transform outcomes for Cincinnati Children’s tiniest patients, it could also transform lighting design standards in the healthcare industry and beyond.
Marty Brennan, AIA, WELL AP, is an associate principal and daylighting specialist at ZGF.
Zining Cheng is a University of Washington graduate student and ARC Fellow, collaborating with ZGF to research non-visual light health in NICUs through light measurement, simulation, and design.
*Project acknowledgements:
- Lead Physician Executive, Critical Care Building and Master Planning: Dr. James Greenberg, Cincinnati Children's
- Architects: ZGF Architects in partnership with GBBN
- General Contractor: Messer Construction
- Discovery Biologist: Dr. Richard Lang and the Lang Lab, Cincinnati Children’s
- Lighting Design: Pivotal Lighting Design
- Lighting: Acuity Brands – Winona®
- User Interface: Acuity Brands – DGLogik™
- Controls: Acuity Brands – Fresco™
- Spectral Technology Manufacturer: BIOS
- Spectral Measurement: Ocean Insight
- Electrical Contractor: Ermco and Archibald Electric
- MEP Engineering: KFI Engineers
Cincinnati Children’s, Critical Care Building Expansion
Children’s Hospital of Philadelphia, Medical Behavioral Unit
Providence Health & Services, Swedish Medical Center-Ballard, Behavioral Health Unit
Ann & Robert H. Lurie Children’s Hospital of Chicago
