Bad Request (Invalid Hostname)

Photo by Steve Brown Photography	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Cindy Harmon, RN, says quiet counts so much for newborns that reducing noise was a major consideration when Wesley Medical Center redesigned its NICU.

Babies are known for their ability to make noise. Nature designed their ear-piercing and often heart-rending cries to be impossible to ignore. It’s ironic, therefore, that newborns — especially premature and critically ill babies — suffer when exposed to excessive noise.

A number of studies during the past three decades have repeatedly shown that newborns suffer a range of physical, emotional, and developmental problems when exposed to excessive noise. These findings have led hospitals across the country to reduce noise levels in their neonatal intensive care units by modifying hospital designs, operational policies, and human behavior.

Measurements of noise levels in NICUs dating back to the 1970s found routine sound levels ranging from 70 decibels to as high as 117 decibels; normal conversation usually measures about 60 decibels. For the protection of public health, the U.S. Environmental Protection Agency has proposed a day-night average sound level (DNL) in hospitals of 45 decibels in the daytime and 35 decibels at night.

What’s at stake

One of the earliest studies conducted on the effect of noise on neonates, which was published in 1980, found that noise and frequent disturbances by nurses and physicians may cause hypoxemia in sleeping babies. Other studies indicate that newborns who are exposed to high levels of noise suffer from hearing loss, stress, psychological changes, and habituation problems. Different studies show that newborns benefit from a “quiet hour” and from wearing specially designed earmuffs.

Cindy Harmon, RN, NICU nurse manager for Wesley Medical Center in Wichita, Kan., says reducing noise was one of the primary considerations when the hospital designed and built a new unit in the early 1990s. The previous NICU was a long room that did little to reduce noise. A person at one end of the room could hear someone talking at the other end, says Harmon, who adds that the new unit took some getting used to.

“When we moved in, we could hear the air flow of the ventilators because it was so quiet,” she says.

The babies didn’t complain, and neither did the parents, who often were shocked when they walked into the hospital’s old NICU. “It was hard for parents to walk into that kind of a setting, especially for the first time, and be inundated with the noise,” Harmon says.

Noises off

Harmon says newborns, and especially ill and low-birthweight babies, need every calorie they get to heal and grow. She says dealing with the fear and stress caused by excessive noise robs them of some of those calories. Taking measures to reduce noise, and therefore increase sleep, helps these babies develop their brains.

“The brain is developing, especially in a premature baby, during that period of time in ICU,” Harmon says. “So keeping things within a normal or expected range is going to reduce potential problems or concerns with that brain development.”

Lisa Logan, RNC, assistant nurse manager at Cox Health South in Springfield, Mo., says her facility’s 52-bed NICU follows the recommendations set forth in the Neonatal Individualized Developmental Care Assessment Program, which was developed by Heidelise Als, PhD, of Children’s Hospital Boston. NIDCAP includes measures for reducing noise in NICUs.

“Part of [the program] is developmentally calming the babies [and] bundling the babies,” says Logan, who has been a nurse for 22 years. “All those factors together help to promote growth and development and help decrease their stays here.”

At Cox Health South, the NICU is divided into sections with “quiet please” signs over each doorway. A monitor tracks the unit’s noise level, and a light flashes when the level exceeds the recommended number of decibels. Earmuffs are even used in some instances to protect precious ears. The smallest babies — those in the 1- to 2-pound range — are kept in high-tech “duress beds” that can be closed to keep the baby warm and insulated from noise.

And Logan says you won’t find nurses yelling across the room to each other, either.

“As a general rule, over the years the nurses have learned in their own conversations to speak quieter,” she says.