NICU Noise and the Preterm Infant

Premature infants in the NICU are often exposed to continuous loud noise despite research documenting the presence and damaging effects of noise on the preterm infant’s development. Excessive auditory stimulation creates negative physiologic responses such as apnea and fluctuations in heart rate, blood pressure, and oxygen saturation. Preterm infants exposed to prolonged excessive noise are also at increased risk for hearing loss, abnormal brain and sensory development, and speech and language problems. Reducing noise levels in the NICU can improve the physiologic stability of sick neonates and therefore enlarge the potential for infant brain development. Recommendations include covering incubators with blankets, removing noisy equipment from the incubator environment, implementing a quiet hour, educating staff to raise awareness, and encouraging staff to limit conversation near infants.

[1]  G. Harold,et al.  The evidence for a neurobiological model of childhood antisocial behavior. , 2007, Psychological bulletin.

[2]  K. Stjernqvist,et al.  Ten‐year follow‐up of children born before 29 gestational weeks: health, cognitive development, behaviour and school achievement , 1999, Acta paediatrica.

[3]  M. Aita,et al.  Assessment of neonatal nurses' behaviors that prevent overstimulation in preterm infants. , 2003, Intensive & critical care nursing.

[4]  D. DePaul,et al.  Environmental noise in the neonatal intensive care unit: Implications for nursing practice , 1995 .

[5]  L. Gray.  Properties of Sound , 2000, Journal of Perinatology.

[6]  D. Holditch-Davis,et al.  Environmental stimulation of the acutely ill premature infant: physiological effects and nursing implications. , 1990, Neonatal network : NN.

[7]  P. Hope,et al.  Educational and behavioural problems in babies of 32–35 weeks gestation , 2001, Archives of disease in childhood. Fetal and neonatal edition.

[8]  A. Robertson,et al.  Sound Transmission Into Incubators in the Neonatal Intensive Care Unit , 1999, Journal of Perinatology.

[9]  G. I. Martin,et al.  Recommended Standards for Newborn ICU Design , 1999, Journal of Perinatology.

[10]  T. Field.  Cardiac and behavioral responses to repeated tactile and auditory stimulation by preterm and term neonates , 1979 .

[11]  B. Morris,et al.  Physiological Effects of Sound on the Newborn , 2000, Journal of Perinatology.

[12]  Leslie Parker,et al.  Elevated Sound Levels within a Busy NICU , 2005, Neonatal Network.

[13]  N. Marlow,et al.  Neurologic and developmental disability at six years of age after extremely preterm birth. , 2005, The New England journal of medicine.

[14]  Neonatal Intermittent Hypoxia Impairs Dopamine Signaling and Executive Functioning , 2002, Sleep & breathing = Schlaf & Atmung.

[15]  G. Levy,et al.  Mean Noise Amounts in Level II vs Level III Neonatal Intensive Care Units , 2003, Neonatal Network.

[16]  White Rd.  Recommended standards for newborn ICU design. Committee to establish recommended standards for newborn ICU design. , 1999 .

[17]  T. Bhattacharyya,et al.  Potentiation of cochlear hair cell loss by acoustic stimulus and gentamicin in the guinea pig , 1991, The Anatomical record.

[18]  R. Abrams,et al.  Fetal Exposures to Sound and Vibroacoustic Stimulation , 2000, Journal of Perinatology.

[19]  H. Wharrad,et al.  Behavioural and autonomic responses to sound in pre-term and full-term babies. , 1997, British journal of audiology.

[20]  A. Steinschneider,et al.  Auditory sensitivity in the infant: effect of intensity on cardiac and motor responsivity. , 1966, Child development.

[21]  C. Strauch,et al.  Implementation of a quiet hour: effect on noise levels and infant sleep states. , 1993, Neonatal network : NN.

[22]  Lincoln Gray,et al.  Changing Levels of Quiet in an Intensive Care Nursery , 2002, Journal of Perinatology.

[23]  Edward F Chang,et al.  Environmental Noise Retards Auditory Cortical Development , 2003, Science.

[24]  S. Balian,et al.  Responses of Premature Infants to Routine Nursing Interventions And Noise in the NICU , 1995, Nursing research.

[25]  Christopher S. Monk,et al.  Mechanisms of Postnatal Neurobiological Development: Implications for Human Development , 2001, Developmental neuropsychology.

[26]  J. Perlman,et al.  Neurobehavioral deficits in premature graduates of intensive care--potential medical and neonatal environmental risk factors. , 2001, Pediatrics.

[27]  J. Byers,et al.  Noise and the premature infant: physiological effects and practice implications. , 2003, Journal of obstetric, gynecologic, and neonatal nursing : JOGNN.

[28]  R. Cantrell.  Prolonged exposure to intermittent noise: audiometric, biochemical, motor, psychological and sleep effects. , 1974, The Laryngoscope.

[29]  F. Bess,et al.  Further observations on noise levels in infant incubators. , 1979, Pediatrics.

[30]  M. M. Jensen,et al.  Stress and susceptibility to viral infection. I. Response of adrenals, liver, thymus, spleen and peripheral leukocyte counts to sound stress. , 1963, Journal of immunology.

[31]  D. Streiner,et al.  School difficulties at adolescence in a regional cohort of children who were extremely low birth weight. , 2000, Pediatrics.

[32]  Cantrell Rw,et al.  Prolonged exposure to intermittent noise: audiometric, biochemical, motor, psychological and sleep effects. , 1974 .

[33]  Robert Lickliter,et al.  Atypical Perinatal Sensory Stimulation and Early Perceptual Development: Insights From Developmental Psychobiology , 2000, Journal of Perinatology.

[34]  G. Gabrielsen,et al.  Autonomic response to auditory stimulation , 1993, Acta paediatrica.

[35]  J. Pinelli,et al.  Developmental care for promoting development and preventing morbidity in preterm infants. , 2006, The Cochrane database of systematic reviews.

[36]  A. K. Bartoshuk.  Human Neonatal Cardiac Acceleration to Sound: Habituation and Dishabituation , 1962, Perceptual and motor skills.

[37]  J. Preisser,et al.  Trends in Mortality and Cerebral Palsy in a Geographically Based Cohort of Very Low Birth Weight Neonates Born Between 1982 to 1994 , 1998, Pediatrics.

[38]  K. Wilbraham,et al.  Noise levels within the ear and post-nasal space in neonates in intensive care , 2003, Archives of disease in childhood. Fetal and neonatal edition.

[39]  E. Hock,et al.  Heart rate variability and cardiac response to an auditory stimulus. , 1974, Biology of the neonate.

[40]  A. N. Saunders.  Incubator noise: a method to decrease decibels. , 1995, Pediatric nursing.

[41]  Lawrence M. Schell,et al.  Noise: a hazard for the fetus and newborn. American Academy of Pediatrics. Committee on Environmental Health. , 1997, Pediatrics.

[42]  A. Steinschneider.  Sound Intensity and Respiratory Responses in the Neonate: Comparison with Cardiac Rate Responsiveness , 1968, Psychosomatic medicine.

[43]  E. Reynolds,et al.  OUTCOME FOR INFANTS OF VERY LOW BIRTHWEIGHT: SURVEY OF WORLD LITERATURE , 1981, The Lancet.

[44]  P. Klaas,et al.  Evaluating Studies of the Behavioral Effects of Sound on Newborns , 2000, Journal of Perinatology.

[45]  G. Salmon,et al.  Attention deficit hyperactivity disorder. , 2018, British journal of hospital medicine.

[46]  W. R. Waugh,et al.  Sound Level Exposure of High-Risk Infants in Different Environmental Conditions , 2006, Neonatal Network.

[47]  N. Roizen.  Nongenetic causes of hearing loss. , 2003, Mental retardation and developmental disabilities research reviews.

[48]  S. An.  Incubator noise: a method to decrease decibels. , 1995 .

[49]  A. Johnson,et al.  Neonatal response to control of noise inside the incubator. , 2001, Pediatric nursing.

[50]  W. Poole,et al.  Trends in neonatal morbidity and mortality for very low birthweight infants. , 2007, American journal of obstetrics and gynecology.

[51]  J. Lucey,et al.  Noise and hypoxemia in the intensive care nursery. , 1980, Pediatrics.

[52]  A. N. Johnson.  Adapting the Neonatal Intensive Care Environment to Decrease Noise , 2003, The Journal of perinatal & neonatal nursing.

[53]  M. M. Jensen,et al.  Stress and susceptibility to viral infections. II. Sound stress and susceptibility to vesicular stomatitis virus. , 1963, Journal of immunology.