Sound Interferes with the Early Tactile Manual Abilities of Preterm Infants

AF among Nurses Working in Neonatal and Paediatric Intensive Care Units: A Cross-Sectional Study

Aim: This research study aims to determine nurses' alarm fatigue (AF) levels in paediatric critical care units in two governmental hospitals and to examine the significant differences in the mean between nurses' attributes, nurses' working environment, and nurses' alarm management with the level of fatigue caused by the alarm. Background: In recent years, AF has become a significant and growing concern among nurses. However, in the Saudi Arabian paediatrics context, the impact of AF on nurses working in intensive care units remains unexplored. Method: A descriptive cross-sectional survey was conducted using a non-probability purposive sampling method. Data were collected from 216 nurses in two governmental hospitals through self-administered questionnaires comprised of four sections: individual attributes, work environment, alarm management, and AF scale. Data analysis: The Statistical Package of Social Science (SPSS) was used to analyse the data, and ANOVA was utilised to describe the sample's demographic characteristics and determine any differences. Results: Most participants were female, held a bachelor's degree, and were aged 31 to 35. Of the participants, 62.5% reported experiencing a medium level of AF, 29.2% reported a low level, and 8.3% reported a high level. Participants expressed that recurrent false alarms disrupt patient care and decrease trust in alarm systems. Significant differences in AF levels were observed based on marital status and the percentage of non-actionable alarms. Conclusions: Nurses working in paediatric critical units with high rates of false alarms, the frequent de-activation of alarms, and decreased trust in alarm systems are more likely to experience AF. Addressing AF is crucial for patient safety; nurse training on alarm management, the collaboration between biomedical and nursing staff, and technological advancements can help mitigate this issue. Implications for Practice: To minimise the adverse effects of AF, policymakers, biomedical experts, and nursing administrators must establish comprehensive policies and protocols concerning alarms. These measures aim to ensure secure and efficient care for the well-being of patients and nurses.

[Towards an ideal environment in neonatology]

The establishment of sensory systems occurs gradually along a transnatal continuum. During premature birth, hospitalization in neonatology, through its atypical sensory stimulations, can disrupt the development of the baby's still immature brain. To promote harmonious development in children, caregivers and parents must learn to take into account their sensory expectations in order to create the most suitable environment possible for their development.

Preventing Excessive Noise Exposure in Infants, Children, and Adolescents

Noise affects people of all ages. Noise-induced hearing loss, a major problem for adults, is also a problem for young people. Sensorineural hearing loss is usually irreversible. Environmental noise, such as traffic noise, can affect learning, physiologic parameters, sleep, and quality of life. Children and adolescents have unique vulnerabilities. Infants and young children must rely on adults to remove them from noisy situations; children may not recognize hazardous noise exposures; teenagers often do not understand consequences of high exposure to music from personal listening devices or attending concerts and dances. Personal listening devices are increasingly used, even by small children. Environmental noise has disproportionate effects on underserved communities. This statement and its accompanying technical report review common sources and effects of noise as well as specific pediatric exposures. Because noise exposure often starts in infancy and effects are cumulative, more attention to noise in everyday activities is needed starting early in life. Pediatricians can potentially lessen harms by raising awareness of children's specific vulnerabilities to noise. Safer listening is possible. Noise exposure is underrecognized as a serious public health issue in the United States. Greater awareness of noise hazards is needed at a societal level.

Preventing Excessive Noise Exposure in Infants, Children, and Adolescents

Noise exposure is a major cause of hearing loss in adults. Yet, noise affects people of all ages, and noise-induced hearing loss is also a problem for young people. Sensorineural hearing loss caused by noise and other toxic exposures is usually irreversible. Environmental noise, such as traffic noise, can affect learning, physiologic parameters, and quality of life. Children and adolescents have unique vulnerabilities to noise. Children may be exposed beginning in NICUs and well-baby nurseries, at home, at school, in their neighborhoods, and in recreational settings. Personal listening devices are increasingly used, even by small children. Infants and young children cannot remove themselves from noisy situations and must rely on adults to do so, children may not recognize hazardous noise exposures, and teenagers generally do not understand the consequences of high exposure to music from personal listening devices or attending concerts and dances. Environmental noise exposure has disproportionate effects on underserved communities. In this report and the accompanying policy statement, common sources of noise and effects on hearing at different life stages are reviewed. Noise-abatement interventions in various settings are discussed. Because noise exposure often starts in infancy and its effects result mainly from cumulative exposure to loud noise over long periods of time, more attention is needed to its presence in everyday activities starting early in life. Listening to music and attending dances, concerts, and celebratory and other events are sources of joy, pleasure, and relaxation for many people. These situations, however, often result in potentially harmful noise exposures. Pediatricians can potentially lessen exposures, including promotion of safer listening, by raising awareness in parents, children, and teenagers. Noise exposure is underrecognized as a serious public health issue in the United States, with exposure limits enforceable only in workplaces and not for the general public, including children and adolescents. Greater awareness of noise hazards is needed at a societal level.

Acoustic conditioning of the neonatal incubator compartment: Improvement proposal

The objective of this work focuses on the study of the main sources of noise associated with incubators and the acoustic effects that derive from them. The method that has been established is based on tests carried out under different operating conditions of the incubators. Noise levels are analyzed under different boundary conditions (Neonatal ICU and "Controlled environment rooms"). Under normal operating conditions, the levels inside the incubator are around 56 dB (A), values that exceed the maximum limits recommended by the American Academy of Pediatrics. The scope of this study is to evaluate the existing noise levels in the incubator and analyze possible design improvements. The study was carried out in the hospitals of Cádiz, Huelva, and Malaga.

The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents' Experience

Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.

Effect of environmental music on autonomic function in infants in intensive and growing care units

BACKGROUND

The aim of this study is (1) to observe the effect of the background music (BGM) in the incubator on heart rate variability (HRV) during the first few weeks of life in preterm infants in the neonatal intensive (NICU) and growing care units (GCU) and (2) to investigate the effect of environmental music on autonomic function in the infants.

METHODS

Thirty infants, including premature (26 3/7 - 38 4/7 weeks) and low-birth weight (LBW) (946-2,440 g) infants, admitted to the NICU or GCU were involved. The heart rate, low- (LF, 0.05-0.15 Hz) and high- (HF, 0.15-0.4 Hz) frequency HRV components, and LF/HF ratio were measured. The BGM, lullabies for a baby, was delivered through a speaker in the incubator, and the HRV components were compared among before, during, and after intervention with BGM.

RESULTS

The mean HR did not change among the experimental conditions. The LF and HF values decreased during the BGM condition, but not LF/HF, compared with the condition before BGM.

CONCLUSIONS

The present results showed that an auditory environment affected the autonomic function of infants with a range of BGM in the NICU/GCU. The present study also suggested that BGM, a non-invasive and non-pharmacological intervention, could be an evaluation tool for autonomic function in infants in NICU/GCU.

Influence of swaddling on tactile manual learning in preterm infants

BACKGROUND AND AIM

Swaddling is a well-known technique in developmental care programs as there is some evidence that swaddling is an appropriate stress-reducing method for preterm infants in the NICU. However, no experimental study has investigated the influence of swaddling in a learning context. This study aimed to assess the impact of swaddling on tactile manual abilities in preterm infants.

METHODS

Two phases were introduced for all infants: habituation (successive presentation of the same object, prism or cylinder in the left hand), followed by discrimination (presentation of a new-shaped object). The infants were assigned to one of the two conditions (swaddled; non-swaddled).

RESULTS

Forty preterm infants were included (between 28 and 35 weeks' postconceptional age). First, swaddled and non-swaddled infants exhibited similar tactile habituation abilities. However, all infants needed more time and more trials to habituate to the cylinder than to the prism. Second, they all exhibited an effective discrimination, but the importance of the increase in holding time for the new-shaped object varied according to the habituated-shape and the condition. Moreover, stress intensity was higher in non-swaddled infants during tactile exploration. Finally, infants with greater previous swaddling experience during the week preceding the test took more time and more trials to habituate to the object, regardless of the condition.

CONCLUSION

Swaddling preterm infants during sensory learning did not influence the tactile memorization process but would improve the use of their attentional resources. Swaddling seems to provide favorable conditions for sensory learning by improving attention to tactile stimuli.

CLINICAL TRIAL REGISTRATION

This trial, EMMASENS, has been registered at www.clinicaltrials.gov (identifier NCT04315428).

The Effect of Music and White Noise on Electroencephalographic (EEG) Functional Connectivity in Neonates in the Neonatal Intensive Care Unit

The purpose of this study is to investigate whether listening to music and white noise affects functional connectivity on scalp electroencephalography (EEG) in neonates in the neonatal intensive care unit.Nine neonates of ≥34 weeks' gestational age, who were already undergoing clinical continuous EEG monitoring in the neonatal intensive care unit, listened to lullaby-like music and white noise for 1 hour each separated by a 2-hour interval of no intervention. EEG segments during periods of music, white noise, and no intervention were band-pass filtered as delta (0.5-4 Hz), theta (4-8 Hz), lower alpha (8-10 Hz), upper alpha (10-13 Hz), beta (13-30 Hz), and gamma (30-45 Hz). Synchronization likelihood was used as a measure of connectivity between any 2 electrodes.In theta, lower alpha, and upper alpha frequency bands, the synchronization likelihood values yielded statistical significance with sound (music, white noise and no intervention) and with edge (between any 2 electrodes) factors. In theta, lower alpha, and upper alpha frequency bands, statistical significance was obtained between music and white noise (t = 3.12, 3.32, and 3.68, respectively; P < .017), and between white noise and no intervention (t = 4.51, 3.09, and 2.95, respectively, P < .017). However, there was no difference between music and no intervention.Although limited by a small sample size and the 1-time only auditory intervention, these preliminary results demonstrate the feasibility of EEG connectivity analyses even at bedside in neonates on continuous EEG monitoring in the neonatal intensive care unit. They also point to the possibility of detecting significant changes in functional connectivity related to the theta and alpha bands using auditory interventions.

Influence of the NICU on the Acoustic Isolation of a Neonatal Incubator

The neonatal intensive care unit (NICU) is a very noisy place as compared to the intrauterine environment. To protect the neonate's health, international guidelines suggest avoiding noise levels above 45 dB in NICUs, but this recommendation is not normally met. The incubator acoustic isolation and the acoustic features of the NICU play important roles in determining the noise measured inside the incubator. In this study, the influence of two types of rooms, one with sound-absorbent covering and the other with reverberant surfaces, on the acoustic isolation of a neonatal incubator was evaluated using three acoustic isolation indexes: the level difference, the apparent sound reduction index, and the standardized level difference. Results show that the acoustic isolation of the incubator is very poor, with a level difference below 11 dBA at all frequencies. At 62.5 Hz, the level difference measured in both rooms exhibits a negative value, indicating that the incubator amplifies the noise coming from the NICU. Isolation of the incubator is poor, and the reverberation time (RT) of the containing room influences RT of the incubator, which is consequently higher when the containing room is reverberant; for example, the incubator RT in the reverberant NICU is 0.72 s higher at 500 Hz than that in a room with sound-absorbent covering.

Health Care Professionals' Perceptions about Sensory-Based Interventions in the NICU

OBJECTIVE

The main objective of this article is to define perceptions of health care professionals regarding current use of sensory-based interventions in the neonatal intensive care unit (NICU).

STUDY DESIGN

A multidisciplinary group of NICU health care professionals (n = 108) defined the types of sensory-based interventions used in their NICU, the postmenstrual age (PMA) sensory-based interventions are administered, conditions under which sensory-based interventions are used, and personnel who administer sensory-based interventions.

RESULTS

The most commonly reported tactile intervention was infant holding (88% of respondents), the most common auditory intervention was recorded music/singing (69% of respondents), the most common kinesthetic intervention was occupational and physical therapy (85% of respondents), and the most common vestibular intervention was infant swings (86% of respondents). Tactile interventions were initiated most often at 24 to 26 weeks PMA (74% of respondents), auditory interventions at 30 to 32 weeks (60% of respondents), kinesthetic interventions at 30 to 32 weeks (76% of respondents), vestibular interventions at 33 to 34 weeks (86% of respondents), and visual interventions at 32 to 36 weeks (72% of respondents). Conditions under which sensory-based interventions were administered, and personnel who provided them, varied across settings.

CONCLUSION

Varied use of sensory-based interventions in the NICU were reported. While this study was limited by biased sampling and the identification of health care professionals' perceptions but not real-world practice, this information can be used to build a comprehensive approach to positive sensory exposures in the NICU.

Preterm infant showed better object handling skills in a neonatal intensive care unit during silence than with a recorded female voice

AIM

This study compared whether preterm infants showed better tactile abilities during silence or when they heard a prerecorded female voice at different intensities.

METHODS

We studied 74 preterm infants of 28-35 weeks' postconceptional age who were admitted to a French neonatal intensive care unit from 2014 to 2017. They were presented with wooden objects, one smooth and one angled, at various points during silence (n = 26) or while listening to a female voice at +5 (n = 24) or +15 decibels (n = 24) inside their incubator. We compared the conditions to see if there was any difference in how the infants handled the objects and also compared familiar and unfamiliar objects.

RESULTS

The preterm infants showed better handling skills and only displayed effective discrimination, during silence. We found that 27.1% of the infants exposed to female voices failed to get habituated to the object, compared to 7.7% in the silence condition (p < 0.05) and success during the voice conditions required more trials (6.1 vs. 5.3) than the silence condition (p = 0.05). The different voice intensities made no difference.

CONCLUSION

Being exposed to a female voice had a negative impact on preterm infants' tactile sensory learning, regardless of its intensity.

Neonatal intensive care unit phthalate exposure and preterm infant neurobehavioral performance

Every year in the United States, more than 300,000 infants are admitted to neonatal intensive care units (NICU) where they are exposed to a chemical-intensive hospital environment during a developmentally vulnerable period. The neurodevelopmental impact of environmental exposure to phthalates during the NICU stay is unknown. As phthalate exposure during the third trimester developmental window has been implicated in neurobehavioral deficits in term-born children that are strikingly similar to a phenotype of neurobehavioral morbidity common among children born premature, the role of early-life phthalate exposure on the neurodevelopmental trajectory of premature infants may be clinically important. In this study, premature newborns with birth weight <1500g were recruited to participate in a prospective environmental health cohort study, NICU-HEALTH (Hospital Exposures and Long-Term Health), part of the DINE (Developmental Impact of NICU Exposures) cohort of the ECHO (Environmental influences on Child Health Outcomes) program. Seventy-six percent of eligible infants enrolled in the study. Sixty-four of 81 infants survived and are included in this analysis. 164 urine specimens were analyzed for phthalate metabolites using high-performance liquid chromatography/tandem mass spectrometry. The NICU Network Neurobehavioral Scale (NNNS) was performed prior to NICU discharge. Linear and weighted quantile sum regression quantified associations between phthalate biomarkers and NNNS performance, and between phthalate biomarkers and intensity of medical intervention. The sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP) was associated with improved performance on the Attention and Regulation scales. Specific mixtures of phthalate biomarkers were also associated with improved NNNS performance. More intense medical intervention was associated with higher ∑DEHP exposure. NICU-based exposure to phthalates mixtures was associated with improved attention and social response. This suggests that the impact of phthalate exposure on neurodevelopment may follow a non-linear trajectory, perhaps accelerating the development of certain neural networks. The long-term neurodevelopmental impact of NICU-based phthalate exposure needs to be evaluated.

Associations Between Nurse-Guided Variables and Plasma Oxytocin Trajectories in Premature Infants During Initial Hospitalization

BACKGROUND

Oxytocin (OT) is a social hormone that may help researchers understand how nurse-guided interventions during initial infant hospitalization, such as supporting human milk expression, promoting comforting touch, and reducing exposure to stressors, affect preterm brain development.

PURPOSE

To determine whether factors related to human milk, touch, or stressor exposure are related to plasma OT trajectories in premature infants.

METHODS

Plasma from 33 premature infants, born gestational ages 25 to (Equation is included in full-text article.)weeks, was collected at 14 days of life and then weekly until 34 weeks' corrected gestational age (CGA). Variables related to feeding volumes of human milk and formula; touch, as indexed by skin-to-skin contact (SSC) and swaddled holding; and clinical stressors were extracted from the electronic medical record. Linear mixed-models tested associations between nurse-guided variables and plasma OT trajectories.

RESULTS

In the final model, same-day SSC was positively related not only to plasma OT levels at 27 weeks' CGA (β= .938, P = .002) but also to a decline in plasma OT levels over time (β=-.177, P = .001). Volume of enteral feeds (mL/kg/d), its interaction with CGA, and number of stressful procedures were not statistically significant (β= .011, P = .077; β=-.002, P = .066; and β= .007, P = .062, respectively).

IMPLICATIONS FOR PRACTICE

Nurse-guided interventions are associated with infant plasma OT levels, suggesting nurses may impact the neurobiology of the developing premature infant.

IMPLICATIONS FOR RESEARCH

Replication with larger sample sizes and randomized controlled trial designs is needed to test effects of specific nursing interventions on infant OT.

Noise in the Neonatal Intensive Care Unit: What Does the Evidence Tell Us?

BACKGROUND

In 2014, more than 10% of all births in the United States were preterm (born at <37-weeks' gestation). These high-risk infants will often spend weeks to months within the neonatal intensive care unit (NICU), where noise levels can easily reach 120 decibels adjusted (dBA) on a regular and sometimes consistent basis. The American Academy of Pediatrics recommends that NICU sound levels remain below 45 dBA to promote optimal growth and development.

PURPOSE

The purpose of this evidence-based brief is to critically appraise the literature concerning preterm infant response to noise within the NICU as well as the use of noise interventions to improve health outcomes for the vulnerable preterm infant population.

METHODS/SEARCH STRATEGY

Systematic searches of databases included the Cochrane Library, CINAHL, PubMed, and Science Direct. Included studies were appraised and then synthesized into a narrative summary.

FINDINGS/RESULTS

Twenty studies met inclusion criteria for this review. While there are numerous methods that have been shown to reduce noise levels within the NICU, most NICU noise levels remain consistently above the American Academy of Pediatrics recommendations. Studies that assessed interventions found that staff reeducation was critical to sustaining appropriate noise levels.

IMPLICATIONS FOR PRACTICE

Implementing interventions with rigorous attention to initial and continued staff education with engagement and ownership is recommended. This review identifies gaps in intervention studies targeting vulnerable NICU populations.

IMPLICATIONS FOR RESEARCH

While noise interventions show promise in the NICU, additional focused research is needed to further strengthen the evidence and inform clinical practice.

The impact of the Neonatal Intensive Care Unit on sensory and developmental outcomes in infants born preterm: A scoping review

Introduction

Preterm infants admitted to the Neonatal Intensive Care Unit are at higher risk of poor neurodevelopmental and sensory outcomes. There is interest in establishing whether elements of the Neonatal Intensive Care Unit sensory environment may influence the sensory and overall development of these infants.

Method

The purpose of this scoping review was to provide a comprehensive overview of relevant research regarding the sensory elements of the Neonatal Intensive Care Unit, and their short- and long-term influence on preterm infants. This scoping review is underpinned by the six-stage framework by Arksey and O’Malley.

Results

There are few studies that have directly examined the influence of the Neonatal Intensive Care Unit environment upon the sensory and developmental outcomes of infants born preterm, in infancy. The findings of the studies included in this review suggest that the Neonatal Intensive Care Unit sensory environment may alter developmental trajectories of preterm infants. However, low-quality evidence exists in this field, with much of the literature being preliminary.

Conclusion

Further experimental studies are required that combine multiple methods of assessment to more rigorously understand the sensory characteristics of the Neonatal Intensive Care Unit, and their relationship with developmental outcomes across early childhood.

[Real-time safety audits in a neonatal unit]

BACKGROUND

Random audits are a safety tool to help in the prevention of adverse events, but they have not been widely used in hospitals. The aim of the study was to determine, through random safety audits, whether the information and material required for resuscitation were available for each patient in a neonatal intensive care unit and determine if factors related to the patient, time or location affect the implementation of the recommendations.

MATERIAL AND METHODS

Prospective observational study conducted in a level III-C neonatal intensive care unit during the year 2012. The evaluation of written information on the endotracheal tube, mask and ambu bag prepared of each patient and laryngoscopes of the emergency trolley were included within a broader audit of technological resources and study procedures. The technological resources and procedures were randomly selected twice a week for audit. Appropriate overall use was defined when all evaluated variables were correctly programmed in the same procedure.

RESULTS

A total of 296 audits were performed. The kappa coefficient of inter-observer agreement was 0.93. The rate of appropriate overall use of written information and material required for resuscitation was 62.50% (185/296). Mask and ambu bag prepared for each patient was the variable with better compliance (97.3%, P=.001). Significant differences were found with improved usage during weekends versus working-day (73.97 vs. 58.74%, P=.01), and the rest of the year versus 3^rd quarter (66.06 vs. 52%, P=.02).

CONCLUSIONS

Only in 62.5% of cases was the information and the material necessary to attend to a critical situation urgently easily available. Opportunities for improvement were identified through the audits.