A Quality Improvement Pilot Project for Noise Reduction in the NICU

Abstract

The sounds that infants in utero are exposed to are muffled and dampened by amniotic fluid and the uterine wall. 1 This decrease in noise allows the infant brain to grow as needed, without interruption. 2 When a healthy term infant is born, the infant can process external stimuli without negative physiologic effects occurring. This is not the case for all infants. Premature and critically ill infants are at increased risk of negative effects related to noxious external stimuli, due to the activation of autonomic and hypothalamic-pituitary-adrenal stress systems. [1][2][3] Noise reduction in the neonatal intensive care unit (NICU) takes heightened awareness by the staff and is a critical aspect of neonatal care.The pod in which this project occurred was high acuity, which led to increased noise levels in the NICU, increased staff and parent stress levels, and decreased rest time for infants. A large portion of this specific neonate population required surgical intervention and increased rest to conserve energy for healing and growth. 3 Per the American Academy of Pediatrics (AAP), the recommended noise level should be less than 45 decibels (dBA). [3][4] The average baseline noise level was 62.6 dBA in a 24-hour period, which is 39% higher than the recommended noise levels (Figure 1). PROBLEMConstant high levels of noise in the NICU have been shown to cause detrimental neurological effects due to an increased stress response, especially for the very low birth-weight and extremely low birthweight population. 3,4 These potential effects include but are not limited to increased risk of hearing loss, periventricular hemorrhage, leukomalacia, developmental delay, disruption in the autonomic nervous system, and dysregulation of the infant's sleep cycle. [4][5][6]

Reducing Noise in the NICU

“…2,4,5,31 To address this problem, several approaches have been reported to promote a "culture of silence" and increase protected sleep, including quiet time protocols, staff education programs, visual noise feedback monitors, and staff "sound compliance supervisors". 3 , 5 , 10 , [32][33][34][35][36][37] Ongoing staff education programs, coupled with monitoring noise levels, are essential to sustaining a commitment to noise reduction in the NICU. Parents and family members can also be supported to engage in developmentally appropriate care to become competent caregivers and advocates for the neuroprotection of their babies.…”

“…Parents and family members can also be supported to engage in developmentally appropriate care to become competent caregivers and advocates for the neuroprotection of their babies. [36][37][38] Craig et al reported that "parents and family members should be supported to engage in developmentally appropriate care to become competent caregivers and advocates for the neuroprotection of their babies" and that parent involvement is associated with improved neonatal outcomes. 38 , 39 In addition, quiet time protocols may significantly decrease exposure to electronic sounds and voices, increasing restful sleep and promoting growth.…”

“…In addition, NICU architecture and the type of bed may contribute to the neonate’s exposure to noxious sounds 2,4,5,31. To address this problem, several approaches have been reported to promote a “culture of silence” and increase protected sleep, including quiet time protocols, staff education programs, visual noise feedback monitors, and staff “sound compliance supervisors” 3,5,10,32-37. Ongoing staff education programs, coupled with monitoring noise levels, are essential to sustaining a commitment to noise reduction in the NICU.…”

“…Ongoing staff education programs, coupled with monitoring noise levels, are essential to sustaining a commitment to noise reduction in the NICU. Parents and family members can also be supported to engage in developmentally appropriate care to become competent caregivers and advocates for the neuroprotection of their babies 36-38. Craig et al reported that “parents and family members should be supported to engage in developmentally appropriate care to become competent caregivers and advocates for the neuroprotection of their babies” and that parent involvement is associated with improved neonatal outcomes 38,39.…”