Noise in the NICU: Is it too loud?
Western Governors University
WGU Student ID#000282046
Noise in the NICU: Is it too loud?
The NICU is often cluttered with loud, unpredictable noises from a variety of sources; such as cardiorespiratory alarms, ventilators, phones, opening and closing of portholes on incubators, and staff conversation. Simple caregiver tasks such as running water, opening packages inside an incubator, disposing of trash in a metal container, and placing formula bottles on a bedside table, all can produce sounds well over recommended levels, some as loud as 75.3 decibels (Johnson, 2003). However, an optimal physical, psychological, and social environment is a necessity for the preterm infant to have the best outcome, and safe sound levels are essential for healthy development. While the mature infant is very equipped to handle the stressors encountered in the extra uterine environment, the fragile preterm infant is very sensitive to stimulation from the outside world and lacks the autonomic and functional maturity to filter and process stimuli (Zahr, 1995). Studies have shown that adults exposed to excessive noise has resulted in noise-induced hearing loss, and a clear correlation has been found between noise incidence and intensity, and noise-induced stimulation of the autonomic nervous system, Results have shown marked increases in blood pressure and cardiovascular disease (Pediatrics, 2007). In a single day an infant in the NICU can be constantly exposed to ambient noise alone that often exceeds recommended levels (Wachman & Lahav, 2010; Zahr, 1995). The American Academy of Pediatrics has recommended noise levels not exceed an hourly level of 45 decibels, but often noise inside an incubator can be found to be greater than 100 decibels (Pediatrics, 2007; Wachman, 2010). There is a growing concern that this intense sound can put the infant at an increased risk for adverse health effects, and the consequences of long- term noise stimulation in the NICU exceeds the capacity of the infant’s central nervous system to cope with it. Many studies have documented the NICU to be a place of continuous noise exposure to infants without periods of quiet. Premature infants in the NICU are rarely left undisturbed for more than an hour, and the information presented in this paper will discuss several important issues the preterm infant faces. First, the infant can suffer from short and long term physiologic effects when exposed to increased noise levels. Physiologic changes can include apnea and fluctuations in heart rate, respiratory rate, blood pressure, and oxygen saturation. Second, the preterm infants’ auditory development is still unstable and can be affected long term; including cochlear and auditory pathway damage, and sensorineural hearing loss. Third, normal sleep and wake patterns are often interrupted and can ultimately contribute to reduced neurodevelopment, inhibited long-term memory development, and parent’s ability to bond correctly with their baby. Therefore this research indicates that controlling noise in the NICU is essential to the physiologic, auditory, and neurodevelopment of the growing preterm infant. Preterm infants have decreased autonomic and self-regulatory abilities and are exceptionally vulnerable to loud noises and noxious stimuli (Wachman, 2010). This is often characterized by an increase in heart rate, blood pressure, and respiratory rate, and a decrease in oxygen saturation. A study was done to document specific changes in heart rate, respiratory rate, and oxygen saturation. Baselines were obtained for each baby, and an observer sat next to the incubator or open warmer and documented environmental noises, nursing interventions, and the infants’ physiological responses to the stimuli every 5 minutes. In most cases, both noise and nursing interventions resulted in clinically important changes in the physiological measures (Zahr L.K, 1995)....
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