Behavioural and physiological reactivity to noise in the newborn

Effect on the health of newborns caused by extreme temperature in Guangzhou

By using 64,270 daily observations from a large hospital in Guangzhou between 2017 and 2019, we analyzed the impact of extreme temperature on the health of newborns via OLS regression with time fixed effect. Given that the short-term temperature change can be regarded as exogenous and random, solving the potential endogenous problem is critical. We find that extreme temperature negatively affects the health of newborns. The Apgar score, an index for evaluating neonatal health, decreases by 0.008 (0.029%) when the duration of extreme temperature events increases by a day. A series of robustness checks verify the reliability of this negative effect. Extreme temperature also has a particularly serious effect on the health of newborns whose mothers have poor education. By gradually extending the observation period, we find that the effect of extreme temperature on neonatal health is mainly concentrated 1-6 weeks before delivery, whereas the effect of extreme temperature on hospitalization cost is mainly concentrated 4-8 weeks before delivery. This paper provides a valuable reference for evaluating the health and social costs of extreme weather, and our findings are conducive to the construction of climate-resilient health systems, especially in Guangzhou.

Helmet Ventilation for Pediatric Patients During the COVID-19 Pandemic: A Narrative Review

The air dispersion of exhaled droplets from patients is currently considered a major route of coronavirus disease 2019 (COVID-19) transmission, the use of non-invasive ventilation (NIV) should be more cautiously employed during the COVID-19 pandemic. Recently, helmet ventilation has been identified as the optimal treatment for acute hypoxia respiratory failure caused by COVID-19 due to its ability to deliver NIV respiratory support with high tolerability, low air leakage, and improved seal integrity. In the present review, we provide an evidence-based overview of the use of helmet ventilation in children with respiratory failure.

Classification of Individual Pain Response Trajectories Following Medically Indicated Heel Lances in Preterm Infants During Their NICU Admission

OBJECTIVES

Infants born preterm are exposed to repeated painful procedures during neonatal intensive care unit admission. Particularly in preterm infants, trajectories of pain response are not well understood. The aim of this study was to classify pain response trajectories over 2 minute following medically indicated heel lances in preterm infants.

MATERIALS AND METHODS

This study used existing clinical trial data (NCT01561547) that evaluated the efficacy of kangaroo care and sucrose for infant pain control. Pain was measured using the Premature Infant Pain Profile at 30, 60, 90, and 120 seconds following a heel lance. Group-based trajectory modeling was used to classify pain response in this 2 minute period.

RESULTS

A total of 236 infants with median gestational age of 33 weeks contributed 610 procedures. A model with 5 trajectory classes best fit the data. Three trajectories were stable over time at different levels of intensity from low-mild to low-moderate pain. One trajectory reflected a linear reduction from high-moderate to low-moderate pain. The final trajectory showed variable moderate-high pain. At all times points, 3 classes were at least 1-point different from the overall sample mean pain score. Only 21 (9%) infants maintained the same class for all 3 procedures.

DISCUSSION

In this sample of preterm infants receiving pain relief, most pain trajectories reflected mild to low-moderate pain that was stable over 2 minute after heel lance initiation. Trajectories were not consistent over multiple procedures within infants, and an overall mean pain score for the sample may misrepresent subgroups of pain response.

Neonatal intensive care unit incubators reduce language and noise levels more than the womb

OBJECTIVE

To assess the sound reducing characteristics of modern incubators in the neonatal intensive care unit (NICU) and to better characterize auditory and language exposures for NICU infants.

STUDY DESIGN

Sound frequency spectral analysis was conducted on language and noise audio acquired simultaneously inside and outside incubators located in the NICU.

RESULTS

Sound transmission into the incubators was nonuniform. Very low-frequency sounds (<100 Hz) were unattenuated or even slightly amplified inside the incubators. Maximal reduction was observed for low-to-mid frequencies (300-600 Hz) and high frequencies (>2000 Hz), which convey important language information.

CONCLUSIONS

Sound reductions observed across NICU incubator walls are more severe than those reported for sound transmission into the intrauterine environment, particularly for midrange frequencies that are important for language. Although incubator walls may serve as a protection against noxious noise levels, these findings reveal a potentially detrimental effect on language exposure for infants inside a NICU incubator.

A Scoping Review of the Impact on Children of the Built Environment Design Characteristics of Healing Spaces

Aim:

This article elucidates current understanding in pediatric healthcare building design via scoping review of research on the impacts on the health and well-being of children of the architectural and landscape characteristics of healing spaces.

Background:

Studies indicate that patients’ phenomenological experiences of the built environment characteristics of healthcare buildings can impact their healing and well-being. It follows that understanding the healing effects of landscape and architecture can inform the design of healthcare settings for increased health benefits.

Method:

This method comprises five search stages: (1) research question is formed; (2) key words, search terms, and search strategy are identified; (3) databases are searched, and papers are assessed via inclusion and exclusion criteria; (4) information of the selected articles is extracted and summarized; and (5) key findings are interpreted and reported via comparative tabulation.

Results:

One hundred seventy-three papers were found during the first search stage. After screening and evaluating for relevance and quality, 13 articles were selected for study. Analysis indicates that the built environment characteristics of pediatric healthcare environments that have healing benefits include access to nature, music, art and natural light, reduced crowding, reduced noise, and soft, cyclical, and user-controlled artificial lighting.

Conclusions:

While it is important to understand the design variables that influence pediatric healthcare, it is also necessary to contextualize them and to distinguish these variables from each other and appreciate their interaction. In other words, a more rounded understanding of these variables is required via research so that their individual and combined impacts are reflected in holistic design recommendations.

The Psychophysiological Implications of Soundscape: A Systematic Review of Empirical Literature and a Research Agenda

The soundscape is defined by the International Standard Organization (ISO) 12913-1 as the human’s perception of the acoustic environment, in context, accompanying physiological and psychological responses. Previous research is synthesized with studies designed to investigate soundscape at the ‘unconscious’ level in an effort to more specifically conceptualize biomarkers of the soundscape. This review aims firstly, to investigate the consistency of methodologies applied for the investigation of physiological aspects of soundscape; secondly, to underline the feasibility of physiological markers as biomarkers of soundscape; and finally, to explore the association between the physiological responses and the well-founded psychological components of the soundscape which are continually advancing. For this review, Web of Science, PubMed, Scopus, and PsycINFO were searched for peer-reviewed articles published in English with combinations of the keywords ‘soundscape’, ‘environmental noise/sound’, ‘physiology/physiological’, ‘psychology/psychological’, and ‘perceptual attributes/affective/subjective assessment/appraisals’. Previous research suggests that Electrocardiography (ECG) and Vectorcardiography (VCG) biometrics quantifying Heart Rate (HR), stimulus-locked experimental design, and passive listening with homogeneous populations are predominantly applied to characterize the psychophysiology underlying the soundscape. Pleasantness and arousal are the most frequent psychological descriptors for soundscape subjective appraisals. Likewise, acoustic environments are reported to inconsistently evoke physiological responses with great variability among studies. The link between the perceptual attributes and physiological responses of soundscape vary within and among existing literature. While a few studies detected a link between physiological manifestations of soundscape and the perceptual attributes, the others failed to validate this link. Additionally, the majority of the study findings were limited to one or two physiological responses.

Exposure of Developing Male Rats to One or Multiple Noise Sessions and Different Housing Conditions: Hippocampal Thioredoxin Changes and Behavioral Alterations

Exposure of developing rats to noise has shown to induce hippocampal-related behavioral alterations that were prevented after a week of housing in an enriched environment. However, neither the effect of repeated exposures nor its impact on key endogenous antioxidants had been studied yet. Thus, the aim of the present work was to reveal novel data about hippocampal oxidative state through the measurement of possible age-related differences in the levels of hippocampal thioredoxins in rats exposed to noise at different developmental ages and subjected to different schemes and housing conditions. In addition, the possibility that oxidative changes could underlie hippocampal-related behavioral changes was also analyzed. Developing male Wistar rats were exposed to noise for 2 h, either once or for 5 days. Upon weaning, some animals were transferred to an enriched cage for 1 week, whereas others were kept in standard cages. One week later, auditory and behavioral assessments, as well as measurement of hippocampal thioredoxin, were performed. Whereas no changes in the auditory function were observed, significant behavioral differences were found, that varied according to the age, scheme of exposure and housing condition. In addition, a significant increase in Trx-1 levels was found in all noise-exposed groups housed in standard cages. Housing animals in an enriched environment for 1 week was effective in preventing most of these changes. These findings suggest that animals become less susceptible to undergo behavioral alterations after repeated exposure to an environmental challenge, probably due to the ability of adaptation to an unfavorable condition. Moreover, it could be hypothesized that damage to younger individuals could be more easily prevented by a housing manipulation.

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 Leq 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.

Noise level in neonatal incubators: A comparative study of three models

BACKGROUND

Preterm infants usually have to spend a long time in an incubator, excessive noise in which can have adverse physiological and psychological effects on neonates. In fact, incubator noise levels typically range from 45 to 70 dB but differences in this respect depend largely on the noise measuring method used. The primary aim of this work was to assess the extent to which noise in an incubator comes from its own fan and how efficiently the incubator can isolate external noise.

METHODS

Three different incubator models were characterized for acoustic performance by measuring their internal noise levels in an anechoic chamber, and also for noise isolation efficiency by using a pink noise source in combination with an internal and an external microphone that were connected to an SVAN958 noise analyzer.

RESULTS

The incubators studied produced continuous equivalent noise levels of 53.5-58 dB and reduced external noise by 5.2-10.4 dB.

CONCLUSIONS

A preterm infant in an incubator is exposed to noise levels clearly exceeding international recommendations even though such levels usually comply with the limit set in the standard IEC60601-2-19: 2009 (60 dBA) under normal conditions of use.

The NICU Environment: Infusing Single-Family Room Benefits into the Open-Bay Setting

Two distinct architectural designs are found in today's NICUs-the open-bay (OPBY) and the single-family room (SFR) designs. When neonatology was recognized as a medical subspecialty in the 1970s, the OPBY design was the only platform offered to neonates and families. The OPBY design facilitated communication between staff, collegiality, and interprofessional collaboration among members of the neonatal team. Over time, pitfalls to the design were recognized, including increased transmission of sound and light. As a result, the SFR design emerged offering a family-centered, customizable environment. Through recognition and adoption of best practices, the neurodevelopmental benefits to SFRs can be infused within the OPBY unit. This article aims to identify best practices to infuse the benefits of SFR design (such as low light, low sound, and less overstimulation) into the OPBY NICU to reduce negative stimulation and optimize developmental outcomes for vulnerable neonates.

Effect of Filters on the Noise Generated by Continuous Positive Airway Pressure Delivered via a Helmet

Introduction:

One of the problems that the delivery of continuous positive airway pressure (CPAP) via a helmet poses is the generation of noise. The objective of our study was to assess the effect that the use of filter has on sound pressure levels generated by the delivery of positive airway pressure at different gas flow rates.

Materials and Methods:

Sound pressure levels generated by neonatal helmet CPAP delivery were measured at different gas flows (20, 30, and 40 l/min) with and without a breathing filter. Noise intensity was measured by installing microphones in the inner ear of dummy heads wearing helmets.

Results:

The sound pressure level increased by 38% at a gas flow of 40 l/min, as compared to a gas flow of 20 l/min {74 dBA [interquartile range (IQR) 2,2] vs 52 dBA (IQR 5,9), respectively}. Using the breathing filter as a diffuser has a variety of effects on sound pressure levels according to the gas flow rate.

Conclusion:

The intensity of the noise generated by helmet delivery of positive airway pressure depends on the type of helmet used, gas flow, and use or not of a diffuser filter. Breathing filters with gas flows over 30 l/min might not be recommended since they would not attenuate but will rather amplify sound pressure.

Noise exposure of immature rats can induce different age-dependent extra-auditory alterations that can be partially restored by rearing animals in an enriched environment

It has been previously shown that different extra-auditory alterations can be induced in animals exposed to noise at 15 days. However, data regarding exposure of younger animals, that do not have a functional auditory system, have not been obtained yet. Besides, the possibility to find a helpful strategy to restore these changes has not been explored so far. Therefore, the aims of the present work were to test age-related differences in diverse hippocampal-dependent behavioral measurements that might be affected in noise-exposed rats, as well as to evaluate the effectiveness of a potential neuroprotective strategy, the enriched environment (EE), on noise-induced behavioral alterations. Male Wistar rats of 7 and 15 days were exposed to moderate levels of noise for two hours. At weaning, animals were separated and reared either in standard or in EE cages for one week. At 28 days of age, different hippocampal-dependent behavioral assessments were performed. Results show that rats exposed to noise at 7 and 15 days were differentially affected. Moreover, EE was effective in restoring all altered variables when animals were exposed at 7 days, while a few were restored in rats exposed at 15 days. The present findings suggest that noise exposure was capable to trigger significant hippocampal-related behavioral alterations that were differentially affected, depending on the age of exposure. In addition, it could be proposed that hearing structures did not seem to be necessarily involved in the generation of noise-induced hippocampal-related behaviors, as they were observed even in animals with an immature auditory pathway. Finally, it could be hypothesized that the differential restoration achieved by EE rearing might also depend on the degree of maturation at the time of exposure and the variable evaluated, being younger animals more susceptible to environmental manipulations.

Noise exposure and oxidative balance in auditory and extra-auditory structures in adult and developing animals. Pharmacological approaches aimed to minimize its effects

Noise coming from urban traffic, household appliances or discotheques might be as hazardous to the health of exposed people as occupational noise, because may likewise cause hearing loss, changes in hormonal, cardiovascular and immune systems and behavioral alterations. Besides, noise can affect sleep, work performance and productivity as well as communication skills. Moreover, exposure to noise can trigger an oxidative imbalance between reactive oxygen species (ROS) and the activity of antioxidant enzymes in different structures, which can contribute to tissue damage. In this review we systematized the information from reports concerning noise effects on cell oxidative balance in different tissues, focusing on auditory and non-auditory structures. We paid specific attention to in vivo studies, including results obtained in adult and developing subjects. Finally, we discussed the pharmacological strategies tested by different authors aimed to minimize the damaging effects of noise on living beings.

Nurses' views of factors affecting sleep for hospitalized children and their families: A focus group study

Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings.

Motor responses and weight gaining in neonates through use of two methods of earmuff and receiving silence in NICU

Background and Aims. With technological advances in NICUs the survival rate of preterm infants has been increased. Because NICU environment is a potent source of stress for infants, its modification is an essential measure to decrease infants' morbidity. The purposes of this study were to compare the effects of wearing earmuff and provision silence for infants on their motor responses and gaining weight. Methods. In a randomized clinical trial 96 preterm infants were enrolled. Their motor responses were evaluated for two consecutive days in the morning and afternoon shifts, in the groups of earmuff and silence, and at similar time points in the control group. Also their weight was measured at days 1 and 10. Results. In the two intervention groups, means of motor responses in infants were significantly less than in the control group, and weight gain of infants was more than the control group. However weight gain was more pronounced in the earmuff group. Conclusion. Both interventions led to decreasing number of motor responses and improvement of weight gain pattern, but these effects were more pronounced in earmuff group; thus because implementation of silence in NICUs has many barriers, it is suggested to use earmuff for preterm infants in these units. This trial obtained IRCT registration number IRCT2012092010812N2.

Long-term recovery from hippocampal-related behavioral and biochemical abnormalities induced by noise exposure during brain development. Evaluation of auditory pathway integrity

Sound is an important part of man's contact with the environment and has served as critical means for survival throughout his evolution. As a result of exposure to noise, physiological functions such as those involving structures of the auditory and non-auditory systems might be damaged. We have previously reported that noise-exposed developing rats elicited hippocampal-related histological, biochemical and behavioral changes. However, no data about the time lapse of these changes were reported. Moreover, measurements of auditory pathway function were not performed in exposed animals. Therefore, with the present work, we aim to test the onset and the persistence of the different extra-auditory abnormalities observed in noise-exposed rats and to evaluate auditory pathway integrity. Male Wistar rats of 15 days were exposed to moderate noise levels (95-97 dB SPL, 2 h a day) during one day (acute noise exposure, ANE) or during 15 days (sub-acute noise exposure, SANE). Hippocampal biochemical determinations as well as short (ST) and long term (LT) behavioral assessments were performed. In addition, histological and functional evaluations of the auditory pathway were carried out in exposed animals. Our results show that hippocampal-related behavioral and biochemical changes (impairments in habituation, recognition and associative memories as well as distortion of anxiety-related behavior, decreases in reactive oxygen species (ROS) levels and increases in antioxidant enzymes activities) induced by noise exposure were almost completely restored by PND 90. In addition, auditory evaluation shows that increased cochlear thresholds observed in exposed rats were re-established at PND 90, although with a remarkable supra-threshold amplitude reduction. These data suggest that noise-induced hippocampal and auditory-related alterations are mostly transient and that the effects of noise on the hippocampus might be, at least in part, mediated by the damage on the auditory pathway. However, we cannot exclude that a different mechanism might be responsible for the observed hippocampal-related changes.

Moderate acoustic changes can disrupt the sleep of very preterm infants in their incubators

AIM

To evaluate the impact of moderate noise on the sleep of very early preterm infants (VPI).

METHODS

Observational study of 26 VPI of 26-31 weeks' gestation, with prospective measurements of sound pressure level and concomitant video records. Sound peaks were identified and classified according to their signal-to-noise ratio (SNR) above background noise. Prechtl's arousal states during sound peaks were assessed by two observers blinded to the purpose of the study. Changes in sleep/arousal states following sound peaks were compared with spontaneous changes during randomly selected periods without sound peaks.

RESULTS

We identified 598 isolated sound peaks (5 ≤ SNR < 10 decibel slow response A (dBA), n = 518; 10 ≤ SNR < 15 dBA, n = 80) during sleep. Awakenings were observed during 33.8% (95% CI, 24-43.7%) of exposures to sound peaks of 5-10 dBA SNR and 39.7% (95% CI, 26-53.3%) of exposures to sound peaks of SNR 10-15 dBA, but only 11.7% (95% CI, 6.2-17.1%) of control periods. The proportions of awakenings following sound peaks were higher than the proportions of arousals during control periods (p < 0.005).

CONCLUSIONS

Moderate acoustic changes can disrupt the sleep of VPI, and efficient sound abatement measures are needed.

Neonatal physiological and behavioral stress during neurological assessment

Physiological and behavioral effects of evaluative handling procedures were studied in 72 newborn infants: 36 preterm (30-35 weeks of gestation) and 36 full-term neonates (39-41 weeks of gestation). While the neurological assessment was physiologically and behaviorally destabilizing to both age groups, preterm subjects had higher heart rate (P < .001), greater increase in blood pressure (P < .01); decreased peripheral oxygenation inferred from mottled skin color (P < .001); and higher frequencies of finger splay (P < .001), arm salute (P < .01), hiccoughs (P < .001), and yawns (P < .001) than full-term subjects. Both groups demonstrated greater stress during the neuromotor phase of testing. Neonatal care professionals must scrutinize the diagnostic benefit, reliability, safety, and timing of neurological assessment given expected physiological and behavioral changes in stable preterm neonates.

Repercussões do ruído na unidade de terapia intensiva neonatal

OBJETIVO: Identificar as repercussões do ruído da unidade de terapia intensiva neonatal sobre as mães, recém-nascidos e interações com o filho e profissionais de saúde, a partir da percepção materna. MÉTODOS: Estudo descritivo transversal, realizado em unidade de terapia intensiva neonatal. A amostra constitui-se de 95 mães. Um formulário foi utilizado como instrumento de coleta de dados. Para análise dos dados utilizou-se estatística descritiva. RESULTADOS: Na percepção das mães o ruído da unidade traz repercussões sobre o neonato provocando agitação, choro, irritabilidade entre outros; desencadeia-lhe cefaléia, agitação e vontade de chorar, levando-a tocar menos e falar mais baixo com o filho. Referem dificuldade em manter sua atenção durante a interação com o profissional. CONCLUSÃO: As repercussões do ruído percebidas pela mãe tanto sobre si como para o seu filho, abrangem alterações comportamentais e físicas; associadas à dificuldade materna de manter a atenção ao interagir com o profissional de saúde.

Neonatal nursery noise: practice-based learning and improvement

OBJECTIVES

To study the impact of interrupted loud noise in Neonatal Intensive Care Unit (NICU) on neonatal physiologic parameters, and apply methods to alleviate noise sources through teaching NICU's staff.

METHODS

Noise level measured at different day times and during different noisy events in the NICU. Changes in the heart rate, respiratory rate and oxygen saturation were recorded just before and immediately after providing noisy events for 36 preterm and 26 full-term neonates. Focused training, guided by sound-level-meter, was provided to the NICU's staff to minimize noise.

RESULTS

The highest mean baseline noise level, 60.5 decibel (dB), was recorded in the NICU critical care area at 12:00 am. The lowest level, 55.2 dB was recorded at 10:00 pm. Noise level inside the incubators was significantly lower than outside, p < 0.001. Noisy events resulted in a significant increase in heart and respiratory rates in preterm neonates as compared to full-terms, p < 0.05.

CONCLUSION

Noise in our NICU exceeded the international permissible levels. Noisy events are numerous, which altered the neonates' physiologic stability especially preterm infants. Staff education is mandatory in ameliorating noise pollution with its deleterious effects on neonatal physiologic homeostasis.

An office or a bedroom? Challenges for family-centered care in the pediatric intensive care unit

Although the modern pediatric intensive care unit (PICU) has followed general pediatrics and adopted the family-centered care model, little is known about how families prospectively experience PICU care. The authors' goal was to better understand the experiences of families whose child was hospitalized in a PICU. They conducted a 12-month prospective ethnographic study in a PICU in a tertiary care hospital in a large North American urban center. Data were obtained via participant-observation and formal and informal interviews with 18 families and staff key informants. Findings revealed a disconnect between the espoused model of family-centered care and quotidian professional practices. This divergence emerged in the authors' analysis as a heuristic that contrasts a professional "office" to a sick child's "bedroom." PICU practices and protocols transformed the child into a patient and parents into visitors; issues such as noise, visitation, turf, and privacy could favor staff comfort and convenience over that of the child and family. The authors' discussion highlights suggestions to overcome this divergence in order to truly make the PICU family centered.

Sleep rounds: a multidisciplinary approach to optimize sleep quality and satisfaction in hospitalized patients

BACKGROUND

Poor sleep has adverse affects on heath, yet few studies have addressed the goal of improving sleep among hospitalized patients. We evaluated the effectiveness of a sleep-promoting intervention on the quality and quantity of sleep among inpatients.

METHODS

This study was conducted on a neurological ward in a large, tertiary care hospital. Sleep quality, quantity, and disruptors were assessed using questionnaires completed by patients during their hospital stay and Press Ganey surveys completed retrospectively. Room noise was also measured using noise meters. Data from each of 4 chronological phases of the study (baseline, basic intervention, "washout," and deluxe intervention) were analyzed. In the intervention phases, nurses conducted "Sleep Rounds" at bedtime, during which sleep-promoting practices were implemented, including lights out, television off, temperature adjustment, and a final restroom usage.

RESULTS

Patients reported 5 (interquartile range [IQR] 3) hours of sleep per night, awoke 3 (IQR 3) times nightly, and reported a median sleep latency of 11 to 15 minutes. Pain, staff interruptions, and roommates were the most significant barriers to good sleep. Noise levels were adequately low (35-40 dB) at night but were not positively impacted by our sleep-promoting interventions. Patients perceived noise on the unit to be worse during phases of the study in which there was no intervention.

CONCLUSIONS

Patient perception of sleep experience improved during the phases in which Sleep Rounds were implemented, despite the fact that there was no measurable improvement in sleep or sleep-disrupting factors.

Infants born very preterm react to variations of the acoustic environment in their incubator from a minimum signal-to-noise ratio threshold of 5 to 10 dBA

INTRODUCTION

Very early preterm infants (VPIs) are exposed to unpredictable noise in neonatal intensive care units. Their ability to perceive moderate acoustic environmental changes has not been fully investigated.

RESULTS

Physiological values of the 598 isolated sound peaks (SPs) that were 5-10 and 10-15 dB slow-response A (dBA) above background noise levels and that occurred during infants' sleep varied significantly, indicating that VPIs detect them. Exposure to 10-15 dBA SPs during active sleep significantly increased mean heart rate and decreased mean respiratory rate and mean systemic and cerebral oxygen saturations relative to baseline.

DISCUSSION

VPIs are sensitive to changes in their nosocomial acoustic environment, with a minimal signal-to-noise ratio (SNR) threshold of 5-10 dBA. These acoustic changes can alter their well-being.

METHODS

In this observational study, we evaluated their differential auditory sensitivity to sound-pressure level (SPL) increments below 70-75 dBA equivalent continuous level in their incubators. Environmental (SPL and audio recording), physiological, cerebral, and behavioral data were prospectively collected over 10 h in 26 VPIs (GA 28 (26-31) wk). SPs emerging from background noise levels were identified and newborns' arousal states at the time of SPs were determined. Changes in parameters were compared over 5-s periods between baseline and the 40 s following the SPs depending on their SNR thresholds above background noise.

[Sensory system development and the physical environment of infants born very preterm]

The sensory systems develop in several sequences, with a process specific to each system and with a transnatal continuum. This development is based partly on interactions between the fetus and the newborn and their physical and human environments. These interactions are key drivers of the child development. The adaptation of the newborn's environment is crucial for his survival, his well-being and his development, especially if he is born prematurely. The physical environment of the hospital where immature infants are immersed differs greatly from the uterine environment from which they were extracted prematurely. There are discrepancies between their sensory expectations originating in the antenatal period and the atypical stimuli that newborns encounter in their postnatal nosocomial environment. These assertions are valid for all sensory modalities. Many studies have proven that very preterm infants are highly sensitive to this environment which can affect their physiological and behavioural well being. Moreover, it can alter their perception of important human sensory signals, particularly the ones coming from their mother. The long term impacts of this environment are more difficult to identify due to the multi-sensory nature of these stimuli and the multifactorial origin of the neurological disorders that these children may develop. However, the adaptation of their physical environment is one of the corner stones of specific developmental care programs, like the NIDCAP program that has been shown to be successful to improve their short and medium term outcomes. The architectural design, technical equipment and used health-care products, and the strategies and organizations of care are the main determinants of the physical environment of these children. Recommendations for the hospital environment, integrating a newborn's developmental perspective, have been made available. They should be applied more widely and should be completed. Technological equipment advances are also expected to allow better compliance to them. All these evolutions are completely in accordance with the concept of humane neonatal care.

Preterm infants' sympathetic arousal and associated behavioral responses to sound stimuli in the neonatal intensive care unit

PURPOSE

To evaluate the utility of skin conductance (SC) as a measure of autonomic arousal to sound stimuli in preterm infants.

DESIGN

A pilot cross-sectional, correlations study.

SUBJECTS

Eleven preterm infants with a mean gestational age of 31.6 weeks without anomalies or conditions associated with neurodevelopmental delay composed the sample.

METHODS

On days 5-7 of life, the following infant responses were simultaneously recorded in response to naturally occurring sound stimuli in the NICU: real-time measurements of heart rate, respiratory rate, and oxygen saturations; sympathetic-mediated sweating via SC; and behavioral responses using the Newborn Individualized Developmental Care and Assessment Program naturalistic observation. Baseline sound levels (BSL, <55 dBA) and high sound levels (HSL, >65 dBA) were measured to index patterns of response during a nonhandling period preceding care.

RESULTS

Mean heart rate during precare was directly associated with higher SC increases to sound stimuli (r[10] = 0.697, P = .017). The SC during HSL was significantly higher than that during BSL (P < .0001). Males demonstrated higher SC increases to sound stimuli than females (P = .030). Changes in SC induced by increases in sound intensity were associated with lower attention responses (r[10] = -0.92, P < .0001) and lower summated behavioral responses (r[10] = -0.59, P = .054).

CONCLUSION

SC provides a noninvasive, sensitive measure of sympathetic arousal that may not be apparent in behavioral cues or states, or determined by standard physiological responses alone.

Noise levels in neonatal intensive care unit and use of sound absorbing panel in the isolette

OBJECTIVE

The purposes of this study were to measure the noise level of a busy neonatal intensive care unit (NICU) and to determine the effect of sound absorbing panel (SAP) on the level of noise inside the isolette.

METHODS

The sound pressure levels (SPL) of background noise, baby crying, alarms and closing of isolette's door/portholes were measured by a 2235-Brüel&Kjaer Sound Level Meter. Readings were repeated after applying SAP (3D pyramidal shaped open cell polyurethane foam) to the three lateral walls and ceiling of the isolette.

RESULTS

The median SPL of background noise inside the NICU was 56dBA and it decreased to 47dBA inside the isolette. The median SPL of monitor alarms and baby crying inside the isolette were not different than SPL measured under radiant warmer (p>0.05). With SAP, the median SPL of temperature alarm inside the isolette decreased significantly from 82 to 72dBA, monitor alarm from 64 to 56dBA, porthole closing from 81 to 74dBA, and isolette door closing from 80 to 68dBA (p<0.01). There was a significant reduction in the noise produced by baby crying when SAP was used in the isolette (79dBA vs 69dBA, respectively) (p<0.0001). There was also significant attenuation effect of panel on the environmental noise.

CONCLUSIONS

The noise level in our NICU is significantly above the universally recommended levels. Being inside the isolette protects infants from noise sources produced outside the isolette. However, very high noises are produced inside the isolette as well. Sound absorbing panel can be a simple solution and it attenuated the noise levels inside the isolette.

Active noise control for infant incubators

This paper presents an active noise control system for infant incubators. Experimental results show that global noise reduction can be achieved for infant incubator ANC systems. An audio-integration algorithm is presented to introduce a healthy audio (intrauterine) sound with the ANC system to mask the residual noise and soothe the infant. Carbon nanotube based transparent thin film speaker is also introduced in this paper as the actuator for the ANC system to generate the destructive secondary sound, which can significantly save the congested incubator space and without blocking the view of doctors and nurses.

The importance of quiet in the home: Teaching noise awareness to parents before the infant is discharged from the NICU

Research over several decades describes various adverse health effects of noise on the hospitalized neonate. Noise is a direct cause of long-lasting auditory problems and a significant cause of cardiovascular and respiratory problems and neurologic impairment. Many hospitals have turned the NICU into a quiet environment that promotes the neonate's health and well-being. But auditory pathways continue to develop during the neonatal period, reaching maturation at 12 months and beyond. Some of this development thus occurs after the neonate is discharged from the hospital. It is a responsibility of NICU professionals to teach families about the health benefits of noise modulation and planned quiet in the home environment. This teaching may make a world of difference to the continued healthy growth, development, and well-being of the infant.

How the NICU environment sounds to a preterm infant: update

PURPOSE

To replicate a previously published descriptive study of sound levels in the NICU.

STUDY DESIGN AND METHODS

A descriptive study of nursery ambient sound levels and sound levels associated with nursery equipment and care activities was conducted in a Level III NICU. Measurements were obtained using a sound level meter and evaluated in light of previous findings.

RESULTS

Contrasted with 16 years ago, room sound levels were reduced; however sound levels associated with caregiving, equipment, and activities continue to be high.

CLINICAL IMPLICATIONS

Sound levels continue to be a clinical challenge for NICU nurses. This study suggests some modification of care practices and equipment selection that could reduce sound levels and concludes that sound reduction is a continuing need in neonatal care.

Reliability of hearing screening in high-risk neonates: Comparative study of otoacoustic emission, automated and conventional auditory brainstem response

OBJECTIVE

To compare the diagnostic reliability of automated transient evoked otoacoustic emissions (a-TEOAE), automated auditory brainstem response (a-ABR) and conventional brainstem auditory evoked potential (BAEP/ABR) for identification of hearing loss in high-risk neonates.

METHODS

Two hundred and six neonatal intensive care unit (NICU) admitted neonates were tested pre-discharge. Follow-up included a-TEOAE in all children, repetition of a-ABR or BAEP if failed in NICU. Sensitivity and specificity were compared and correlated with auditory risk factors.

RESULTS

BAEP had the highest sensitivity (100%) and specificity (90.8%), a-ABR the lowest (88.9% and 70.6%). A statistically significant difference in risk factors for temporary hearing loss was observed between normal and false positive a-TEOAE and BAEP, but not a-ABR outcome. Differences in specificity between a-ABR and a-TEOAE explain the pattern of "absent a-ABR/present a-TEOAE" in 13.8% of ears.

CONCLUSIONS

The BAEP appears the more reliable test for hearing screening of high-risk neonates because of highest sensitivity and specificity and should be used to confirm the diagnosis of "auditory neuropathy" in high-risk neonates. The reliability of a-ABR devices in critically ill neonates needs further investigation.

SIGNIFICANCE

This is, to our knowledge, the first attempt to compare the diagnostic reliability of a-TEOAE, a-ABR and BAEP in high-risk neonates.