Elevated Sound Levels in the Neonatal Intensive Care Unit

Abstract

Background: Premature and sick neonates may require weeks of hospitalization in a noisy neonatal intensive care unit (NICU) environment with sound levels that may reach 120 decibels. The American Academy of Pediatrics recommends a maximum sound level of 45 decibels. Purpose: To measure sound levels in a level III NICU and to describe contributing environmental factors. Methods: Descriptive quantitative study. Sound levels were measured using a portable sound meter in an open-bay level III NICU. Contributing environmental factors were recorded and analyzed. Results: Mean sound levels for day, evening, and night shifts were 83.5, 83, and 80.9 decibels, respectively. Each period of time exceeded the recommended guidelines 90% of the time and was almost double the American Academy of Pediatrics' recommendation. Multiple linear regression findings demonstrated significant factors associated with elevated sound levels including number of neonates, number of people, number of alarms, acuity level, and shift type. Observational data explain 14.5% of elevated sound levels. Implications for Practice: An understanding of baseline sound levels and contributing environmental factors is the first step in developing strategies to mitigate excessive noise in the NICU. Implications for Research: Research should focus on effective and sustainable ways to reduce sound levels in the NICU, including inside the isolette, in order to provide an environment that is conducive to optimal growth and neurodevelopment for preterm and sick infants.

Supporting and Enhancing NICU Sensory Experiences (SENSE), 2nd Edition: An Update on Developmentally Appropriate Interventions for Preterm Infants

“…While the American Academy of Pediatrics and the World Health Organization recommendation for sound exposure is an average of 45 decibels, few NICUs meet this requirement [ 38 , 39 ]. The majority of reports suggest that decibel levels in the NICU average between 65 and 70 decibels [ 40 , 41 ], and there is some concern that sound exposures below this may not be perceived by the high-risk infant. However, just because sound exposures are high in the NICU does not justify an intervention to exceed the level it was intended to be at.…”

Noise: the importance of silencing the loud NICU

“…These sources of noise have been linked to spikes in noise levels and have been barriers to successful noise reduction programs. Other factors contributing to the elevated noise levels in the NICU include healthcare providers talking in loud conversational voices at the bedside and not promptly silencing the monitor alarms, the number of people in the patient room, the number of neonates in the room, the number of alarms activated, infant acuity, and the work-shift type [50,51]. Staff and visitors' general attitudes have also been identified as a main source of noise.…”

“…The increased number of acoustic noise events in an open bay setup arises from the combined activities of patient care, visiting, conversations, and alarm activations [40,51,57]. In response to this issue, many modern NICU redesigns have increasingly adopted single or hybrid patient rooms equipped with sound-dampening technology [45].…”

“…Although the literature differs greatly in the forms of interventions and type of study design, the common themes in these studies support the evidence that noise in the NICU needs to be reduced. Future sound-reduction strategies should include adapting evidence to the local context, assessing barriers and facilitators to practice change, and including all HCPs and families in the planned design and implementation of interventions [51]. In addition, it is important to have a unit commitment to promote the growth and development of the neonate.…”

Music Therapy in the Neonatal Intensive Care Unit: A Center’s Experience with Program Development, Implementation, and Preliminary Outcomes

“…For VP infants in the NICU, optimal brain development is contingent upon enriching sensory experiences occurring during their NICU hospitalization, which create the foundation for later cognitive, language, and social-emotional development [2][3][4][5]. From an auditory perspective, the NICU is an environment composed primarily of loud equipment sounds at a volume far exceeding recommended levels [6], silence, and overall reduced human interaction [4]. Concerns have been documented that limited desirable auditory and other parent-facilitated meaningful experiences, along with increased adverse auditory exposures (such as monitor alarms, mechanical ventilators and other equipment sounds, background noise during busy staff shifts, increased periods of silence), during a critical period can negatively impact brain maturation as well as neurodevelopment for hospitalized infants [4].…”