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NOISE IN THE NEONATAL INTENSIVE CARE UNIT (NICU)

In “Challenging Designs of Neonatal Intensive Care Units“, Anne Marie Dazé Floyd, RN, MSN, CNS says:
A link has been established between exposure to constant room noise and loss in frequency and pattern discrimination essential to understanding the spoken word. Loss of an ability to discriminate speech can cause profound developmental delay by interfering with language acquisition.
In addition to the connection between noise levels and deficits in hearing discrimination, clear connections also exist between noise and physiological instability.

Unlike light, noise is a normal aspect of fetal development. Fetuses normally mature in utero accompanied by a variety of noises generated by the maternal viscera and voice. These uterine noises are rhythmic and familiar and are generally low frequency, at a mean of 50 dB. In the past, noise levels inside isolettes have been measured in excess of 90 dB, the level at which the Occupational Safety and Health Administration requires ear protection in adults to prevent hearing loss. Newer models of isolettes now meet the recommended standard that motor noises not exceed 50 dB. However, infants in isolettes can still be exposed to high levels of noise. Something as simple as abruptly closing a solid plastic porthole can generate in excess of 100 dB inside an isolette.
Although normal NICU room noise, which averages less than 70 dB, has not been proved to cause classic hearing loss, a link has been established between exposure to constant room noise and loss in frequency and pattern discrimination essential to understanding the spoken word. Loss of an ability to discriminate speech can cause profound developmental delay in survivors with no other disabilities by interfering with language acquisition.
In addition to the connection between noise levels and deficits in hearing discrimination, clear connections also exist between noise and physiological instability. Preterm infants can experience repeated apneic episodes and clinically important reductions in oxygen saturation and bradycardia when exposed to normal adult activities in a NICU. Limiting neonates’ exposure to adult activities can decrease the number of alarms that represent physiological decompensation. One result of private and semi-private rooms is that fewer adults are in the room and a natural decrease occurs in the noise generated by activity and conversation. In a study by Robertson et al, decreasing conversation had the greatest effect on decreasing noise levels in the NICU.
Anne Marie Dazé Floyd is the clinical administrator for the Replacement Hospital Project
at Childrens Hospital Los Angeles, Los Angeles, Calif. She has more than 15 years of experience
in nursing administration on both coasts in pediatric, neonatal, and pediatric
intensive care units. She is the coauthor of Code Pink: A System of Neonatal-Perinatal
Resuscitation and Neonatal Nursing.

Healthcare Environments 150

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