International Journal of Pediatric Otorhinolaryngology
The effects of noise reduction by earmuffs on the physiologic and behavioral responses in very low birth weight preterm infants
Introduction
Preterm infants are continuously exposed to loud noises such as alarm, ventilator and phone noises during their stay in the neonatal intensive care unit (NICU) [1]. American Academy of Pediatrics (AAP) recommends noise levels <45 dBA in the NICU, but the noise levels often exceed this level [1], [2]. Earlier studies investigating the effects of loud NICU noises have shown the negative short-term alterations in blood pressure, oxygen saturation, respiratory and heart rates in preterm infants [1]. Inside the incubators, noise levels range from 58 to 75 dbA and preterm infants are not mostly protected from external noise. For example, inside the incubator, the noise level of tapping incubator with fingers is 80 dBA [2]. Previous studies have demonstrated negative synergistic effect of aminoglycosides and noise on hearing in preterm infants cared in an incubator [1], [3]. In addition, Winkel et al. have found that among preterm infants in closed incubator care, 52% had an abnormal audiogram pattern without hearing loss [3]. Studies have shown that reducing the noise level by interventions such as closing the incubator portholes gently and eliminating radios in the NICU result in positive physiologic and behavioral changes [1], [4]. However, a few studies have investigated the benefits of noise reduction by earmuffs in preterm infants [5], [6]. Only one study has demonstrated that when very low birth weight preterm infants in an open warmer or incubator care wore the earmuffs, they had less fluctuation in oxygen saturation and less frequent behavioral state changes [6]. The objective of the present study is to evaluate the effectiveness of the earmuffs in preterm infants solely cared for in closed incubators.
Section snippets
Patients
A comparative prospective design was used, to describe differences related to using the earmuffs in very low birth weight preterm infants. The present study was approved by the Trakya University Local Ethics Committee. Parental consent was obtained from the parents of study patients. The study was conducted in the Neonatal Intensive Care Unit (NICU) of the Trakya University Hospital, where all preterm infants weighing less than 1500 g are routinely nursed in incubators (Air-Shields, Isolette
Results
The present comparative prospective study comprised 20 preterm infants; 6 male and 14 female infants with a mean birth weight of 1220 ± 209 g, a mean gestational age 29.9 ± 2.1 weeks and a mean age at observation 30 ± 2.2 weeks. The first and five minute Apgar scores in preterm infants were 6.6 ± 1.3 and 8.6 ± 1.1, respectively.
The total number of measurements was 320. The means of inside and outside incubator noise levels were 57.83 ± 2.72 and 61.34 ± 3.16 dBA, respectively which was significantly different (p
Discussion
Many NICUs have been built to maintain noise control, using sound absorbing materials, noise-reducing incubators, and separating noisy spaces from patient areas. However, advances in technology have caused more noise sources in the NICU, such as telephones, high-frequency ventilators, and alarms [11], [12]. In this study, the effectiveness of the earmuffs was evaluated for the noise reduction in very low birth weight preterm infants solely cared in closed incubator. We found that noise level
Conflict of interest
The authors do not have any conflict of interest.
Acknowledgements
The residents and nurses in the Trakya University Hospital NICU are gratefully acknowledged for their support and assistance.
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