Correlation of Premature Infant Sleep/Wakefulness and Noise Levels in the Presence or Absence of “Quiet Time”

Abstract

Background: Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day. Purpose: To determine the impact of quiet time on reducing sound levels and increasing total sleep time. Methods: This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours. Results: The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours. Implications for Practice: Quiet time is a nursing intervention that should be implemented in all neonatal units. Implications for Research: Future research should use a greater sample size and other factors that influence sleep should be further investigated.

Influence of Quiet Time on the Auditory Environment of Infants in the NICU

“…Quiet Time in the NICU Quiet time has been implemented in NICUs across the country as part of efforts to provide more developmentally appropriate care for hospitalized infants (AAP Committee on Fetus and Newborn & ACOG Committee on Obstetric Practice, 2007). Our findings are consistent with previous studies, suggesting that quiet time is associated with reduced noise (Casavant et al, 2017;Chawla et al, 2017;Laubach et al, 2014;Pugliesi et al, 2018;Wang et al, 2014). Although most of the previous researchers evaluating quiet time identified a reduction in noise levels (L eq ), we identified a decrease in the amount of time in which infants in the NICU were exposed to electronic noises.…”

“…Current practice models designed to improve the environment tend to focus on minimizing noise stimulation through the renovation of NICU spaces to include private rooms; education for staff about the toxic effects of noise; and implementation of quiet time in which staff are encouraged to keep conversations quiet, respond to alarms quickly, and minimize procedures and patient handling (Rand & Lahav, 2014;Szymczak & Shellhaas, 2014). Implementation of a quiet time protocol in the NICU has led to significant reductions in noise levels (L eq ) during quiet time compared with nonquiet time (Chawla et al, 2017;Laubach et al, 2014;Pugliesi et al, 2018;Wang et al, 2014). In one study, researchers observed a 26% reduction in L eq during quiet time, which correlated with improved sleep in preterm infants (Pugliesi et al, 2018).…”

“…Implementation of a quiet time protocol in the NICU has led to significant reductions in noise levels (L eq ) during quiet time compared with nonquiet time (Chawla et al, 2017;Laubach et al, 2014;Pugliesi et al, 2018;Wang et al, 2014). In one study, researchers observed a 26% reduction in L eq during quiet time, which correlated with improved sleep in preterm infants (Pugliesi et al, 2018). However, relatively few researchers have examined the effectiveness of quiet time on the auditory environment in the NICU, and the effect of quiet time on language exposure is unknown.…”

Change to Hearing Loss–Related Risks and Screening in Preterm Infants

“…The uterus is an ideal environment for the fetus, where the anatomical, physiological, and neurophysiological structures of the fetus develop and mature. 23 Because their central nervous system is immature, premature infants are vulnerable to environmental stimuli and cannot coordinate autonomous responses to environmental and tactile stimuli. 24 Uterine walls can reduce the decibels (dB) of sound, and the fetus is exposed to approximately 28 dB in the uterus; however, in the NICU, the sounds are much louder, as high as 70 to 80 dB.…”

“…24 Uterine walls can reduce the decibels (dB) of sound, and the fetus is exposed to approximately 28 dB in the uterus; however, in the NICU, the sounds are much louder, as high as 70 to 80 dB. 23 The main sources of noise are human voices and device alarms and sounds, including incubators. Even simple things, such as the sound of running water, closing incubator doors, placing bottles, and the nasal continuous positive airway pressure (NCPAP) airflow will increase the decibel value of the NICU.…”