No Noise Please-For The baby in NICU
(Voice of the newborn penned down by Dr Rahul Gupta)
VOICE OF THE NEWBORN
I am the voice of the newborn
This is the time and platform to raise my voice and to be heard
Sometimes, I have a feeling that my treating doctor could have been more sensitive when it
comes to “Noise” in the neonatal intensive care unit (NICU). I get physically and mentally
disturbed by the noise in my sanctuary (cradle/incubator). Here I have a chance to raise my
voice through this platform and to tell all my treating paediatricians and paediatric surgeons
as to how I feel about it.
The structural aspects of my auditory system for audition are well developed by 20 weeks of
gestation, and all the vibro-acoustic stimulations are felt by me at 24 weeks, while
functioning vestibular system is developed by 29 weeks. Acoustic signals producing a
pleasing sensation are referred to as “sound” while the unpleasant, undesirable sounds are
referred to as “noise”. The American Academy of Pediatrics (AAP) Committee on
Environmental Health has recommended that average noise levels should be at or below 45
dB and the transient sounds should not exceed 65dB in my neonatal intensive care units
(NICU).
I would like to classify “noise” which I bear during my treatment into (a) Partially
preventable and (b) completely preventable noise in NICU. The former comes from
incubators, ventilators, alarms, suction machines, infusion pumps, and doors. The latter
group constitutes noise from mobile phones, audio-visual aids and loud conversations
between my treating team. The sound levels from all the devices and armamentarium for
my service may range from 50 to 140 Db.
If I am exposed to sound above 45 decibels, I get lot of stress with a sympathetic response
with an increase in my blood pressure, heart rate, respiratory rate and intracranial pressure.
This decreases my oxygen saturation and increases my caloric consumption significantly and
finally decreasing the number of calories available for growth. The gastrointestinal motility
is also affected. If I am repeatedly aroused, I feel fatigue and irritable. The electrical activity
of the central nervous system changes in response to acoustic stimulation in the range
between 36 dB and 90 dB. Sudden noise results in increase in intracranial pressure and
electromyographic and behavioural changes in newborns. Excessive sound may influence
the neuroendocrine system and may have an indirect effect on immunity. There is overall
negative impact on my physiological activity.
Long term consequences of high intensity noise include damaged cochlear cilia and
sensorineural hearing loss and also interference with neurological development. Hearing
impairment is diagnosed in 2% to 10% of preterm babies as opposed to 0.1% of the general
paediatric population. The adverse outcomes include poor growth, abnormal sleep patterns,
bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular haemorrhage,
and developmental delay.
I would request all my doctors to give attention to put your mobile phones in silent mode
before entering into my sanctuary. Care must be taken if dealing with my premature
companions as they are more sensitive to me. Allow neonates to wear earplugs and
earmuffs as early as possible to have them natural sleep cycle. As per a study, the Mental
Developmental Index at 18 to 22 months was higher in the silicone earplug group as
compared to the control group. Avoid talking, laughing and discussions over my cradle-side.
Modify your behaviour, and focus on staff training programs. Be gentle during manipulation
of devices as I am not a miniature adult. Give me a “quiet period”, especially during the
night as it would increase the sleep time during these periods. Remember, the neonatal
NICU is a specialized care unit that treats medically fragile newborns, especially premature
neonates that are highly sensitive to loud noise.
Kindly give attention to the NICU design with sound proofing and without re-echoing space
(architectural remodelling). Install noise assessment devices (dosimeters) to give feedback
and develop a program of noise control. Keep a space for placement of monitors with less
noisy visual alarms away from the cradle or incubator. Elevated levels of speech are needed
to overcome the noisy environment in the NICU, thereby increasing its negative impacts on
me. High noise levels are associated with an increased accident rate in NICU. Also, focused
on a combination of
Finally, aim at reducing the sound levels in the NICU that reach the neonate to 45 dB or less.
Kindly have discussions outside the patient areas, put phones in silent mode. Encourage use
of newer technologies like multisensory display (worn on the skin of the staff) having LED
alarms and tactile outputs. Use of artificial intelligence and graphical user interface to
reduce auditory alarms. Reduce all acoustic events that disrupt my physiological state. This
would in turn optimize neurodevelopmental outcomes of all the neonates in NICU.
TAKE HOME (NICU) MESSAGE
1.“Noise” interferes with neonatal physiological stability and sleep patterns.
2. Minimise “Noise” from alarms and CPAP circuits.
3. Prioritize staff training and encourage behaviour modification in NICU which is the highly effective means to curtail undesirable “Noise”.
4. Plan audit of sound levels in all neonatal units.
Further reading:
- American Academy of Pediatrics, Committee on Environmental Health. Noise: A hazard for the fetus and newborn. Pediatrics. 1997;100:724-7.
- Thakur N, Batra P, Gupta P. Noise as a Health Hazard for Children, Time to Make a Noise about it. Indian Pediatr. 2016;53:111-4.
- Almadhoob A, Ohlsson A. Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst Rev. 2020;27(1):CD010333.
- Freudenthal A, van Stuijvenberg M, van Goudoever JB. A quiet NICU for improved infants’ health, development and well-being: a systems approach to reducing noise and auditory alarms. Cogn Tech Work 2013;15:329-45.
- Almadhoob A, Ohlsson A. Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst Rev. 2020;27(1):CD010333.
- Venkataraman R, Kamaluddeen M, Harish Amin H, Lodha A. Is less noise, light and parental/caregiver stress in the neonatal intensive care unit better for neonates? Indian Pediatrics 2018;18:17-21.
- Freudenthal, A., van Stuijvenberg, M. & van Goudoever, J.B. A quiet NICU for improved infants’ health, development and well-being: a systems approach to reducing noise and auditory alarms. Cogn Tech Work 2023;15:329–345.