Noise in the neonatal intensive care unit: A new approach to examining acoustic events

Introduction: Environmental noise is associated with negative developmental outcomes for infants treated in the neonatal intensive care unit (NICU). The existing noise level recommendations are outdated, with current studies showing that these standards are universally unattainable in the modern NICU environment. Study Aim: This study sought to identify the types, rate, and levels of acoustic events that occur in the NICU and their potential effects on infant physiologic state. Materials and Methods: Dosimeters were used to record the acoustic environment in open and private room settings of a large hospital NICU. Heart and respiratory rate data of three infants located near the dosimeters were obtained. Infant physiologic data measured at time points when there was a marked increase in sound levels were compared to data measured at time points when the acoustic levels were steady. Results: All recorded sound levels exceeded the recommended noise level of 45 decibels, A-weighted (dBA). The 4-h L_eq of the open-pod environment was 58.1 dBA, while the private room was 54.7 dBA. The average level of acoustic events was 11-14 dB higher than the background noise. The occurrence of transient events was 600% greater in the open room when compared to the private room. While correlations between acoustic events and infant physiologic state could not be established due to the extreme variability of infant state, a few trends were visible. Increasing the number of data points to overcome the extreme physiologic variability of medically fragile neonates would not be feasible or cost-effective in this environment. Conclusion: NICU noise level recommendations need to be modified with an emphasis placed on reducing acoustic events that disrupt infant state. The goal of all future standards should be to optimize infant neurodevelopmental outcomes.