1
|
Rangaswamy DR, Kamble N, Veeramachaneni A. Quieting the neonatal intensive care unit: A quality improvement initiative. World J Clin Pediatr 2024; 13:96018. [DOI: 10.5409/wjcp.v13.i3.96018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/18/2024] [Accepted: 06/05/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND The neonatal intensive care unit (NICU) is vital for preterm infants but is often plagued by harmful noise levels. Excessive noise, ranging from medical equipment to conversations, poses significant health risks, including hearing impairment and neurodevelopmental issues. The American Academy of Pediatrics recommends strict sound limits to safeguard neonatal well-being. Strategies such as education, environmental modifications, and quiet hours have shown to reduce noise levels. However, up to 60% of the noises remain avoidable. High noise exposure exacerbates physiological disturbances, impacting vital functions and long-term neurological outcomes. Effective noise reduction in the NICU is crucial for promoting optimal neonatal development.
AIM To measure the sound levels in a NICU and reduce ambient sound levels by at least 10% from baseline.
METHODS A quasi-experimental quality improvement project was conducted over 4 mo in a 20-bed level 3 NICU in a tertiary care medical college. Baseline noise levels were recorded continuously using a sound level meter. The interventions included targeted education, environmental modifications, and organizational changes, and were implemented through three rapid Plan-Do-Study-Act (PDSA) cycles. Weekly feedback and monitoring were conducted, and statistical process control charts were used for analysis. The mean noise values were compared using the paired t-test.
RESULTS The baseline mean ambient noise level in the NICU was 67.8 dB, which decreased to 50.5 dB after the first cycle, and further decreased to 47.4 dB and 51.2 dB after subsequent cycles. The reduction in noise levels was 21% during the day and 28% at night, with an overall decrease of 25% from baseline. The most significant reduction occurred after the first PDSA cycle (mean difference of −17.3 dB, P < 0.01). Peak noise levels decreased from 110 dB to 88.24 dB after the intervention.
CONCLUSION A multifaceted intervention strategy reduced noise in the NICU by 25% over 4 months. The success of this initiative emphasizes the significance of comprehensive interventions for noise reduction.
Collapse
Affiliation(s)
| | - Niranjan Kamble
- Department of Pediatrics, Subbaiah Institute of Medical Sciences, Shimoga 577222, Karnataka, India
| | - Amulya Veeramachaneni
- Department of Pediatrics, Subbaiah Institute of Medical Sciences, Shimoga 577222, Karnataka, India
| |
Collapse
|
2
|
Çuhacı AB, Efe YS, Güneş T. The effect of music on pain, comfort, and physiological parameters during premature retinopathy examination. J Pediatr Nurs 2024; 78:149-157. [PMID: 38943838 DOI: 10.1016/j.pedn.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/29/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
AIM To determine the effect of music applied during the ROP examination on pain, comfort, and physiological parameters in preterm infants. METHODS The sample of this prospective randomized controlled double-blind experimental study consisted of 28 preterm infants who were examined for ROP of a tertiary hospital in the Neonatal Unit. Data were collected with a Questionnaire, Physiological Parameters Observation Form (PPOF), Revised-Premature Infant Pain Profile (PIPP-R), and Premature Infant Comfort Scale (PICS). RESULTS The results revealed that the crying times of the infants in the experimental group were shorter than the infants in the control group. The preterm infants in the experimental group had statistically lower PIPP-R scores during and after the procedure than the PIPP-R scores of the infants in the control group (p < 0.001) and the music applied to the preterm infants resulted in a mean decrease of 3.857 in the post-procedure and pre-procedure PIPP-R scores (p < 0.05). While there was no statistical difference between the pre-procedure and pre-procedural PICS scores of the preterm infants in the experimental and control groups (p = 0.599; p = 117), the post-procedure PICS values of the preterm infants in the experimental group were found to be lower than those of the control group (p < 0.001). It was found that the music applied to preterm infants during the ROP examination resulted in a mean decrease of 1.286 in PICS scores after the procedure and before the procedure (p < 0.05). CONCLUSION It was determined that the music listened to during the ROP examination decreased the PIPP-R pain scores of preterm infants, had a positive effect on the PICS scores after the procedure, but did not affect the physiological parameters positively. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05263973.
Collapse
Affiliation(s)
| | - Yağmur Sezer Efe
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye.
| | - Tamer Güneş
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Türkiye.
| |
Collapse
|
3
|
Ali TM, Alharbi MF. AF among Nurses Working in Neonatal and Paediatric Intensive Care Units: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1574. [PMID: 39201133 PMCID: PMC11353546 DOI: 10.3390/healthcare12161574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Taibah M. Ali
- Maternal & Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 12371, Saudi Arabia
- Ministry of Health, Heraa General Hospital, Makkah 24227, Saudi Arabia
| | - Manal F. Alharbi
- Maternal & Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 12371, Saudi Arabia
| |
Collapse
|
4
|
Rangaswamy DR, Kamble N. Utility of Smartphone Application to Detect Noise in NICU. Indian J Pediatr 2024; 91:760. [PMID: 38556615 DOI: 10.1007/s12098-024-05109-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Affiliation(s)
| | - Niranjan Kamble
- Department of Pediatrics, Subbaiah Institute of Medical Sciences, Shimoga, Karnataka, 577222, India
| |
Collapse
|
5
|
Bubshait KS, Maldonado MM, Krueger C. Effect of Maternal Speech on Neural Development in Premature Infant. J Perinat Neonatal Nurs 2024; 38:290-296. [PMID: 37967270 DOI: 10.1097/jpn.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Maternal speech has been shown to benefit premature infants by improving feeding outcomes and potentiating the development of the auditory cortex. To our knowledge, limited studies have addressed the benefits of exposure to maternal speech on neural development in premature infants. The objective of this study was to investigate the effect of early controlled exposure to maternal recording a passage of speech on heart rate variability (obtained before, during, and after playback of a test stimulus of a female stranger speaking the same passage) in very low-birth-weight premature infants tracked weekly from 28 to 34 weeks. METHODS Prospective, randomized controlled trial, longitudinal, and repeated-measures design were conducted on 49 subjects. Infants heard a recording of their mother's speech twice a day from either 28 to 34 weeks (group 1) or from 32 to 34 weeks (group 2). Spectral analysis was measured weekly for 45 seconds before, during, and after playback of maternal speech. A generalized linear mixed model was conducted to examine the 2-way interaction in the log high-frequency power between groups, genders, sessions, and conditions. RESULTS It was found that there were no significant differences between groups before, during, and after playback of the stimulus. A significant difference, however, was noted between conditions (before vs during period). CONCLUSION It can be concluded cautiously that playing back of maternal speech recordings to the premature infant has a beneficial impact on neural development after 32 weeks gestational age.
Collapse
Affiliation(s)
- Khlood S Bubshait
- Author Affiliations: Fundamentals of Nursing Department, Pediatric Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Dr Bubshait); Department of Health Education in Behavior, School of Health and Human Performance, University of Florida,Gainesville (Dr Maldonado); and Biobehavioral Nursing Science Faculty, College of Nursing, University of Florida, Gainesville (Dr Krueger)
| | | | | |
Collapse
|
6
|
Dewan MV, Jungilligens J, Kobus S, Diezel M, Dathe AK, Schweiger B, Hüning B, Felderhoff-Müser U, Bruns N. The effect of live music therapy on white matter microstructure in very preterm infants - A randomized controlled trial. Eur J Paediatr Neurol 2024; 51:132-139. [PMID: 38941879 DOI: 10.1016/j.ejpn.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE Music therapy (MT) is proposed to enrich the acoustic environment of very preterm infants (VPT) on the neonatal intensive care unit during a vulnerable period of brain development. The objective of this study was to investigate the effect of MT on the white matter (WM) microstructure. It is hypothesized that MT affects WM integrity in VPT. METHODS Randomized controlled trial enrolling infants born <32 weeks' gestation. Infants were randomized to MT or standard care. Live MT was provided twice weekly from the second postnatal week onwards by a trained music therapist. At term equivalent age, participants underwent a cranial magnetic resonance imaging scan including sequences for diffusion tensor imaging analysis. Differences in WM microstructure were assessed using tract based spatial statistics with fractional anisotropy. RESULTS Of 80 infants enrolled, 42 were eligible for diffusion tensor imaging analysis (MT: n = 22, standard care: n = 20). While primary tract based spatial statistics analysis revealed no significant differences between groups, post hoc analysis with uncorrected p-values and a significance threshold of p < 0.01 revealed significant fractional anisotropy differences in several WM tracts including the bilateral superior longitudinal fasciculus, the left forceps minor and left fasciculus uncinatus, the corpus callosum, the left external capsule, and the right corticospinal tract. CONCLUSION Post hoc analysis results suggest an effect of MT on WM integrity in VPT. Larger studies including long-term outcome are necessary to confirm these effects of MT on WM microstructure and to assess its impact on clinical neurodevelopment. CLINICAL TRIAL REGISTRATION Clinical trial number DRKS00025753.
Collapse
Affiliation(s)
- Monia Vanessa Dewan
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
| | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Susann Kobus
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Marlis Diezel
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Anne-Kathrin Dathe
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany; Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences Jena, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Britta Hüning
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
7
|
Di Fiore JM, Liu G, Loparo KA, Bearer CF. The effect of early postnatal auditory stimulation on outcomes in preterm infants. Pediatr Res 2024:10.1038/s41390-024-03329-7. [PMID: 38909158 DOI: 10.1038/s41390-024-03329-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/18/2024] [Indexed: 06/24/2024]
Abstract
Preterm infants are deprived of in utero sensory stimulation during the third trimester, an important period of central nervous system development. As a result, maturational trajectories are often reduced in infants born preterm. One such system affected is the brain including the auditory and respiratory control pathways. During normal pregnancy the intrauterine environment attenuates external auditory stimuli while exposing the fetus to filtered maternal voice, intra-abdominal sounds, and external stimuli. In contrast, during the third trimester of development, preterm infants are exposed to a vastly different soundscape including non-attenuated auditory sounds and a lack of womb related stimuli, both of which may affect postnatal brain maturation. Therefore, fostering a nurturing postnatal auditory environment during hospitalization may have a significant impact on related outcomes of preterm infants. Studies using a range of postnatal auditory stimulations have suggested that exposure to sounds or lack thereof can have a significant impact on outcomes. However, studies are inconsistent with sound levels, duration of exposure to auditory stimuli, and the gestational age at which infants are exposed. IMPACT: Auditory stimulation can provide a low cost and low risk intervention to stabilize respiration, improve neuronal maturation and reduce long-term sequelae in preterm infants. The potential benefits of auditory stimulation are dependent on the type of sound, the duration of exposure and age at time of exposure. Future studies should focus on the optimal type and duration of sound exposure and postnatal developmental window to improve outcomes.
Collapse
Affiliation(s)
- Juliann M Di Fiore
- Dept of Pediatrics, Case Western Reserve University, Cleveland, OH, 44016, USA
- Division of Neonatology, Rainbow Babies and Children's Hospital, Cleveland, OH, 44016, USA
| | - Gloria Liu
- Dept of Pediatrics, Case Western Reserve University, Cleveland, OH, 44016, USA
| | - Kenneth A Loparo
- ISSACS: Institute for Smart, Secure and Connected Systems, Case Western Reserve University, Cleveland, OH, USA
| | - Cynthia F Bearer
- Dept of Pediatrics, Case Western Reserve University, Cleveland, OH, 44016, USA.
- Division of Neonatology, Rainbow Babies and Children's Hospital, Cleveland, OH, 44016, USA.
| |
Collapse
|
8
|
Solvik-Olsen T, Kåsin JI, Hagemo J, Heyerdahl F. Manikin study showed that neonates are exposed to high sound and vibration levels during helicopter incubator transports. Acta Paediatr 2024. [PMID: 38884542 DOI: 10.1111/apa.17326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/19/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
AIM This initial Norwegian study aimed to quantify the vibrations and sounds experienced by neonates when they were transported by helicopter in an incubator. METHODS Two neonatal manikins weighing 500 and 2000 g were placed in a transport incubator and transported in an Airbus H145 D3 helicopter during standard flight profiles. The vibrations were measured on the mattress inside the incubator and the sound levels were measured inside and outside the incubator. RESULTS The highest vibration levels were recorded during standard flight profiles when the lighter manikin was used. These ranged 0.27-0.94 m/s2, compared to 0.27-0.76 m/s2 for the heavier manikin. The measurements exceeded the action levels set by the European Union Vibration Directive for adult work environments. The sound levels inside the incubator ranged 84.6-86.3 A-weighted decibels, with a C-weighted peak level of 122 decibels. The sound levels inside the incubator were approximately 10 decibels lower than outside, but amplification was observed in the incubator at frequencies below 160 Hz. CONCLUSION Vibrations were highest for the lighter manikin. The sound levels during helicopter transport were higher than recommended for neonatal environments and sounds were amplified within the incubator at lower frequencies.
Collapse
Affiliation(s)
- Tone Solvik-Olsen
- Division of Pediatric and Adolescent Medicine, Department of Neonatology, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan Ivar Kåsin
- Norwegian Armed Forces, Occupational Health Services, Oslo, Norway
| | - Jostein Hagemo
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Heyerdahl
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Prehospital Services, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
9
|
Sibrecht G, Wróblewska-Seniuk K, Bruschettini M. Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants. Cochrane Database Syst Rev 2024; 5:CD010333. [PMID: 38813836 PMCID: PMC11137833 DOI: 10.1002/14651858.cd010333.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are subjected to different types of stress, including sounds of high intensity. The sound levels in NICUs often exceed the maximum acceptable level recommended by the American Academy of Pediatrics, which is 45 decibels (dB). Hearing impairment is diagnosed in 2% to 10% of preterm infants compared to only 0.1% of the general paediatric population. Bringing sound levels under 45 dB can be achieved by lowering the sound levels in an entire unit; by treating the infant in a section of a NICU, in a 'private' room, or in incubators in which the sound levels are controlled; or by reducing sound levels at the individual level using earmuffs or earplugs. By lowering sound levels, the resulting stress can be diminished, thereby promoting growth and reducing adverse neonatal outcomes. This review is an update of one originally published in 2015 and first updated in 2020. OBJECTIVES To determine the benefits and harms of sound reduction on the growth and long-term neurodevelopmental outcomes of neonates. SEARCH METHODS We used standard, extensive Cochrane search methods. On 21 and 22 August 2023, a Cochrane Information Specialist searched CENTRAL, PubMed, Embase, two other databases, two trials registers, and grey literature via Google Scholar and conference abstracts from Pediatric Academic Societies. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs in preterm infants (less than 32 weeks' postmenstrual age (PMA) or less than 1500 g birth weight) cared for in the resuscitation area, during transport, or once admitted to a NICU or stepdown unit. We specified three types of intervention: 1) intervention at the unit level (i.e. the entire neonatal department), 2) at the section or room level, or 3) at the individual level (e.g. hearing protection). DATA COLLECTION AND ANALYSIS We used the standardised review methods of Cochrane Neonatal to assess the risk of bias in the studies. We used the risk ratio (RR) and risk difference (RD), with their 95% confidence intervals (CIs), for dichotomous data. We used the mean difference (MD) for continuous data. Our primary outcome was major neurodevelopmental disability. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included one RCT, which enroled 34 newborn infants randomised to the use of silicone earplugs versus no earplugs for hearing protection. It was a single-centre study conducted at the University of Texas Medical School in Houston, Texas, USA. Earplugs were positioned at the time of randomisation and worn continuously until the infants were 35 weeks' postmenstrual age (PMA) or discharged (whichever came first). Newborns in the control group received standard care. The evidence is very uncertain about the effects of silicone earplugs on the following outcomes. • Cerebral palsy (RR 3.00, 95% CI 0.15 to 61.74)and Mental Developmental Index (MDI) (Bayley II) at 18 to 22 months' corrected age (MD 14.00, 95% CI 3.13 to 24.87); no other indicators of major neurodevelopmental disability were reported. • Normal auditory functioning at discharge (RR 1.65, 95% CI 0.93 to 2.94) • All-cause mortality during hospital stay (RR 2.07, 95% CI 0.64 to 6.70; RD 0.20, 95% CI -0.09 to 0.50) • Weight (kg) at 18 to 22 months' corrected age (MD 0.31, 95% CI -1.53 to 2.16) • Height (cm) at 18 to 22 months' corrected age (MD 2.70, 95% CI -3.13 to 8.53) • Days of assisted ventilation (MD -1.44, 95% CI -23.29 to 20.41) • Days of initial hospitalisation (MD 1.36, 95% CI -31.03 to 33.75) For all outcomes, we judged the certainty of evidence as very low. We identified one ongoing RCT that will compare the effects of reduced noise levels and cycled light on visual and neural development in preterm infants. AUTHORS' CONCLUSIONS No studies evaluated interventions to reduce sound levels below 45 dB across the whole neonatal unit or in a room within it. We found only one study that evaluated the benefits of sound reduction in the neonatal intensive care unit for hearing protection in preterm infants. The study compared the use of silicone earplugs versus no earplugs in newborns of very low birth weight (less than 1500 g). Considering the very small sample size, imprecise results, and high risk of attrition bias, the evidence based on this research is very uncertain and no conclusions can be drawn. As there is a lack of evidence to inform healthcare or policy decisions, large, well designed, well conducted, and fully reported RCTs that analyse different aspects of noise reduction in NICUs are needed. They should report both short- and long-term outcomes.
Collapse
Affiliation(s)
- Greta Sibrecht
- II Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
10
|
Han Y, Li S, Song Y, Sun J, Yan W, Wang J, Gao X, Li X, Ren C, Zhao Q. Risk factors for infant hearing loss: a meta-analysis. Eur J Pediatr 2024; 183:2401-2409. [PMID: 38456989 DOI: 10.1007/s00431-024-05498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Hearing loss is a common disability in infants that significantly impacts their cognitive, language, and literacy development. This study aimed to systematically assess the risk factors for the early identification and intervention in infant hearing loss. Databases were searched for meta-analyses of observational studies until November 2023. The quality assessment was performed using the Cochrane risk of bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the evidence. A meta-analysis identified 14 risk factors significantly associated with infant hearing loss. According to the GRADE approach, there were four factors with moderate-certainty evidence (low birth weight(LBW), congenital anomalies, craniofacial anomalies, intracranial hemorrhages), seven factors with low-certainty evidence (ototoxic medications, family history of hearing loss, mechanical ventilation > 5 days, intrauterine infection, admission to neonatal intensive care unit (NICU) > 5 days, mechanical ventilation and asphyxia) and six with extremely-low-certainty evidence (very low birth weight < 1500 g (VLBW), hyperbilirubinemia, sepsis or meningitis, male sex, premature birth, small for gestational age (SGA)). Nevertheless, no significant association was found between infant hearing loss and factors such as small for gestational age (SGA), male sex, and premature birth (P > 0.05). Conclusion: The identification of these 14 interrelated risk factors can prove advantageous in clinical practice, as these findings could guide hearing screening and parental counseling. Furthermore, prospective research could be conducted to develop risk-based scoring systems based on these factors. What is Known: • Infant hearing loss is a worldwide issue. • Risk factors for this condition are debated. What is New: • This is the first meta-analysis to comprehensively evaluate perinatal and postnatal risk factors for hearing loss in infants. • Intracranial hemorrhage, mechanical ventilation, and low birth weight are associated with infant hearing loss. However, no evidence of an association was found between premature birth, being small for gestational age, or male sex and hearing loss.
Collapse
Affiliation(s)
- Yiwei Han
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Shangbin Li
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Yankun Song
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Jingfei Sun
- Department of Pediatrics, Zhengding People's Hospital, Shijiazhuang, 050000, China
| | - Weichen Yan
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Jie Wang
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiong Gao
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xueying Li
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Changjun Ren
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China.
| | - Qian Zhao
- Department of Pediatrics, First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China.
| |
Collapse
|
11
|
Düken ME, Yayan EH. The effects of massage therapy and white noise application on premature infants' sleep. Explore (NY) 2024; 20:319-327. [PMID: 37806925 DOI: 10.1016/j.explore.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
AIM Sleep is vital to premature infants' physical, social and emotional development. The significance of sleep duration, efficiency, and function in premature infants regarding growth development, behavior and neurological development has been increasing. MATERIALS AND METHODS This study was conducted in a randomized controlled experimental design with three groups. Premature infants at 28-37 weeks of gestation who were admitted to the Neonatal Intensive Care Unit of Şanlıurfa Mehmet Akif İnan Training and Research Hospital Haliliye Annex Building were the research population. The sample of the present study consisted of 120 premature infants in the massage therapy group (40), white noise group (40), and control group (40). RESULTS The sleep duration and sleep efficiency of the premature infants in the massage group increased compared to before the application, whereas the number of awakenings and WASO values decreased. The sleep duration of premature infants in the massaged group increased by some five hours. In the white noise group, the sleep duration increased by about two hours than the pre-treatment, and there was an increase in sleep efficiency. White noise application provided a significant decrease in the number of awakenings and WASO values in premature infants. CONCLUSION In this experimental study, which was designed with three groups, it was revealed that massage and white noise application in premature infants were significant non-pharmacological methods to increase sleep duration and sleep efficiency. It was concluded that massage therapy and white noise application is one of the considerable interventions regarding sleep duration, efficiency and functions in premature infants who left the intrauterine period early.
Collapse
Affiliation(s)
- Mehmet Emin Düken
- Health Sciences of Faculty, Department of Child Health and Diseases Nursing, Harran University, Şanlıurfa 63000, Turkey.
| | - Emriye Hilal Yayan
- Faculty of Nursing, Department of Child Health and Diseases Nursing, Inönü University, Malatya 44280, Turkey.
| |
Collapse
|
12
|
Ou W, Tao C, Zhang Y, Gan M, Xie Y, Wu Y, Zheng X, Shu B, Duan G, Xu F. Effects of postoperative environmental noise on surgery induced pain: Evidence based on a prospective observational study. Gen Hosp Psychiatry 2024; 88:61-67. [PMID: 38508077 DOI: 10.1016/j.genhosppsych.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
CONTEXT Many patients recovering from surgery in wards are disturbed by environmental noise. However, the effects of environmental noise on postoperative pain are unclear. OBJECTIVES This study aimed to assess the association between postoperative noise and pain. METHODS This prospective study included 182 women who underwent cesarean sections. Postoperative noise was continuously recorded, and pain intensity at rest was assessed using a numerical rating scale (NRS) for 0-6, 6-12, 12-18, and 18-24 h after the patients were returned to the ward. Cumulative pain scores were calculated by summing the NRS scores at each time point and comprised the primary outcome. The maximum pain NRS score and analgesic consumption during the 24 h after surgery were also recorded. RESULTS Mean environmental noise intensity during the daytime was an independent factor for cumulative pain scores, maximum pain scores, and analgesic use during the first postoperative 24 h (β, 0.37; 95% CI, 0.21-0.53 and β, 0.12; 95% CI, 0.07-0.17; P < 0.001 for both; β, 0.86; 95% CI, 0.25-1.46; P = 0.006). Cumulative and maximum NRS pain scores as well as the incidence of NRS ≥ 4 were significantly higher in patients under mean daytime environmental noise of ≥58, than <58 decibels (dB) (8.0 [6.0-11.3] vs. 6.0 (5.0-7.0); 3.0 [2.0-4.0] vs. 2.0 [2.0-2.0, and 25.6% vs. 11.0%; RR, 2.32; 95% CI, 1.19-4.54, respectively; P < 0.001 for all). CONCLUSIONS Higher-level postoperative noise exposure was associated with more severe postoperative pain and increased analgesic needs, as well as a higher incidence of moderate-to-severe pain in patients recovering from cesarean delivery. Our findings indicate that reducing environmental ward noise might benefit for postoperative pain management.
Collapse
Affiliation(s)
- Wenjun Ou
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chengkun Tao
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yang Zhang
- Department of Gynaecology and Obstetrics, Linshui Branch of The Second Affiliated Hospital of Chongqing Medical University, Sichuan, China
| | - Min Gan
- Department of Gynaecology and Obstetrics, Linshui Branch of The Second Affiliated Hospital of Chongqing Medical University, Sichuan, China
| | - Yan Xie
- Department of Gynaecology and Obstetrics, Linshui Branch of The Second Affiliated Hospital of Chongqing Medical University, Sichuan, China
| | - Yingcai Wu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xuemei Zheng
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bin Shu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
| | - Fang Xu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
| |
Collapse
|
13
|
Meillère A, Buchanan KL, Eastwood JR, Mariette MM. Pre- and postnatal noise directly impairs avian development, with fitness consequences. Science 2024; 384:475-480. [PMID: 38662819 DOI: 10.1126/science.ade5868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/28/2024] [Indexed: 05/03/2024]
Abstract
Noise pollution is expanding at an unprecedented rate and is increasingly associated with impaired reproduction and development across taxa. However, whether noise sound waves are intrinsically harmful for developing young-or merely disturb parents-and the fitness consequences of early exposure remain unknown. Here, by only manipulating the offspring, we show that sole exposure to noise in early life in zebra finches has fitness consequences and causes embryonic death during exposure. Exposure to pre- and postnatal traffic noise cumulatively impaired nestling growth and physiology and aggravated telomere shortening across life stages until adulthood. Consistent with a long-term somatic impact, early life noise exposure, especially prenatally, decreased individual offspring production throughout adulthood. Our findings suggest that the effects of noise pollution are more pervasive than previously realized.
Collapse
Affiliation(s)
- Alizée Meillère
- School of Life and Environmental Sciences, Deakin University, Waurn Ponds, VIC 3216, Australia
- Doñana Biological Station EBD-CSIC, Seville, Spain
| | - Katherine L Buchanan
- School of Life and Environmental Sciences, Deakin University, Waurn Ponds, VIC 3216, Australia
| | - Justin R Eastwood
- School of Life and Environmental Sciences, Deakin University, Waurn Ponds, VIC 3216, Australia
- School of Biological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Mylene M Mariette
- School of Life and Environmental Sciences, Deakin University, Waurn Ponds, VIC 3216, Australia
- Doñana Biological Station EBD-CSIC, Seville, Spain
| |
Collapse
|
14
|
Cowan K, Semmens EO, Lee JY, Walker ES, Smith PG, Fu L, Singleton R, Cox SM, Faiella J, Chassereau L, Lawrence L, Ying J, Baldner J, Garza M, Annett R, Chervinskiy SK, Snowden J. Bronchiolitis recovery and the use of High Efficiency Particulate Air (HEPA) Filters (The BREATHE Study): study protocol for a multi-center, parallel, double-blind, randomized controlled clinical trial. Trials 2024; 25:197. [PMID: 38504367 PMCID: PMC10953277 DOI: 10.1186/s13063-024-08012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Acute viral bronchiolitis is the most common reason for hospitalization of infants in the USA. Infants hospitalized for bronchiolitis are at high risk for recurrent respiratory symptoms and wheeze in the subsequent year, and longer-term adverse respiratory outcomes such as persistent childhood asthma. There are no effective secondary prevention strategies. Multiple factors, including air pollutant exposure, contribute to risk of adverse respiratory outcomes in these infants. Improvement in indoor air quality following hospitalization for bronchiolitis may be a prevention opportunity to reduce symptom burden. Use of stand-alone high efficiency particulate air (HEPA) filtration units is a simple method to reduce particulate matter ≤ 2.5 µm in diameter (PM2.5), a common component of household air pollution that is strongly linked to health effects. METHODS BREATHE is a multi-center, parallel, double-blind, randomized controlled clinical trial. Two hundred twenty-eight children < 12 months of age hospitalized for the first time with bronchiolitis will participate. Children will be randomized 1:1 to receive a 24-week home intervention with filtration units containing HEPA and carbon filters (in the child's sleep space and a common room) or to a control group with units that do not contain HEPA and carbon filters. The primary objective is to determine if use of HEPA filtration units reduces respiratory symptom burden for 24 weeks compared to use of control units. Secondary objectives are to assess the efficacy of the HEPA intervention relative to control on (1) number of unscheduled healthcare visits for respiratory complaints, (2) child quality of life, and (3) average PM2.5 levels in the home. DISCUSSION We propose to test the use of HEPA filtration to improve indoor air quality as a strategy to reduce post-bronchiolitis respiratory symptom burden in at-risk infants with severe bronchiolitis. If the intervention proves successful, this trial will support use of HEPA filtration for children with bronchiolitis to reduce respiratory symptom burden following hospitalization. TRIAL REGISTRATION NCT05615870. Registered on November 14, 2022.
Collapse
Affiliation(s)
- Kelly Cowan
- Department of Pediatrics, Larner College of Medicine at the University of Vermont, 111 Colchester Ave, Smith 5, Burlington, VT, 05403, USA.
| | - Erin O Semmens
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Jeannette Y Lee
- University of Arkansas for Medical Sciences, 4301 West Markham, #781, Little Rock, AR, 72205, USA
| | - Ethan S Walker
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Paul G Smith
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Linda Fu
- National Institutes of Health Environmental Influences On Child, Health Outcomes (ECHO) Program, 11601, Landsdown Street, Rockville, MD, 20852, USA
| | - Rosalyn Singleton
- Alaska Native Tribal Health Consortium, AIP-CDC, 4055 Tudor Centre Drive, Anchorage, AK, 99508, USA
| | - Sara McClure Cox
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Jennifer Faiella
- School of Public and Community Health Sciences, University of Montana, 177 Skaggs, Missoula, MT, 59812-2016, USA
| | - Laurie Chassereau
- University of Vermont, Given C421, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Lora Lawrence
- IDeA States Pediatric Network Data Coordination and Operations Center, 13 Children's Way, Slot 512-35, Little Rock, AR, 72202, USA
| | - Jun Ying
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Mail Stop F496, Academic Office One L15-3407, 12631 E 17th Avenue, Aurora, CO, 80045, USA
| | - Jaime Baldner
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA
| | - Maryam Garza
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA
| | - Robert Annett
- University of New Mexico Health Sciences Center, Albuquerque, NM, 87106, USA
| | - Sheva K Chervinskiy
- Cook Children's Department of Immunology, 1500 Cooper St, Fort Worth, TX, 76104, USA
| | - Jessica Snowden
- IDeA States Pediatric Network Data Coordination and Operations Center, 13 Children's Way, Slot 512-35, Little Rock, AR, 72202, USA
| |
Collapse
|
15
|
Segal O, Moyal D. Listening Preference for Child-Directed Speech Versus Time-Reversed Speech in Moderate-Preterm Infants Compared to Full-Term Infants. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:900-916. [PMID: 38394254 DOI: 10.1044/2023_jslhr-23-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE The purpose of the present study was to examine whether there is a listening preference for child-directed speech (CDS) over backward speech in moderate-preterm infants (MPIs). METHOD Eighteen MPIs of gestational age of 32.0 weeks (range: 32-34.06 weeks), chronological age of 8.09 months, and maturation age of 6.48 months served as the experimental group. The two control groups consisted of a total of 36 infants-20 full-term infants matched for chronological age and 16 full-term infants matched for maturation age. The infants were tested using the central fixation procedure and were presented with 16 trials of CDS and backward speech. A follow-up was conducted 5 years after the initial experiment using a developmental and a five-item parent questionnaire. RESULTS MPIs did not demonstrate a preference for CDS over backward speech, whereas both control groups demonstrated a listening preference for CDS over backward speech. MPIs showed a delayed use of first words and word combinations and lower scores on the five-item questionnaire compared to term infants. Twelve MPIs (67%) did not demonstrate a preference for CDS over backward speech. Four of them (33%) were later diagnosed with neurodevelopmental disorders. CONCLUSIONS The lack of preference for CDS over backward speech in the MPIs group suggests delayed developmental pattern of speech processing compared to full-term peers. Delays in neurological maturation as well as listening experience in an unregulated environment outside the uterus during a sensitive period of brain development may affect the recognition of phonological and prosodic patterns that support listening preference for speech over backward speech.
Collapse
|
16
|
Fusch G, Mohamed S, Bakry A, Li EW, Dutta S, Helou SE, Fusch C. Analysis of noise levels in the neonatal intensive care unit: the impact of clinical microsystems. Eur J Pediatr 2024; 183:1245-1254. [PMID: 38095715 DOI: 10.1007/s00431-023-05335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 03/20/2024]
Abstract
Reorganization of neonatal intensive care by introducing clinical microsystems may help to allocate nursing time more appropriately to the needs of patients. However, there is concern that cohorting infants according to acuity may enhance noise levels. This single-center study investigated the impact of reorganization of neonatal intensive care unit by implementing clinical microsystems in a Level III NICU on environmental noise. This prospective study measured 24-h noise levels over a period of 6 months during pre- and post-implementation of microsystems cohorting infants of similar acuity. Comparative analyses of the mixed acuity (i.e., before) and the cohorting (i.e., after) model were performed by creating daily profiles from continuous noise level measurements and calculating the length of exposure to predefined noise levels. Compared to baseline daytime measurements, noise levels were 3-6 dBA higher during physician handover. Noise levels were 2-3 dBA lower on weekends and 3-4 dBA lower at night, independent of the organizational model. The introduction of clinical microsystems slightly increased average noise levels for high-acuity pods (A and B) but produced a much more substantial decrease for low-acuity pods (E), leading to an overall reduction in unit-wide noise levels. Conclusion: Our data show that noise levels are more driven by human behavior than by technical devices. Implementation of microsystems may help to reduce noise exposure in the lower acuity pods in a NICU. What is Known: • Excessive noise levels can lead to adverse effects on the health and development of premature infants and other critically ill newborns. • The reorganization of the neonatal intensive care unit following the clinical microsystems principles might improve quality of care but also affect noise exposure of staff and patients. What is New: • The transition from a mixed -acuity to cohorting model is associated with an overall reduction in noise levels, particularly in low-acuity pods requiring less nursing care. • Nevertheless, baseline noise levels in both models exceeded the standard permissible limits.
Collapse
Affiliation(s)
- Gerhard Fusch
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Saber Mohamed
- Department of Mechanical Engineering, McMaster University, Hamilton, Canada
| | - Ahmad Bakry
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Edward W Li
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Sourabh Dutta
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
- Department of Pediatrics, Neonatology Unit, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Salhab El Helou
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Christoph Fusch
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada.
- Department of Pediatrics, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| |
Collapse
|
17
|
Anbalagan S, Velasquez JH, Staufert Gutierrez D, Devagiri S, Nieto D, Ankola P. Music for pain relief of minor procedures in term neonates. Pediatr Res 2024; 95:679-683. [PMID: 37640940 DOI: 10.1038/s41390-023-02746-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Music for neonatal pain has not been exclusively studied in term neonates in a well-designed trial compared to the standard of care. This study aims to assess the effectiveness of music intervention as an adjuvant in relieving acute pain in term newborns undergoing minor painful procedures. METHODS This randomized, controlled, blinded trial included any term neonate undergoing heel prick. Both control and intervention groups received oral sucrose 2 min before heel prick. Intervention group was exposed to 'Bedtime Mozart' lullaby recorded music via bedside speakers. Pain was measured using Neonatal Infant Pain Scale (NIPS) at 1-min intervals. Investigators were blinded using noise-canceling headphones that played random music. RESULTS A total of 100 neonates were enrolled. Mean gestational age was 39.2 weeks, and mean duration of the procedure was 113 s. Music group was found to have significantly lower pain scores [OR = 0.42 (0.31, 0.56), p < 0.001]. Baseline NIPS scores were similar across groups and there was no interaction effect between groups and time. When NIPS were categorized as pain and no pain, there continued to be statistically significant lower NIPS scores in the music group (p < 0.001). CONCLUSION Recorded music, in addition to sucrose, is efficacious in reducing pain, encouraging its use in term neonates. IMPACT Recorded music effectively reduces pain induced by minor procedures in term neonates. Clinical studies have shown that live and recorded music induces changes in vital signs and pain scores in the NICU's predominantly preterm population. Most of these studies were also conducted in the white ethnic population. Our study objectively proves reduction in pain scores by using recorded music in a randomized, controlled, blinded study of predominantly non-white, term neonates. Recorded music is effective in reducing acute pain in term neonates and can be widely used even in low-resource nurseries.
Collapse
Affiliation(s)
- Saminathan Anbalagan
- Department of Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, USA.
- Department of Pediatrics/Neonatology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Juan H Velasquez
- Department of Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, USA
- Department of Pediatrics/Neonatology, University of Southern California, Los Angeles, CA, USA
| | - Denisse Staufert Gutierrez
- Department of Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, USA
- Department of Pediatrics/Developmental Medicine, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Sailaja Devagiri
- Department of Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, USA
- Department of Pediatrics/Neonatology, East Carolina University, Greenville, NC, USA
| | - Daniel Nieto
- Department of Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, USA
- Department of Pediatrics, Family Health Centers of Southwest, Florida, Cape Coral, FL, USA
| | - Pratibha Ankola
- Department of Pediatrics, Lincoln Medical & Mental Health Center, Bronx, NY, USA
- Department of Obstetrics/Neonatology, BronxCare Health System & Icahn School of Medicine, Bronx, NY, USA
| |
Collapse
|
18
|
Lisanti AJ, Vittner DJ, Peterson J, Van Bergen AH, Miller TA, Gordon EE, Negrin KA, Desai H, Willette S, Jones MB, Caprarola SD, Jones AJ, Helman SM, Smith J, Anton CM, Bear LM, Malik L, Russell SK, Mieczkowski DJ, Hamilton BO, McCoy M, Feldman Y, Steltzer M, Savoca ML, Spatz DL, Butler SC. Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2023; 33:2521-2538. [PMID: 36994672 PMCID: PMC10544686 DOI: 10.1017/s1047951123000525] [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] [Indexed: 03/31/2023]
Abstract
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
Collapse
Affiliation(s)
- Amy J. Lisanti
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA, Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dorothy J. Vittner
- Egan School of Nursing and Health Studies, Fairfield University Fairfield, CT, USA, Connecticut Children’s, Hartford, CT, USA
| | | | - Andrew H. Van Bergen
- Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Thomas A. Miller
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Erin E. Gordon
- DO, Inpatient Cardiac Neurodevelopment Program, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karli A Negrin
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Hema Desai
- Rehabilitation Services, CHOC Children’s Hospital, Orange, CA, USA
| | - Suzie Willette
- Department of Speech-Language Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Melissa B Jones
- Cardiac Critical Care, Children’s National Hospital, Washington DC USA
| | - Sherrill D. Caprarola
- Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Anna J. Jones
- Office of Advanced Practice Providers, UT Southwestern Medical Center, Dallas, TX, USA, Heart Center, Children’s Health, Dallas, TX, USA
| | - Stephanie M. Helman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jodi Smith
- Parent Representative, The Mended Hearts, Inc., Program Director, Richmond, VA, USA
| | - Corinne M. Anton
- Department of Psychology and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA, Department of Cardiology, Children’s Health, Dallas, Texas, USA
| | - Laurel M. Bear
- Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI, USA
| | - Lauren Malik
- Department of Acute Care Therapy Services, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah K. Russell
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Dana J. Mieczkowski
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Bridy O. Hamilton
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Meghan McCoy
- Pediatric and Congenital Heart Center, Duke University Hospital, Durham, NC, USA
| | - Yvette Feldman
- Nursing & Patient Care Center of Excellence, St. Luke’s Health System, Boise, ID, USA
| | - Michelle Steltzer
- Single Ventricle Center of Excellence, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Melanie L Savoca
- Department of Clinical Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diane L. Spatz
- Department of Family & Community Health, University of Pennsylvania School of Nursing, The Center for Pediatric Nursing Research and Evidence Based Practice, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samantha C. Butler
- Department of Psychiatry (Psychology), Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
Mata Ferro M, Falcó Pegueroles A, Fernández Lorenzo R, Saz Roy MÁ, Rodríguez Forner O, Estrada Jurado CM, Bonet Julià N, Geli Benito C, Hernández Hernández R, Bosch Alcaraz A. The effect of a live music therapy intervention on critically ill paediatric patients in the intensive care unit: A quasi-experimental pretest-posttest study. Aust Crit Care 2023; 36:967-973. [PMID: 36868934 DOI: 10.1016/j.aucc.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/29/2022] [Accepted: 01/07/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Music therapy as a nonpharmacological means of managing patient pain, anxiety, and discomfort is a recognised technique, although it is not widely used in the paediatric intensive care unit (PICU). AIM The aim of this study was to assess the clinical effect of a live music therapy intervention on vital signs and levels of discomfort and pain for paediatric patients in the PICU. METHODS This was a quasi-experimental pretest-posttest study. The music therapy intervention was carried out by two music therapists who were specifically trained, each possessing a master's degree in the field of hospital music therapy. Ten minutes before the start of the music therapy session, the investigators recorded the vital signs of the patients and assessed their levels of discomfort and pain. The procedure was repeated at the start of the intervention; at 2, 5, and 10 min during the intervention; and at 10 min following the conclusion of the intervention. RESULTS Two hundred fifty-nine patients were included; 55.2% were male, with a median age of 1 year (0-21). A total of 96 (37.1%) patients suffered a chronic illness. The main reason for PICU admission was respiratory illness, at 50.2% (n = 130). Significantly lower values were observed for heart rate (p = 0.002), breathing rate (p < 0.001), and degree of discomfort (p < 0.001) during the music therapy session. CONCLUSIONS Live music therapy results in reduced heart rates, breathing rates, and paediatric patient discomfort levels. Although music therapy is not widely used in the PICU, our results suggest that using interventions such as that used in this study could help reduce patient discomfort.
Collapse
Affiliation(s)
- María Mata Ferro
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Anna Falcó Pegueroles
- Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
| | | | - M Ángeles Saz Roy
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
| | | | | | | | | | | | - Alejandro Bosch Alcaraz
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain; Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain.
| |
Collapse
|
20
|
Balk SJ, Bochner RE, Ramdhanie MA, Reilly BK. Preventing Excessive Noise Exposure in Infants, Children, and Adolescents. Pediatrics 2023; 152:e2023063753. [PMID: 37864408 DOI: 10.1542/peds.2023-063753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Sophie J Balk
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Risa E Bochner
- Department of Pediatrics, New York City Health and Hospitals Harlem, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Brian K Reilly
- Otolaryngology and Pediatrics, George Washington University Medical School, Children's National Hospital, Washington, District of Columbia
| |
Collapse
|
21
|
Aminudin N, Franta J, Bowden A, Corcoran JD, El-Khuffash A, McCallion N. Noise exposure exceeded safe limits during neonatal care and road transport but was reduced by active noise cancelling. Acta Paediatr 2023; 112:2060-2065. [PMID: 37405936 DOI: 10.1111/apa.16900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
AIM Noise levels above 45 dB in a neonatal intensive care unit (NICU) and 60 dB during neonatal transport are recognised hazards, but protective equipment is not standard. We measured noise levels in both settings, with and without noise protection. METHODS Peak sound and equivalent continuous sound levels were measured in a NICU and during road transport, at a mannequin's ear and inside and outside the incubator. Recordings were made without protective earwear, with noise protecting earmuffs and with active noise cancelling headphones. RESULTS In the NICU, the peak levels at the ear, and inside and outside the incubator, were 61, 68 and 76 dB. The equivalent continuous sound levels were 45, 54 and 59 dB. During road transport, the respective levels were 70, 77 and 83 dB and 54, 62 and 68 dB. In the NICU, 80% of environmental peak noise reached the ear and this was reduced to 78% with earmuffs and 75% with active noise cancelling. The respective figures during transport were 87% without protection and 72% with active noise cancelling, with an unexpected increase for ear muffs. CONCLUSION Noise levels exceeded safe limits in the NICU and during transport, but active noise cancelling reduced exposure.
Collapse
Affiliation(s)
- Nurul Aminudin
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- National Neonatal Transport Programme, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jan Franta
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- National Neonatal Transport Programme, Dublin, Ireland
| | - Ann Bowden
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- National Neonatal Transport Programme, Dublin, Ireland
| | - John David Corcoran
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Naomi McCallion
- Department of Neonatology, Rotunda Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
22
|
Massa-Buck B, Rastogi D, Rastogi S. Complications associated with incorrect use of nasal CPAP. J Perinatol 2023; 43:975-981. [PMID: 37231122 DOI: 10.1038/s41372-023-01700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
Nasal continuous positive airway pressure (nCPAP) is a safe, effective, non-invasive respiratory modality to deliver positive end expiratory pressure in neonates. Many studies have established its associated improved respiratory outcomes without increase in major morbidities associated with preterm neonates. In contrast, there is paucity in literature addressing complications such as nasal injury, abdominal distention, air leak syndromes (especially pneumothorax), hearing loss, heat and chemical burns, swallowing and aspiration of small components of the nasal interface and delay in escalation of respiratory support associated with the use of nCPAP, most frequently due to its incorrect use. This is a comprehensive review that seeks to address the different complications that are associated with the incorrect use of nCPAP highlighting that these are operator-related and not device-related.
Collapse
Affiliation(s)
- Beri Massa-Buck
- George Washington University Hospital, Division of Neonatology, Children's National Hospital, Washington DC, USA
| | - Deepa Rastogi
- Division of Pediatric Pulmonology, Children's National Hospital, Washington DC, USA
| | - Shantanu Rastogi
- George Washington University Hospital, Division of Neonatology, Children's National Hospital, Washington DC, USA.
| |
Collapse
|
23
|
Bringel JMDA, Abreu I, Muniz MCMC, de Almeida PC, Silva MRG. Excessive Noise in Neonatal Units and the Occupational Stress Experienced by Healthcare Professionals: An Assessment of Burnout and Measurement of Cortisol Levels. Healthcare (Basel) 2023; 11:2002. [PMID: 37510443 PMCID: PMC10379383 DOI: 10.3390/healthcare11142002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Excessive noise in the work environment has been associated with extra-auditory symptoms, which can have harmful long-term effects on individuals. The purpose of this study was to identify noise levels in neonatal intensive care units and investigate their impact on the occurrence of stress among healthcare professionals, using cortisol levels as a biomarker for Burnout Syndrome. This descriptive, observational, and cross-sectional study was conducted in four public teaching hospitals in Fortaleza, Ceará, Brazil. Sound pressure levels in the environment were measured, and questionnaires were administered to collect sociodemographic data and assess perceptions of the work environment and Burnout symptoms. Saliva samples were collected at the beginning and end of work shifts for cortisol quantification. The average sound pressure ranged from 59.9 to 66.4 dB(A), exceeding the recommended levels set by Brazilian and international legislation. Among the 256 participants, the average age was 39.4 years, with 95% being female. The majority (70.9%) were nurses, and 22.7% were physicians. There was no significant association found between noise and Burnout Syndrome, nor with changes in cortisol levels. However, a significant association was observed between the perception of excessive noise and the sensation of a stressful work shift (p = 0.012). All evaluated professionals displayed symptoms of Burnout. The high sound pressure levels indicated that the assessed environments did not meet the recommended standards for acoustic comfort, and this was associated with the participants' perception of stressful work shifts. While Burnout symptoms were evident in our participants, it was not possible to confirm a correlation with high noise levels.
Collapse
Affiliation(s)
| | - Isabel Abreu
- Faculty of Science and Technology, University Fernando Pessoa, 4249-004 Porto, Portugal
- FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal
| | | | - Paulo César de Almeida
- Postgraduate Program in Clinical Health Care Nursing, Universidade Estadual do Ceará, Fortaleza 60714-903, Brazil
| | - Maria-Raquel G Silva
- FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, 4200-150 Porto, Portugal
- CIAS-Research Centre for Anthropology and Health-Human Biology, Health and Society, University of Coimbra, 3000-456 Coimbra, Portugal
- CHRC-Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, 1150-090 Lisbon, Portugal
| |
Collapse
|
24
|
Jaschke AC, Bos AF. Concept and considerations of a medical device: the active noise cancelling incubator. Front Pediatr 2023; 11:1187815. [PMID: 37465419 PMCID: PMC10350684 DOI: 10.3389/fped.2023.1187815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Background An increasingly 24/7 connected and urbanised world has created a silent pandemic of noise-induced hearing loss. Ensuring survival to children born (extremely) preterm is crucial. The incubator is a closed medical device, modifying the internal climate, and thus providing an environment for the child, as safe, warm, and comfortable as possible. While sound outside the incubator is managed and has decreased over the years, managing the noise inside the incubator is still a challenge. Method Using active noise cancelling in an incubator will eliminate unwanted sounds (i.e., from the respirator and heating) inside the incubator, and by adding sophisticated algorithms, normal human speech, neonatal intensive care unit music-based therapeutic interventions, and natural sounds will be sustained for the child in the pod. Applying different methods such as active noise cancelling, motion capture, sonological engineering. and sophisticated machine learning algorithms will be implemented in the development of the incubator. Projected Results A controlled and active sound environment in and around the incubator can in turn promote the wellbeing, neural development, and speech development of the child and minimise distress caused by unwanted noises. While developing the hardware and software pose individual challenges, it is about the system design and aspects contributing to it. On the one hand, it is crucial to measure the auditory range and frequencies in the incubator, as well as the predictable sounds that will have to be played back into the environment. On the other, there are many technical issues that have to be addressed when it comes to algorithms, datasets, delay, microphone technology, transducers, convergence, tracking, impulse control and noise rejection, noise mitigation stability, detection, polarity, and performance. Conclusion Solving a complex problem like this, however, requires a de-disciplinary approach, where each discipline will realise its own shortcomings and boundaries, and in turn will allow for innovations and new avenues. Technical developments used for building the active noise cancellation-incubator have the potential to contribute to improved care solutions for patients, both infants and adults.Code available at: 10.3389/fped.2023.1187815.
Collapse
Affiliation(s)
- Artur C. Jaschke
- Department of Paediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Music Therapy, ArtEZ University of the Arts, Enschede, Netherlands
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge, United Kingdom
| | - Arend F. Bos
- Department of Paediatrics, Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
25
|
Pineda R, Kellner P, Ibrahim C, Smith J. Supporting and Enhancing NICU Sensory Experiences (SENSE), 2nd Edition: An Update on Developmentally Appropriate Interventions for Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 10:961. [PMID: 37371193 DOI: 10.3390/children10060961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023]
Abstract
The Supporting and Enhancing NICU Sensory Experiences (SENSE) program promotes consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for preterm infants each day of NICU hospitalization to optimize infant and parent outcomes. The initial development included an integrative review, stakeholder input (NICU parents and healthcare professionals), and feasibility focus groups. To keep the program updated and evidence-based, a review of the recent evidence and engagement with an advisory team will occur every 5 years to inform changes to the SENSE program. Prior to the launch of the 2nd edition of the SENSE program in 2022, information from a new integrative review of 57 articles, clinician feedback, and a survey identifying the barriers and facilitators to the SENSE program's implementation in a real-world context were combined to inform initial changes. Subsequently, 27 stakeholders (neonatologists, nurse practitioners, clinical nurse specialists, bedside nurses, occupational therapists, physical therapists, speech-language pathologists, and parents) carefully considered the suggested changes, and refinements were made until near consensus was achieved. While the 2nd edition is largely the same as the original SENSE program, the refinements include the following: more inclusive language, clarification on recommended minimum doses, adaptations to allow for variability in how hospitals achieve different levels of light, the addition of visual tracking in the visual domain, and the addition of position changes in the kinesthetic domain.
Collapse
Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
- Department of Pediatrics, Keck School of Medicine, Los Angeles, CA 90089, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Polly Kellner
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
| | - Carolyn Ibrahim
- Department of Health Sciences, Rush University, Chicago, IL 60612, USA
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO 63110, USA
| |
Collapse
|
26
|
Management of Newborns With In Utero Substance Exposure: AWHONN Practice Brief Number 18. Nurs Womens Health 2023; 27:e8-e11. [PMID: 36907796 DOI: 10.1016/j.nwh.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
|
27
|
Management of Newborns With In Utero Substance Exposure: AWHONN Practice Brief Number 18. J Obstet Gynecol Neonatal Nurs 2023; 52:e1-e4. [PMID: 36907797 DOI: 10.1016/j.jogn.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
|
28
|
Imaging modalities and optimized imaging protocols in pregnant patients with cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1579-1589. [PMID: 36688976 DOI: 10.1007/s00261-023-03798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
Medical imaging during pregnancy may be necessary to diagnose conditions that affect the outcome of the mother and fetus. Diagnosis and staging of cancer in pregnant women can be particularly challenging due to fear of inherent risk to the fetus, lack of standardized imaging protocols, and ethical challenges posed while choosing the best imaging option. Ultrasound and MRI, due to lack of ionizing radiation, are preferred over CT and nuclear imaging. The latter may be considered only if the benefits of imaging outweigh maternal and fetal risk without exceeding the cumulative established fetal radiation dose threshold. This article provides an overview of all currently available imaging options that can be used for imaging cancer during pregnancy to support the best possible maternal and fetal outcomes.
Collapse
|
29
|
Ülgen Ö, Barış HE, Aşkan ÖÖ, Akdere SK, Ilgın C, Özdemir H, Bekiroğlu N, Gücüyener K, Özek E, Boran P. Sleep assessment in preterm infants: Use of actigraphy and aEEG. Sleep Med 2023; 101:260-268. [PMID: 36459917 DOI: 10.1016/j.sleep.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Objective methods to monitor the sleep of preterm infants at the neonatal intensive care unit (NICU) are required to prevent potentially adverse neurodevelopmental outcomes. This study aimed to determine the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) against gold standard direct observation (DO) in assessing sleep/wake states of typically developing preterm infants. METHODS This prospective observational study was conducted in a single center level III NICU. Sleep variables were measured using Philips Respironics Mini-Mitter® Actiwatch-2 for 24 h and compared with 8-h matched data of aEEG and DO. Sensitivity-specificity analysis, Cohen's kappa, prevalence-adjusted and bias-adjusted kappa (PABAK), and Bland Altman plots were generated. RESULTS Seventeen preterm infants were recruited. A total of 11252 epochs were studied. Sensitivity (86.4%), agreement rate (67.9%), and predictive value for wake (47.9%) for the actigraphy were highest at the automatic activity threshold whereas specificity (54.5%) and predictive value for sleep (75.5%) were highest at low threshold. The sensitivity of aEEG was 79.3% and the specificity was 54.3%. At all thresholds, the agreement was largely equivalent with low kappas (0.14-0.17) and PABAK coefficients (0.22-0.35) for actigraphy and DO. Moderate agreement was observed between aEEG and DO according to the PABAK coefficient (0.44). Mean differences in sleep parameters were not different between DO and aEEG as well as DO/aEEG and actigraphy at medium threshold (p > 0.05). CONCLUSIONS Actigraphy at medium threshold can be used in depicting sleep in typically developing preterm infants at NICU. aEEG may be an alternative adjunctive method to actigraphy for the evaluation of sleep/wake states in the NICU setting. CLINICAL TRIAL REGISTRATION NUMBER NCT04145362.
Collapse
Affiliation(s)
- Özge Ülgen
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Hatice Ezgi Barış
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Öykü Özbörü Aşkan
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Selda Küçük Akdere
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey
| | - Can Ilgın
- Marmara University, School of Medicine, Division of Public Health, Istanbul, Turkey
| | - Hülya Özdemir
- Marmara University, School of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Nural Bekiroğlu
- Marmara University, School of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Kıvılcım Gücüyener
- Gazi University, School of Medicine, Division of Pediatric Neurology, Ankara, Turkey
| | - Eren Özek
- Marmara University, School of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
| | - Perran Boran
- Marmara University, School of Medicine, Department of Pediatrics, Division of Social Pediatrics, Istanbul, Turkey.
| |
Collapse
|
30
|
Reuter C, Bartha-Doering L, Czedik-Eysenberg I, Maeder M, Bertsch MA, Bibl K, Deindl P, Berger A, Giordano V. Living in a box: Understanding acoustic parameters in the NICU environment. Front Pediatr 2023; 11:1147226. [PMID: 37051427 PMCID: PMC10083238 DOI: 10.3389/fped.2023.1147226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
Background In the last years, a significant body of scientific literature was dedicated to the noisy environment preterm-born infants experience during their admission to Neonatal Intensive Care Units (NICUs). Nonetheless, specific data on sound characteristics within and outside the incubator are missing. Therefore, this study aimed to shed light on noise level and sound characteristics within the incubator, considering the following domain: environmental noise, incubator handling, and respiratory support. Methods The study was performed at the Pediatric Simulation Center at the Medical University of Vienna. Evaluation of noise levels inside and outside the incubator was performed using current signal analysis libraries and toolboxes, and differences between dBA and dBSPL values for the same acoustic noises were investigated. Noise level results were furthermore classed within previously reported sound levels derived from a literature survey. In addition, sound characteristics were evaluated by means of more than 70 temporal, spectral, and modulatory timbre features. Results Our results show high noise levels related to various real-life situations within the NICU environment. Differences have been observed between A weighted (dBA) and unweighted (dBSPL) values for the same acoustic stimulus. Sonically, the incubator showed a dampening effect on sounds (less high frequency components, less brightness/sharpness, less roughness, and noisiness). However, a strong tonal booming component was noticeable, caused by the resonance inside the incubator cavity. Measurements and a numerical model identified a resonance of the incubator at 97 Hz and a reinforcement of the sound components in this range of up to 28 dB. Conclusion Sound characteristics, the strong low-frequency incubator resonance, and levels in dBSPL should be at the forefront of both the development and promotion of incubators when helping to preserve the hearing of premature infants.
Collapse
Affiliation(s)
- Christoph Reuter
- Musicological Department (Acoustics/Music Psychology), University of Vienna, Vienna, Austria
- Correspondence: Christoph Reuter
| | - Lisa Bartha-Doering
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Isabella Czedik-Eysenberg
- Musicological Department (Acoustics/Music Psychology), University of Vienna, Vienna, Austria
- Music Technology and Digital Musicology Lab, Institute for Musicology and Music Pedagogy, Osnabrück University, Osnabrück, Germany
| | - Marcus Maeder
- Department of Engineering Physics and Computation, School of Engineering and Design, Technical University Munich, Munich, Germany
| | - Matthias A. Bertsch
- Department of Music Physiology, University of Music and Performing Arts Vienna, Vienna, Austria
| | - Katharina Bibl
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
31
|
Lärmbelastung einer neonatologischen Intensivstation. ZENTRALBLATT FÜR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2022. [DOI: 10.1007/s40664-022-00486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
32
|
Mayhew KJ, Lawrence SL, Squires JE, Harrison D. Elevated Sound Levels in the Neonatal Intensive Care Unit: What Is Causing the Problem? Adv Neonatal Care 2022; 22:E207-E216. [PMID: 35446264 PMCID: PMC10519292 DOI: 10.1097/anc.0000000000000996] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Premature and sick neonates may require weeks of hospitalization in a noisy neonatal intensive care unit (NICU) environment with sound levels that may reach 120 decibels. The American Academy of Pediatrics recommends a maximum sound level of 45 decibels. PURPOSE To measure sound levels in a level III NICU and to describe contributing environmental factors. METHODS Descriptive quantitative study. Sound levels were measured using a portable sound meter in an open-bay level III NICU. Contributing environmental factors were recorded and analyzed. RESULTS Mean sound levels for day, evening, and night shifts were 83.5, 83, and 80.9 decibels, respectively. Each period of time exceeded the recommended guidelines 90% of the time and was almost double the American Academy of Pediatrics' recommendation. Multiple linear regression findings demonstrated significant factors associated with elevated sound levels including number of neonates, number of people, number of alarms, acuity level, and shift type. Observational data explain 14.5% of elevated sound levels. IMPLICATIONS FOR PRACTICE An understanding of baseline sound levels and contributing environmental factors is the first step in developing strategies to mitigate excessive noise in the NICU. IMPLICATIONS FOR RESEARCH Research should focus on effective and sustainable ways to reduce sound levels in the NICU, including inside the isolette, in order to provide an environment that is conducive to optimal growth and neurodevelopment for preterm and sick infants.
Collapse
Affiliation(s)
- Kelli J. Mayhew
- The Ottawa Hospital, Ottawa, Ontario, Canada (Ms Mayhew and Dr Lawrence); The Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada (Dr Lawrence); University of Ottawa, Ottawa, Ontario, Canada (Ms Mayhew and Drs Lawrence, Squires, and Harrison) The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Dr Squires); and University of Melbourne, Melbourne, Australia (Dr Harrison)
| | - Sarah L. Lawrence
- The Ottawa Hospital, Ottawa, Ontario, Canada (Ms Mayhew and Dr Lawrence); The Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada (Dr Lawrence); University of Ottawa, Ottawa, Ontario, Canada (Ms Mayhew and Drs Lawrence, Squires, and Harrison) The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Dr Squires); and University of Melbourne, Melbourne, Australia (Dr Harrison)
| | - Janet E. Squires
- The Ottawa Hospital, Ottawa, Ontario, Canada (Ms Mayhew and Dr Lawrence); The Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada (Dr Lawrence); University of Ottawa, Ottawa, Ontario, Canada (Ms Mayhew and Drs Lawrence, Squires, and Harrison) The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Dr Squires); and University of Melbourne, Melbourne, Australia (Dr Harrison)
| | - Denise Harrison
- The Ottawa Hospital, Ottawa, Ontario, Canada (Ms Mayhew and Dr Lawrence); The Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada (Dr Lawrence); University of Ottawa, Ottawa, Ontario, Canada (Ms Mayhew and Drs Lawrence, Squires, and Harrison) The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (Dr Squires); and University of Melbourne, Melbourne, Australia (Dr Harrison)
| |
Collapse
|
33
|
Storey HM, Austin J, Davies-White NL, Ransley DG, Hodkinson PD. Navigating Pregnancy for Employees in Civilian Rotary-Wing Aeromedicine. Aerosp Med Hum Perform 2022; 93:866-876. [PMID: 36757253 DOI: 10.3357/amhp.6115.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION: Women of child-bearing age make up an ever-increasing element of the aeromedical workforce in Australia and the UK. However, policy relating to the management of risk for pregnant employees in this sector is often missing or inadequate, with many women facing detrimental impacts on their career progression and financial well-being. For women who choose to continue flying, there is a lack of transparent guidance about the risks of flying within a helicopter in an aeromedical role. While grounding pregnant employees removes some risks, it is at the cost of autonomy and brings other adverse effects for the employee and employer. Updated reflections on this important topic will empower the audience to make informed discussions around pregnancy in aeromedical roles.TOPIC: Applying principles from literature surrounding commercial, military, and medical aviation, the risks to pregnant employees and the fetus are reviewed. These risks are complex and dynamic depending on gestation and underlying medical problems; thus, individualization of risk management is of key importance. In low-risk pregnancies, incapacitation risk is below the usual threshold adopted for safety-sensitive aviation activities. Based on available evidence we have quantified risks where possible and provide guidance on the relevant factors to consider in creating a holistic risk-management framework. The greatest unknown surrounds the risk from vibration, noise, and winching. These are reviewed and suggestions given for discussing this risk. We also highlight the need for policy providing acceptable nonflying options to remove the pressure to continue flying in pregnancy.APPLICATION: Based on a literature review we have generated a framework for understanding and assessing risk relating to pregnant employees in the aeromedical sector. This is intended for use by aeromedical organizations, pregnant employees, and their treating medical practitioners to provide rational and sensible policy and guidance.Storey HM, Austin J, Davies-White NL, Ransley DG, Hodkinson PD. Navigating pregnancy for employees in civilian rotary-wing aeromedicine. Aerosp Med Hum Perform. 2022; 93(12):866-876.
Collapse
|
34
|
Lin TH, Deng J, Chen YC. Using Response Surface for Searching the Nearly Optimal Parameters Combination of the Foam Concrete Muffler. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8128. [PMID: 36431613 PMCID: PMC9692282 DOI: 10.3390/ma15228128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
A car muffler is a device to improve car noise emission. Some conventional mufflers use layers of glass fiber as a material to absorb noise. However, filling glass fiber is an environmentally unfriendly work, mainly manually filling with chop strand fiber. This research selected a composite material of glass fiber and foam concrete to replace chop strand fiber to avoid this hazard and maintain the muffler's good noise reduction performance. A response surface methodology with a two-way factorial experimental design repeated the center point twice is performed. The density of the foamed concrete and the weight of the glass fiber is being considered in order to determine the nearly optimal combination of the values in two factors. The response variable is the loudness sensation in Sone of the noise generated from the muffler. At present, the lowest loudness sensation from the two-way factorial design is 16.6494 Sones, which occurred for a muffler with a formula combination of a density of 0.2 g/cm3 and 40 g of glass fiber. The significance of this paper is the presentation of a new application of foam concrete to the green muffler design. To the best of our knowledge, this unique area has never been tackled in the material application of concrete. We have discovered that foam concrete indeed does an excellent job in terms of noise reduction as compared with that of a market muffler.
Collapse
Affiliation(s)
- Teng-Hsuan Lin
- Department of Environmental Engineering, Da-Yeh University, 168 University Rd., Dacun 515006, Taiwan
| | - Jyhjeng Deng
- Department of Information Management, Da-Yeh University, 168 University Rd., Dacun 515006, Taiwan
| | - Yi-Ching Chen
- Department of Environmental Engineering, Da-Yeh University, 168 University Rd., Dacun 515006, Taiwan
| |
Collapse
|
35
|
Measurement of sound levels in a neonatal intensive care unit of a tertiary care hospital, Karachi, Pakistan. Pediatr Neonatol 2022; 63:618-624. [PMID: 35963810 DOI: 10.1016/j.pedneo.2022.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/09/2022] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND High sound levels in the neonatal intensive care unit (NICU) can alter preterm newborn hemodynamics and cause long-term neuro-developmental delays and hearing loss. The study aims to collate data on sound levels in a level IV NICU of a tertiary care hospital, identify the factors associated with them, and compare them with the international standards set by the World Health Organization (WHO), Environmental Protection Agency (EPA), and American Academy of Pediatrics (AAP). METHODS We carried out a cross-sectional study in NICU from 8th April 2019 to 30th June 2019. Sound levels were recorded for 480 h, using a portable sound meter, the Larson Davis 824. We captured sound levels on alternate days, during different shifts and shift changes and in open pods and single isolation rooms within the NICU. Additionally, we documented the total census, acuity of care, number of staff, number of procedures, and number of items of equipment used. The data was analyzed using t-test, ANOVA, and logistic regression. RESULTS The average sound level (Leq) and the maximum level (Lmax) recorded were 60.66 ± 2.99 dBA and 80.19 ± 2.63 dBA, respectively, which exceeds international recommendations. The sound level gradually decreased from morning to night hours. The major increase in sound was observed during nursing shift change. Similarly, a significant increase in sound was observed in open bays compared to isolation rooms. However, no difference in sound levels was recorded during weekdays and weekends. The number of healthcare professionals and the number of procedures performed were strongly associated with an increased noise level. CONCLUSION Sound levels in NICU were beyond the safety range and international recommendations. We observed a significant sound increment during morning hours and at the time of nursing shift change. High sound levels were associated with increased number of healthcare workers and bedside procedures in NICU.
Collapse
|
36
|
Maternal Voice Exposure and Its Effect on Premature Infants' Feeding Milestones: A Systematic Review. Adv Neonatal Care 2022; 23:E40-E49. [PMID: 36191331 DOI: 10.1097/anc.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Premature infants experience alterations in maternal stimulation (including auditory sensory alteration such as talking or singing to the infant in the neonatal intensive care unit) due to admission to the neonatal intensive care unit. Because of their physiological and neurobehavioral immaturity, infants are at an increased risk of delays in reaching feeding milestones (a key developmental milestone), which often need to be achieved before discharge. PURPOSE This systematic review evaluated the literature regarding the effect of maternal speech on achievement of feeding milestones in premature infants. DATA SOURCES A systematic search of CINAHL, PubMed, Web of Science, and Google Scholar from 2010 to 2021. STUDY SELECTION Studies were selected if they examined the effect of maternal voice interventions on premature infants' feeding milestones. DATA EXTRACTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. RESULTS Six studies were identified. This systematic review of the literature on the effects of maternal voice on feeding milestones in premature infants found equivocal results. IMPLICATIONS FOR PRACTICE Given the inconsistent results, this systematic review does not support a change in clinical practice. However, encouragement of maternal visits is highly recommended as the additional benefits of the mother's presence may extend beyond exposure to maternal voice. IMPLICATIONS FOR RESEARCH More research is needed including use of more homogenous samples, application of recommended decibel levels, and utilization of an adequately powered randomized controlled trial to further examine the effects of maternal voice on feeding milestones.
Collapse
|
37
|
De Luca LM, Malesci R, Gallus R, Melis A, Palmas S, Degni E, Crescio C, Piras ML, Arca Sedda MF, Canu GM, Rizzo D, Olzai MG, Dessole S, Sotgiu G, Fetoni AR, Bussu F. Audiological Risk Factors, Referral Rates and Dropouts: 9 Years of Universal Newborn Hearing Screening in North Sardinia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091362. [PMID: 36138671 PMCID: PMC9497641 DOI: 10.3390/children9091362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
Background: Objectives of the present work were to analyze the prevalence of hearing loss in our population of screened newborns during the first 9 years of the universal newborn hearing screening (UNHS) program at University Hospital Sassari (Italy) (AOU Sassari), to analyze the risk factors involved, and to analyze our effectiveness in terms of referral rates and dropout rates. Methods: Monocentric retrospective study whose target population included all the newborns born or referred to our hospital between 2011 and 2019. Results: From 2011 to 2019, a total of 11,688 babies were enrolled in our screening program. In total, 3.9‱ of wellborn babies and 3.58% of neonatal intensive care unit (NICU) babies had some degree of hearing loss. The most frequently observed risk factors among non-NICU babies were family history of hearing loss (3.34%) and craniofacial anomalies (0.16%), among NICU babies were low birth weight (54.91%) and prematurity (24.33%). In the multivariate analysis, family history of hearing loss (p < 0.001), NICU (p < 0.001), craniofacial anomalies (p < 0.001), low birth weight (<1500 g) (p = 0.04) and HIV (p = 0.03) were confirmed as risk factors. Conclusions: Our data are largely consistent with the literature and most results were expected, one relevant exception being the possible role of NICU as a confounding factor and the limited number of risk factors confirmed in the multivariate analysis.
Collapse
Affiliation(s)
- Laura Maria De Luca
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Rita Malesci
- Audiology Section, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, 80138 Naples, Italy
| | - Roberto Gallus
- Otolaryngology, Mater Olbia Hospital, 07026 Olbia, Italy
- Correspondence: ; Tel.: +39-3284867021
| | - Andrea Melis
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Sara Palmas
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Emilia Degni
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Claudia Crescio
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Maria Lucia Piras
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | | | - Giovanna Maria Canu
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Davide Rizzo
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Otolaryngology Division, Department of Medical, Surgical and Experimental Science, University of Sassari, 07100 Sassari, Italy
| | - Mauro Giorgio Olzai
- Neonatology and Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
| | - Salvatore Dessole
- Gynecologic and Obstetric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Anna Rita Fetoni
- Audiology Section, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University, 80138 Naples, Italy
| | - Francesco Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria, 07100 Sassari, Italy
- Otolaryngology Division, Department of Medical, Surgical and Experimental Science, University of Sassari, 07100 Sassari, Italy
| |
Collapse
|
38
|
Arnon S, Epstein S, Ghetti C, Bauer-Rusek S, Taitelbaum-Swead R, Yakobson D. Music Therapy Intervention in an Open Bay Neonatal Intensive Care Unit Room Is Associated with Less Noise and Higher Signal to Noise Ratios: A Case-Control Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081187. [PMID: 36010077 PMCID: PMC9406854 DOI: 10.3390/children9081187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Noise reduction in the Neonatal Intensive Care Unit (NICU) is important for neurodevelopment, but the impact of music therapy on noise is not yet known. OBJECTIVE To investigate the effect of music therapy (MT) on noise levels, and whether individual MT (IMT) or environmental MT (EMT) increases meaningful signal-to-noise ratios (SNR). STUDY DESIGN This case-control study was conducted in a level III NICU. Noise levels were recorded simultaneously from two open bay rooms, with a maximum of 10 infants in each room: one with MT and the other without. MT sessions were carried out for approximately 45 min with either IMT or EMT, implemented according to the Rhythm Breath and Lullaby principles. Noise production data were recorded for 4 h on 26 occasions of EMT and IMT, and analyzed using R version 4.0.2 software. RESULTS Overall average equivalent continuous noise levels (Leq) were lower in the room with MT as compared to the room without MT (53.1 (3.6) vs. 61.4 (4.7) dBA, p = 0.02, d = 2.1 (CI, 0.82, 3.42). IMT was associated with lower overall Leq levels as compared to EMT (51.2 vs. 56.5 dBA, p = 0.04, d = 1.6 (CI, 0.53, 1.97). The lowest sound levels with MT occurred approximately 60 min after the MT started (46 ± 3.9 dBA), with a gradual increase during the remaining recording time, but still significantly lower compared to the room without MT. The SNR was higher (18.1 vs. 10.3 dBA, p = 0.01, d = 2.8 (CI, 1.3, 3.86)) in the room with MT than in the room without MT. CONCLUSION Integrating MT modalities such as IMT and EMT in an open bay NICU room helps reduce noise. Both MT modalities resulted in higher SNR compared to the control room, which may indicate that they are meaningful for the neurodevelopment of preterm infants.
Collapse
Affiliation(s)
- Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Shulamit Epstein
- School for Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel
| | - Claire Ghetti
- GAMUT-The Grieg Academy Music Therapy Research Centre, University of Bergen, 5020 Bergen, Norway
| | - Sofia Bauer-Rusek
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428163, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | | | - Dana Yakobson
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428163, Israel
- Music Therapy Department, Aalborg University, 9220 Aalborg, Denmark
| |
Collapse
|
39
|
Ziv N, Zagon‐Rogel M, Waisman Y, Rom E, Attias J, Krause I. The effect of environmental noise isolation on bronchiolitis severity in hospitalised children. Acta Paediatr 2022; 111:1795-1800. [PMID: 35642684 DOI: 10.1111/apa.16437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022]
Abstract
AIM Bronchiolitis is an infectious disease, with no effective treatment. Music and Mozart's works specifically are known to have a positive effect on physiological parameters, while noise is considered harmful. We aim to evaluate the short-term effect of environmental noise detachment and/or music listening on the course of bronchiolitis in hospitalised children. METHODS This is a prospective, double-blinded randomised controlled trial. Patients were divided into three intervention groups: 1-Mozart's Sonata, 2-instrumental music, 3-silence. Music was heard via media players and soundproof headphones. Disease severity was evaluated before and after intervention using the Modified Tal score. RESULTS Seventy music sessions were included in the analysis (Mozart n = 23, instrumental n = 22, silence n = 25). A one-point drop in the average bronchiolitis severity score was observed in all three groups from 7.1 (CI 95%, 5 to 9.2) to 6.1 (CI 95%, 4.3 to 7.9), p < 0.001. No significant difference was found between the three groups with respect to change in the severity score before and after the intervention. CONCLUSION Isolation from disturbing sounds heard in paediatric departments could be considered a simple non-invasive intervention in children hospitalised with bronchiolitis. Further studies are warranted to evaluate long-term effects of this intervention and the specific effect of music.
Collapse
Affiliation(s)
- Noa Ziv
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | | | - Yehezkel Waisman
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Emergency Care Schneider Children's Medical Center of Israel Petah Tikva Israel
| | - Eran Rom
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Joseph Attias
- Department of Communication Sciences and Disorders University of Haifa Haifa Israel
- Department of Audiology and Neurophysiology Schneider Children's Medical Center Petach Tikva Israel
| | - Irit Krause
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petah Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| |
Collapse
|
40
|
Shin HJ, Park J, Oh HK, Kim N. Comparison of Effects of Mothers' and Mozart's Lullabies on Physiological Responses, Feeding Volume, and Body Weight of Premature Infants in NICU. Front Public Health 2022; 10:870740. [PMID: 35707055 PMCID: PMC9189372 DOI: 10.3389/fpubh.2022.870740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives The purpose of this study was to compare the effects of mothers' and Mozart's lullabies on physiological parameters, feeding volume, and body weight of premature infants in a neonatal intensive care unit (NICU). Methods This study used a non-equivalent control group, non-synchronized design as a quasi-experimental study. Two intervention groups (recorded mother's lullaby and Mozart's lullaby) and a control group were formed from a total of 65 premature infants: a mother's lullaby group of 22 infants, a Mozart's lullaby group of 22 infants, and a control group of 21 infants not provided with any lullabies. Their physiological parameters included heart rate, blood pressure, respiratory rate, and O2 saturation. The infants' feeding volume and body weight were measured as indicators related to the growth of premature infants. The mother's and Mozart's lullabies were played on a speaker in an incubator for 15 min for 7 consecutive days per group. Results There were significant differences in the mean difference before and after intervention in neonatal heart rate (χ2 = 45.03, P < 0.001), systolic pressure (F = 43.29, P < 0.001), diastolic pressure (χ2 = 33.01, P < 0.001), respiratory rate (F = 76.06, P < 0.001), and O2 saturation (χ2 = 40.82, P < 0.001) between the three groups. The mean differences of both mother's and Mozart's lullaby groups were significantly higher than those of the routine care group in all physiological parameters, and those of the mother's lullaby group was significantly higher when compared with the Mozart's lullaby group. In repeated-measures ANOVA, there was a significant interaction between time and group in feeding volume (F = 2.46, P = 0.041). However, body weight did not significantly differ in an interaction between time and group (F = 1.75, P = 0.151). Conclusion This study showed beneficial effects of mother's lullaby and Mozart's lullaby on physiological parameters. Especially, the mother's lullaby was found to significantly improve all physiological parameters and feeding volume of premature infants in the NICU compared to Mozart's lullaby group. Therefore, we recommend the regular integration of the mother's lullaby into supportive care of premature infants in the NICU, as this intervention highlights the need for mothers to participate in their care. Trial Registration ClinicalTrials.gov, identifier: KCT0004842 (https://cris.nih.go.kr).
Collapse
Affiliation(s)
- Hyo-Jin Shin
- College of Nursing, Keimyung University, Daegu, South Korea
| | - Jooyeon Park
- Department of Nursing, Daegu University, Daegu, South Korea
| | - Hye-Kyung Oh
- Department of Nursing, Daegu University, Daegu, South Korea
| | - Nahyun Kim
- College of Nursing, Keimyung University, Daegu, South Korea
| |
Collapse
|
41
|
How Could Nanomedicine Improve the Safety of Contrast Agents for MRI during Pregnancy? SCI 2022. [DOI: 10.3390/sci4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnancy is a delicate state, during which timely investigation of possible physiological anomalies is essential to reduce the risk of maternal and fetal complications. Medical imaging encompasses different technologies to image the human body for the diagnosis, course of treatment management, and follow-up of diseases. Ultrasound (US) is currently the imaging system of choice for pregnant patients. However, sonographic evaluations can be non-effective or give ambiguous results. Therefore, magnetic resonance imaging (MRI), due to its excellent tissue penetration, the possibility of acquisition of three-dimensional anatomical information, and its high spatial resolution, is considered a valid diagnostical alternative. Nevertheless, currently employed contrast agents to improve the MRI image quality are harmful to the fetus. Because of their ability to cross the placenta, their use on pregnant patients is avoided. This review will firstly recapitulate the most common non-obstetrical, obstetrical, and fetal indications for magnetic resonance imaging on pregnant women. Fetal safety risks, due to the use of strong magnetic fields and exogenous contrast agents, will be presented. Then, possible advantages of nanostructured contrast agents compared to current molecular ones are explored. Nanosystems’ characteristics affecting contrast efficiency, and their potential for improving contrast-enhanced MRI’s safety in pregnant women, are discussed. Lastly, promising examples of nanoparticles as safer alternatives to current MRI contrast agents in pregnancy are discussed.
Collapse
|
42
|
Li Y, Zhang J, Yang C, Xia B. Effects of maternal sound stimulation on preterm infants: A systematic review and meta‐analysis. Int J Nurs Pract 2022; 29:e13039. [PMID: 35187754 DOI: 10.1111/ijn.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 10/20/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the effects of maternal sound stimulation on preterm infants. BACKGROUND With an increased focus of studies on maternal sound stimulation for preterm infants, there is a need for an up-to-date systematic review and meta-analysis of randomized controlled trials to measure the effects of maternal sound stimulation on preterm infants. DESIGN A systematic review and meta-analysis. DATA SOURCES We searched PubMed, EMBASE, the Cochrane Library, CINAHL Complete, VIP Journal Integration Platform, China National Knowledge Infrastructure, Wanfang Data and China Biology Medicine disc from database establishment to 28 April 2021. REVIEW METHODS We conducted the meta-analysis using Review Manager 5.3. Integrative description was used for data that were not suitable for meta-analysis. RESULTS A total of 380 studies between 1979 and 2021 were retrieved and 26 were included in this systematic review. Maternal sound stimulation could significantly reduce the pain level and increase the comfort level of preterm infants during a painful procedure. Compared with routine care, maternal sound stimulation could help preterm infants achieve better physiological stability by reducing their heart rate and increasing their oxygen saturation. CONCLUSION Maternal sound stimulation is a feasible and effective intervention for preterm infants, which is highly recommended in the clinical setting.
Collapse
Affiliation(s)
- Yawei Li
- School of Health Sciences Wuhan University Wuhan China
- Henan Provincial Health Publicity and Education Center Zhengzhou China
| | - Jun Zhang
- School of Health Sciences Wuhan University Wuhan China
| | - Chao Yang
- School of Health Sciences Wuhan University Wuhan China
| | - Biying Xia
- Ruijin Hospital, School of Medicine Shanghai Jiaotong University Shanghai China
| |
Collapse
|
43
|
Mu SC, Chien YH, Lai PZ, Chao KY. Helmet Ventilation for Pediatric Patients During the COVID-19 Pandemic: A Narrative Review. Front Pediatr 2022; 10:839476. [PMID: 35186812 PMCID: PMC8847782 DOI: 10.3389/fped.2022.839476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 12/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pin-Zhen Lai
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
44
|
Capriolo C, Viscardi RM, Broderick KA, Nassebeh S, Kochan M, Solanki NS, Leung JC. Assessment of Neonatal Intensive Care Unit Sound Exposure Using a Smartphone Application. Am J Perinatol 2022; 39:189-194. [PMID: 32702769 DOI: 10.1055/s-0040-1714679] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to determine the impact of neonatal intensive care unit (NICU) design and environmental factors on neonatal sound exposures. We hypothesized that monitoring with a smartphone application would identify modifiable environmental factors in different NICU design formats. STUDY DESIGN Minimum, maximum, and peak decibel (dB) recordings were obtained using the Decibel X phone app, and the presence of noise sources was recorded in each patient space at three NICUs over a 6-month period (December 2017 to May 2018). Data were analyzed by Student's t-test and ANOVA with Bonferroni correction. Data were collected at the University of Maryland Medical Center single family room (SFR) level IV and St. Agnes Healthcare hybrid pod/single family room level III NICU, Baltimore, MD and at Prince George's Hospital Center open-pod design Level III NICU, Cheverly, MD. RESULTS All recordings in the three NICUs exceeded the American Academy of Pediatrics (AAP) recommended <45 dB level. The maximum and peak dB were highest in the open pod format level III NICU. Conversations/music alone and combined with other factors contributed to increased sound exposure. Sound exposure varied by day/night shift, with higher day exposures at the level III hybrid and open pod NICUs and higher night exposures at the level IV SFR NICU. CONCLUSION Although sound exposure varied by NICU design, all recordings exceeded the AAP recommendation due, in part, to potentially modifiable environmental factors. A smartphone application may be useful for auditing NICU sound exposure in quality improvements efforts to minimize environmental sound exposure. KEY POINTS · Smartphone application was used to assess NICU sound exposure.. · All cases of sound exposure exceed recommendations.. · A smartphone application was used to identify modifiable factors..
Collapse
Affiliation(s)
- Christine Capriolo
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rose M Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Sepideh Nassebeh
- Department of Pediatrics, St. Agnes Hospital, Baltimore, Maryland
| | - Michael Kochan
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nina S Solanki
- Department of Pediatrics, Jersey Shore University Medical Center Neptune City, Neptune City, New Jersey
| | - Jocelyn C Leung
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
45
|
Singh D, Fusch G. Investigating Noise Exposure to Newborn Infants From Respiratory Support: Methodological Considerations. Cureus 2021; 13:e19353. [PMID: 34909314 PMCID: PMC8653757 DOI: 10.7759/cureus.19353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Excessive noise in the neonatal intensive care unit (NICU) may lead to serious long-term effects on hearing and sensory development in newborns. As such, the maximum allowed noise level is 45 A-weighted decibels (dBA). Studies regarding noise exposure to ventilated preterm infants show inconsistent results; however, these studies also vary considerably in their methodology in terms of noise ascertainment. We hypothesized that the study methodology can significantly influence data quality when measuring noise levels. In this study, we aimed to investigate whether the variations in ventilator noise levels in NICUs could be a result of methodological differences in study designs. Methods A ventilator circuit was set up using nasal continuous positive airway pressure (nCPAP) and high-frequency (HF) modes with nasal prongs. Noise levels were measured using a commercially calibrated noise meter. Three different scenarios were tested: (1) measurements were taken at different angles (0° to 180°), with 180° facing the end of the nasal prongs, without a mannequin, with the membrane/orifice of the noise meter placed 2 mm laterally from the prongs; (2) noise levels were measured at 180° at distances of 0-20 mm from the nasal prongs; (3) measurements were taken in the oral cavity of a life-size intubation mannequin of a newborn baby. Results Overall, the noise levels produced at different settings varied significantly, ranging from 45.7 dB to 82.2 dB. The average environmental background noise was 44.4 dB. Noise levels typically increased as the angle increased, with the highest noise level recorded at 180° for both HF and nCPAP modes, at 58.4 dB and 58.2 dB, respectively. Noise levels recorded at HF were slightly higher than nCPAP values. Furthermore, with regard to distance, the highest mean value, 82.2 dB, was recorded with the noise meter approximately 3 mm from the nasal prongs, and the lowest mean value, 47.6 dB, was recorded at ~20 mm. During trials with the mannequin, the lowest value, 50.1 dB, was recorded at the entrance of the mouth with slightly higher values being recorded within the oral cavity. Conclusion The results indicate that small changes in experimental settings, such as positioning and distance from the nasal prongs, can greatly influence noise levels, particularly above the recommended levels for neonates. These differences may be attributed to wind-generated noise. In summary, some study results are potentially influenced more by the study design than the device type or ventilator setting. We recommend further research and detailed reporting in the NICU to gain deeper insights into the topic.
Collapse
Affiliation(s)
- Devika Singh
- Department of Pediatrics, McMaster University, Hamilton, CAN
| | - Gerhard Fusch
- Department of Pediatrics, McMaster University, Hamilton, CAN.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, CAN
| |
Collapse
|
46
|
Verderber S, Gray S, Suresh-Kumar S, Kercz D, Parshuram C. Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020). HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:368-415. [PMID: 34000842 PMCID: PMC8597197 DOI: 10.1177/19375867211009273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities. METHOD AND RESULT Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications. CONCLUSIONS Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.
Collapse
Affiliation(s)
- Stephen Verderber
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Seth Gray
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
| | - Shivathmikha Suresh-Kumar
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Damian Kercz
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Christopher Parshuram
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
| |
Collapse
|
47
|
Farquharson S, O'Neill R, McGrory L, Gopalakrishnan P. Neonatal Sound Exposure During Respiratory Support. J Paediatr Child Health 2021; 57:1345-1346. [PMID: 34075653 DOI: 10.1111/jpc.15599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Sarah Farquharson
- Paediatric trainee, Royal Hospital for Children, Glasgow, United Kingdom
| | - Rebecca O'Neill
- Paediatric trainee, Royal Hospital for Children, Glasgow, United Kingdom
| | - Lorraine McGrory
- Consultant Neonatologist, University Hospital Wishaw, Wishaw, United Kingdom
| | | |
Collapse
|
48
|
Beken S, Önal E, Gündüz B, Çakir U, Karagöz İ, Kemaloğlu YK. Negative Effects of Noise on NICU Graduates' Cochlear Functions. Fetal Pediatr Pathol 2021; 40:295-304. [PMID: 31984823 DOI: 10.1080/15513815.2019.1710788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate the adverse effects of noise on hearing. Methods: Thirty-two infants that had been admitted to neonatal intensive care unit (NICU) and 25 healthy controls were included in this study. Noise levels were recorded continously during the hospitalization period. Results: All healthy controls passed the hearing screening tests before discharge and on the sixth-month follow up. Hospitalized infants had lower "Distortion Product Auto Acoustic Emission Signal Noise Ratio" (DPOAE SNR) amplitudes (dB) at five frequencies (1001, 1501, 3003, 4004, 6006 Hz in both ears). DPOAE fail rates at 1001 Hz and 1501 Hz were higher than in hospitalized infants (81.8% and 50.0% vs 20.0% and 4.0%). Infants who failed the test at 1001 and 1501 Hz were exposed to noise above the recommended maximum level for longer periods of time. Conclusion: Hearing tests performed at sixth-months of life were adversely affected in NICU graduates.
Collapse
Affiliation(s)
- Serdar Beken
- Acibadem Mehmet Ali Aydinlar University, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey.,Gazi University, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Esra Önal
- Gazi University, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - Bülent Gündüz
- Gazi University, Department of Otorhinolaryngology, Head & Neck Surgery, Audiology Subdivision, Ankara, Turkey
| | - Ufuk Çakir
- Gazi University, Department of Pediatrics, Division of Neonatology, Ankara, Turkey
| | - İrfan Karagöz
- Gazi University, Department of Electrical and Electronics Engineering, Ankara, Turkey
| | - Yusuf Kemal Kemaloğlu
- Gazi University, Department of Otorhinolaryngology, Head & Neck Surgery, Audiology Subdivision, Ankara, Turkey
| |
Collapse
|
49
|
Gaden TS, Ghetti C, Kvestad I, Gold C. The LongSTEP approach: Theoretical framework and intervention protocol for using parent-driven infant-directed singing as resource-oriented music therapy. NORDIC JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1080/08098131.2021.1921014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tora Söderström Gaden
- GAMUT – The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Claire Ghetti
- GAMUT – The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
- GAMUT – the Grieg Academy Music Therapy Research Centre, the Grieg Academy – Department of Music, University of Bergen, Bergen, Norway
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre AS, Bergen, Norway
| | - Christian Gold
- GAMUT – The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre AS, Bergen, Norway
| |
Collapse
|
50
|
Knudsen K, McGill G, Ann Waitzman K, Powell J, Carlson M, Shaffer G, Morris M. Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: Team Education and Family Engagement. Neonatal Netw 2021; 40:212-223. [PMID: 34330871 DOI: 10.1891/11-t-680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
The number of babies born extremely low birth weight surviving to be discharged home after experiencing the NICU continues to improve. Unfortunately, early sensory development for these babies occurs in an environment vastly different from the intended in-utero environment and places them at high risk of long-term neurodevelopmental and neurocognitive challenges. Our goal in the NICU must transition from simply discharge home to supporting the neurosensory development necessary for a thriving lifetime. To accomplish a goal of thriving families and thriving babies, it is clear the NICU interprofessional team must share an understanding of neurosensory development, the neuroprotective strategies safeguarding development, the neuropromotive strategies supporting intended maturational development, and the essential nature of family integration in these processes. We share the educational endeavors of 11 center collaboratives in establishing the foundational knowledge necessary to support preterm babies and their families.
Collapse
|