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Chumley PL, Dudding KM, Patrician P. Defining the Concept of Acoustic Neuroprotection in the Neonate: A Concept Analysis. Adv Neonatal Care 2024:00149525-990000000-00128. [PMID: 38907701 DOI: 10.1097/anc.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND It has long been understood and acknowledged that the Neonatal Intensive Care Unit (NICU) environment and the transport environments are extremely loud, with both long- and short-term sequelae to the neonate, being well over the recommended amount of noise by the American Academy of Pediatrics (AAP). This problem has yet to be properly addressed. The purpose of this manuscript is to define and explain the concept of acoustic neuroprotection. While we cannot change the internal structures of the neonates' auditory system, we could change the acoustics of the environment to be support neuroprotection of these sensitive patients. EVIDENCE ACQUISITION Walker and Avant's concept analysis steps were followed to create and define the idea of acoustic neuroprotection, as it has not had a definition before. A total of 45 articles from multiple search engines were chosen. A combination of 2 concepts were used: acoustic protection and neurodevelopmental protection/support. The search was expanded past 20 years for lack of research and importance of seminal works. RESULTS To achieve acoustic neuroprotection, a neonate should not be exposed to sound greater than 45 decibels (dBa) for longer than 10 s, and exposure to sound above 80 dBa should never occur. Appropriate interventions need to include supporting the neurodevelopment of the neonate through therapeutic sound, while decreasing the amount of toxic noise exposure to safe levels. IMPLICATIONS FOR PRACTICE AND RESEARCH By further understanding and having a quantifiable goal of acoustic neuroprotection for neonates, neonatal clinicians can work together to create new interventions for how to better protect and support the care of our tiniest patients.
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Affiliation(s)
- Peyton Lewis Chumley
- Author Affiliations: UAB School of Nursing University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama
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Lin CW, Liu HM, Liu CY, Chu YH, Wang ST, Chen CW. Effects of parents' voice on reducing heel puncture pain in high-risk newborns: A randomized controlled trial. Nurs Crit Care 2024; 29:521-531. [PMID: 37632338 DOI: 10.1111/nicc.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND High-risk newborns, such as premature or severely ill infants, often experience painful treatments and separation from their parents. While previous studies have focused on the positive impacts of a mother's voice on newborns' physiology and pain response, research on the father's voice and vocal acoustics in high-risk newborns is limited. AIM To examine whether parents' voices reduce heel puncture pain in high-risk newborns and the relationship between parents' vocal acoustics, physiological parameters and pain response. STUDY DESIGN A randomized controlled clinical trial was conducted with 105 high-risk newborn-parent dyads. Participants were randomly assigned to three groups: recorded mother's voice, recorded father's voice or control group without any recorded voice. Outcome measures included heart rate, respiratory rate, oxygen saturation and pain response assessed using the Neonatal Infant Pain Scale. Data analysis utilized generalized estimation equations, and parents' vocal acoustics were analysed using Praat voice credit software. RESULTS The mother's voice group exhibited significantly lower heart rates at 1, 5 and 10 min after the procedure, along with lower respiratory rates and pain levels at 5 and 10 min after the procedure compared with the control group. Similarly, the father's voice group demonstrated significantly lower heart rates at 1 and 5 min after the procedure, decreased respiratory rates at 5 and 10 min after the procedure and reduced pain levels at 1 and 5 to 10 min after the procedure compared with the control group. Higher minimum and mean pitches in parents' voices correlated with slower heart rates, while slower parental speech was associated with reduced newborn pain. CONCLUSION Both maternal and paternal vocal interventions alleviated pain during heel puncture procedures among high-risk newborns. RELEVANCE TO CLINICAL PRACTICE The noninvasive intervention serves as a reference for parental participation in care. Nurses can help parents to intervene with the acoustic characteristics that alleviate pain among high-risk newborns.
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Affiliation(s)
- Chi-Wei Lin
- College of Nursing, Asia University, Taichung, Taiwan
| | - Huei-Mei Liu
- Department of Special Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yen-Hung Chu
- Department of Nursing, Lin Shin Hospital, Taichung, Taiwan
| | - Shou-Tzu Wang
- Department of Nursing, Lin Shin Hospital, Taichung, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Monson BB, Ambrose SE, Gaede C, Rollo D. Language Exposure for Preterm Infants is Reduced Relative to Fetuses. J Pediatr 2023; 262:113344. [PMID: 36736889 PMCID: PMC10390654 DOI: 10.1016/j.jpeds.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/21/2022] [Accepted: 12/29/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess changes and deficits in language and auditory exposures consequent to preterm birth and neonatal intensive care unit stay compared with exposures in utero among typically developing fetuses. STUDY DESIGN We analyzed over 23 000 hours of auditory exposure data in a cohort study of 27 typically-developing fetuses and 24 preterm infants. Extrauterine exposures for fetuses were captured by having pregnant women wear 24-hour audio recording devices. For preterm infants, recording devices were placed in the infant's crib. Multilevel linear regressions were conducted to test for group differences and effects of infant sex, maternal education, and mother' occupation. A linear mixed-effects model was used to test for an effect of speaker gender. RESULTS Fetuses were exposed to an estimated 2.6 ± 1.8 hours/day of nearby, predominantly female language, nearly 5 times greater than 32 ± 12 minutes/day estimated for preterm infants (P < .001). Preterm infants had greater daily exposure to electronic sounds (5.1 ± 2.5 vs 1.3 ± 0.6 hours; P < .001) and noise (4.4 ± 2.1 vs 2.9 ± 2.8 hours; P < .05), with 4.7 ± 3.9 hours/day of silence. Language and extrauterine sound exposure for fetuses showed a marked day/night cyclical pattern, with low exposure during nighttime hours, but preterm infants' exposures showed significantly less change across the 24-hour cycle (P < .001). Maternal occupation requiring frequent communication predicted greater language exposure (P < .05). CONCLUSIONS Our findings provide the first comparison of preterm infant auditory exposures to typically-developing fetuses. Some preterm infants may incur deficits of over 150 hours of language exposure over the preterm period. Given known effects of prenatal/preterm language exposure on neurobehavioral outcomes, this magnitude of deficit is alarming.
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Affiliation(s)
- Brian B. Monson
- Department of Speech and Hearing Science, University of Illinois Urbana-Champaign
- Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine
- Neuroscience Program, University of Illinois Urbana-Champaign
- Carle Foundation Hospital, Urbana, Illinois
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Gay JD, Dangcil E, Nacipucha J, Botrous JE, Suresh N, Tucker A, Carayannopoulos NL, Khan MR, Meng R, Yao JD, Wackym PA, Mowery TM. An Animal Model of Neonatal Intensive Care Unit Exposure to Light and Sound in the Preterm Infant. Integr Comp Biol 2023; 63:585-596. [PMID: 37164937 PMCID: PMC10503467 DOI: 10.1093/icb/icad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
According to the World Health Organization, ∼15 million children are born prematurely each year. Many of these infants end up spending days to weeks in a neonatal intensive care unit (NICU). Infants who are born prematurely are often exposed to noise and light levels that affect their auditory and visual development. Children often have long-term impairments in cognition, visuospatial processing, hearing, and language. We have developed a rodent model of NICU exposure to light and sound using the Mongolian gerbil (Meriones unguiculatus), which has a low-frequency human-like audiogram and is altricial. To simulate preterm infancy, the eyes and ears were opened prematurely, and animals were exposed to the NICU-like sensory environment throughout the gerbil's cortical critical period of auditory development. After the animals matured into adults, auditory perceptual testing was carried out followed by auditory brainstem response recordings and then histology to assess the white matter morphology of various brain regions. Compared to normal hearing control animals, NICU sensory-exposed animals had significant impairments in learning at later stages of training, increased auditory thresholds reflecting hearing loss, and smaller cerebellar white matter volumes. These have all been reported in longitudinal studies of preterm infants. These preliminary results suggest that this animal model could provide researchers with an ethical way to explore the effects of the sensory environment in the NICU on the preterm infant's brain development.
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Affiliation(s)
- Jennifer D Gay
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - Evelynne Dangcil
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Jacqueline Nacipucha
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Jonathon E Botrous
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Nikhil Suresh
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Aaron Tucker
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Nicolas L Carayannopoulos
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Muhammad R Khan
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Raphael Meng
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
| | - Justin D Yao
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - P Ashley Wackym
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
| | - Todd M Mowery
- Department of Otolaryngology—Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08854, USA
- Rutgers Brain Health Institute, New Brunswick, NJ, USA
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Oxytocin Levels Increase and Anxiety Decreases in Mothers Who Sing and Talk to Their Premature Infants during a Painful Procedure. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020334. [PMID: 36832462 PMCID: PMC9955880 DOI: 10.3390/children10020334] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
(1) Background: Preterm infants spend their first weeks of life in the hospital partially separated from their parents and subjected to frequent potentially painful clinical procedures. Previous research has found that early vocal contact reduces infant pain perception while simultaneously increasing oxytocin (OXT) levels. The current study aims to assess the effect of maternal singing and speaking on mothers. (2) Methods: During a painful procedure over two days, twenty preterm infants were randomly exposed to their mother's live voice (speaking or singing). Maternal OXT levels were measured twice: before and after singing, as well as before and after speaking. The anxiety and resilience responses of mothers were studied before and after the two-day interventions, regardless of the speaking/singing condition. OXT levels in mothers increased in response to both singing and speech. Concurrently, anxiety levels decreased, but no significant effects on maternal resilience were found. (3) Conclusions: OXT could be identified as a key mechanism for anxiety regulation in parents, even in sensitive care situations, such as when their infant is in pain. Active involvement of parents in the care of their preterm infants can have a positive effect on their anxiety as well as potential benefits to their sensitivity and care abilities through OXT.
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Sanchez VA, Arnold ML, Moore DR, Clavier O, Abrams HB. Speech-in-noise testing: Innovative applications for pediatric patients, underrepresented populations, fitness for duty, clinical trials, and remote services. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:2336. [PMID: 36319253 PMCID: PMC9722269 DOI: 10.1121/10.0014418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Speech perception testing, defined as providing standardized speech stimuli and requiring a listener to provide a behavioral and scored response, has been an integral part of the audiologic test battery since the beginning of the audiology profession. Over the past several decades, limitations in the diagnostic and prognostic validity of standard speech perception testing as routinely administered in the clinic have been noted, and the promotion of speech-in-noise testing has been highlighted. This review will summarize emerging and innovative approaches to speech-in-noise testing with a focus on five applications: (1) pediatric considerations promoting the measurement of sensory and cognitive components separately; (2) appropriately serving underrepresented populations with special attention to racial, ethnic, and linguistic minorities, as well as considering biological sex and/or gender differences as variables of interest; (3) binaural fitness for duty assessments of functional hearing for occupational settings that demand the ability to detect, recognize, and localize sounds; (4) utilization of speech-in-noise tests in pharmacotherapeutic clinical trials with considerations to the drug mechanistic action, the patient populations, and the study design; and (5) online and mobile applications of hearing assessment that increase accessibility and the direct-to-consumer market.
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Affiliation(s)
- Victoria A Sanchez
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 73, Tampa, Florida 33612, USA
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida 33612, USA
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital, Cincinnati, Ohio 45229, USA
| | | | - Harvey B Abrams
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida 33612, USA
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Restin T, Gaspar M, Bassler D, Kurtcuoglu V, Scholkmann F, Haslbeck FB. Newborn Incubators Do Not Protect from High Noise Levels in the Neonatal Intensive Care Unit and Are Relevant Noise Sources by Themselves. CHILDREN (BASEL, SWITZERLAND) 2021; 8:704. [PMID: 34438595 PMCID: PMC8394397 DOI: 10.3390/children8080704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND While meaningful sound exposure has been shown to be important for newborn development, an excess of noise can delay the proper development of the auditory cortex. AIM The aim of this study was to assess the acoustic environment of a preterm baby in an incubator on a newborn intensive care unit (NICU). METHODS An empty but running incubator (Giraffe Omnibed, GE Healthcare) was used to evaluate the incubator frequency response with 60 measurements. In addition, a full day and night period outside and inside the incubator at the NICU of the University Hospital Zurich was acoustically analyzed. RESULTS The fan construction inside the incubator generates noise in the frequency range of 1.3-1.5 kHz with a weighted sound pressure level (SPL) of 40.5 dB(A). The construction of the incubator narrows the transmitted frequency spectrum of sound entering the incubator to lower frequencies, but it does not attenuate transient noises such as alarms or opening and closing of cabinet doors substantially. Alarms, as generated by the monitors, the incubator, and additional devices, still pass to the newborn. CONCLUSIONS The incubator does protect only insufficiently from noise coming from the NICUThe transmitted frequency spectrum is changed, limiting the impact of NICU noise on the neonate, but also limiting the neonate's perception of voices. The incubator, in particular its fan, as well as alarms from patient monitors are major sources of noise. Further optimizations with regard to the sound exposure in the NICU, as well as studies on the role of the incubator as a source and modulator, are needed to meet the preterm infants' multi-sensory needs.
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Affiliation(s)
- Tanja Restin
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland; (M.G.); (V.K.)
| | - Mikael Gaspar
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland; (M.G.); (V.K.)
| | - Dirk Bassler
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
| | - Vartan Kurtcuoglu
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland; (M.G.); (V.K.)
| | - Felix Scholkmann
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
| | - Friederike Barbara Haslbeck
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
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