Influence of the NICU on the Acoustic Isolation of a Neonatal Incubator

Puyana‐Romero, Virginia; Núñez-Solano, Daniel; Molina, Ricardo Hernández; Jara-Muñoz, Edgar

doi:10.3389/fped.2020.00588

Cited by 9 publications

(8 citation statements)

References 39 publications

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“…We have regularly observed exceedances of recommended maximum noise limits in our settings, which reflect the daily life in a NICU. Our results are also consistent with previous reports showing attenuation of numerous noise sources generated in the NICU inside an incubator, reducing continuous sound exposure 5 15 23 27 . Other sound sources such as phone ringing, music boxes on top of the incubator, remote alarms in other rooms, conversations, using disinfectant dispensers, or opening windows did not produce any relevant variation in sound pressure level at the incubator microphone 2 .…”

Section: Discussionsupporting

confidence: 93%

Noise and Critical Sound Levels During Non-Invasive Ventilation of a Preterm Infant in the Incubator

et al. 2022

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Background Preterm birth and the subsequent necessary treatment in neonatal intensive care units (NICU) subjects the preterm infant to non-physiological noise exposure with potentially adverse consequences for short-and long-term development. Adjusters to improve the acoustic environment for the preterm infant need to be defined.Methods Sound pressure level measurements during routine procedures in a NICU were performed by ¼" microphones placed inside and outside the incubator. The microphones need to be suitably positioned to measure sound pressure levels that are representative for the sound field inside and outside the incubator. The sound pressure level spectra generated by respiratory support and corresponding monitor alarms were compared.Results Inside the incubator, higher sound level pressures (in dBA) were generated primarily by the use of the system components of the incubator itself than outside, whereas when the incubator was closed, it had an insulating effect on sounds generated in the NICU. Non-invasive ventilation resulted in an increase in sound pressure levels from 50 to 60 dBA in the neonate's environment, with sound pressure levels increasing particularly in the frequency range above 1 kHz. ConclusionPreterm infants are exposed to high sound levels, especially in the non-physiological high-frequency range, particularly during non-invasive ventilation. The continuous sound exposure could be further reduced to some extent by an optimized design of the incubator. ZuSAMMEnFASSunGHintergrund Frühgeburt und die anschließend notwendige Behandlung auf der Neugeborenen-Intensivstation (NICU) setzen das Frühgeborene einer unphysiologischen Schallexposition mit potentiell nachteiligen Folgen für die kurz-und langfristige Entwicklung aus. Stellschrauben zur Verbesserung der akustischen Umgebung für das Frühgeborene müssen definiert werden.Methodik Schalldruckpegelmessungen während der Routineabläufe auf einer NICU wurden durch inner-und außerhalb des Inkubators angebrachte ¼" Messmikrophone durchgeführt.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

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Section: Discussionsupporting

confidence: 93%

Noise and Critical Sound Levels During Non-Invasive Ventilation of a Preterm Infant in the Incubator

et al. 2022

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“…Finally, a concern about incubators may be the constant noise of the fan-operated airflow. Even though the American Academy of Pediatrics recommends avoiding sound levels above 45 dB in neonatal care units, some studies demonstrated noise within incubators exceeded these recommendations frequently ( 59 , 60 ), disrupting sleep cycles ( 61 ) and possibly influencing hearing development.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, maintenance and cleaning require technical competence and considerable human resources for dissembling and assembling between patients. Improper maintenance and cleaning increase the risk of malfunction and infection (57,58). Furthermore, the common practice in low-resource settings of placing multiple neonates in a single incubator increases the risk of cross-infections (55).…”

Section: Incubatorsmentioning

confidence: 99%

Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?

2023

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Hypothermia occurs frequently among clinically unstable neonates who are not suitable to place in skin-to-skin care. This study aims to explore the existing evidence on the effectiveness, usability, and affordability of neonatal warming devices when skin-to-skin care is not feasible in low-resource settings. To explore existing data, we searched for (1) systematic reviews as well as randomised and quasi-randomised controlled trials comparing the effectiveness of radiant warmers, conductive warmers, or incubators among neonates, (2) neonatal thermal care guidelines for the use of warming devices in low-resource settings and (3) technical specification and resource requirement of warming devices which are available in the market and certified medical device by the US Food and Drug Administration or with a CE marking. Seven studies met the inclusion criteria, two were systematic reviews comparing radiant warmers vs. incubators and heated water-filled mattresses vs. incubators, and five were randomised controlled trials comparing conductive thermal mattresses with phase-change materials vs. radiant warmers and low-cost cardboard incubator vs. standard incubator. There was no significant difference in effectiveness between devices except radiant warmers caused a statistically significant increase in insensible water loss. Seven guidelines covering the use of neonatal warming devices show no consensus about the choice of warming methods for clinically unstable neonates. The main warming devices currently available and intended for low-resource settings are radiant warmers, incubators, and conductive warmers with advantages and limitations in terms of characteristics and resource requirements. Some devices require consumables which need to be considered when making a purchase decision. As effectiveness is comparable between devices, specific requirements according to patients' characteristics, technical specification, and context suitability must play a primary role in the selection and purchasing decision of warming devices. In the delivery room, a radiant warmer allows fast access during a short period and will benefit numerous neonates. In the neonatal unit, warming mattresses are low-cost, effective, and low-electricity consumption devices. Finally, incubators are required for very premature infants to control insensible water losses, mainly during the first one to two weeks of life, mostly in referral centres.

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“…Therefore, in this experiment, the influence of the resonant frequencies of the room can be considered negligible. However, the resonant frequencies of rooms with acoustic reflective surfaces -like NICUs- may influence the T of the incubator, especially considering that the acoustic insulation of the incubator is very poor ( 43 , 44 ).…”

Section: Discussionmentioning

confidence: 99%

The Importance of Reverberation for the Design of Neonatal Incubators

et al. 2021

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Low frequency noises are predominant in neonatal intensive care units (NICUs). Some studies affirm that neonates can perceive noises from 113 Hz, and can therefore be affected by sound sources with high spectral content at low frequencies (e.g., incubator engine, air fan). Other studies suggest that reverberation amplifies noise within incubators. In this paper, the reverberation time (T, T30) within an incubator with standard dimensions was measured in one-third octave bands. To get reliable results, the T was measured in 15 positions at the neonate's ear height, in a room with low T values (to reduce the influence of the room in the results), using an impulsive sound method. Results show a heterogeneous T distribution at the neonate's ear height, with maximum average T differences between positions of 1.07 s. The highest average T of all microphone positions is 2.27 s at 125 Hz, an extremely high mean value for such a small space. As the frequency of electrical devices in America is 60 Hz, some harmonics lay within the one-third octave band of 125 Hz, and therefore may create a very reverberant and inappropriate acoustic environment within the audible spectrum of neonates. As the acoustic environment of the incubator and the room are coupled, it is expected that the results are higher in the NICUs than in the room where the measurements were conducted, as NICUs are more reverberant. Therefore, it is recommended that the T will be limited in the international standards, and that incubator designers take it into account.

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Influence of the NICU on the Acoustic Isolation of a Neonatal Incubator

Cited by 9 publications

References 39 publications

Noise and Critical Sound Levels During Non-Invasive Ventilation of a Preterm Infant in the Incubator

Noise and Critical Sound Levels During Non-Invasive Ventilation of a Preterm Infant in the Incubator

Neonatal warming devices: What can be recommended for low-resource settings when skin-to-skin care is not feasible?

The Importance of Reverberation for the Design of Neonatal Incubators

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