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The influence of auditory experience on the behavior of preterm newborns
1University of Texas-Houston Medical School, Houston, TX, USA.
Insights
Research on sound's effects on preterm infants offers limited clinical guidance due to flawed studies. Improving nursery quietness may require environmental changes, not just behavior modification.
Area of Science:
- Neonatal care
- Auditory environment research
- Developmental pediatrics
Background:
- The impact of sound on preterm infant behavior and development is a critical area of neonatal care.
- Existing research often lacks methodological rigor, providing insufficient reliable clinical guidance for healthcare providers.
- High ambient noise levels in neonatal intensive care units are a persistent concern.
Purpose of the Study:
- To review and critically evaluate the existing research literature on the effects of sound on preterm infant behavior and development.
- To identify limitations in current studies and provide clinicians with guidance on interpreting findings.
- To propose evidence-based recommendations for managing the auditory environment in neonatal settings.
Main Methods:
- Systematic review of research studies examining sound exposure in preterm infants.
- Critical analysis of study methodologies, including sound level measurement, reporting of infant responses, and consideration of ambient noise.
- Evaluation of interventions aimed at noise reduction in neonatal intensive care units.
Main Results:
- Many studies on sound stimulation in preterm infants are methodologically flawed, limiting their clinical applicability.
- A significant issue is the lack of reporting on ambient nursery noise, which acts as a confounding variable.
- Efforts to reduce noise through staff behavior changes have shown limited success, suggesting environmental modifications may be more effective.
Conclusions:
- Clinicians should exercise caution when interpreting research on sound stimulation for preterm infants.
- Reducing ambient noise in neonatal units is crucial and may necessitate changes to the physical space.
- Facilitating parental interaction and limiting unnecessary sound stimulation are key recommendations for care.
Abstract:
This review of the research literature is addressed to clinicians who care for, interact with, and advise parents of preterm newborns. In summary, research on the effects of sound on preterm infant behavior and development provide only a little reliable clinical guidance as many of the studies are flawed, some badly. Some studies use a high sound level (i.e., loud) stimulus yet fail to report effects of the stimulus on vital signs, movement, and behavioral state. Only a handful of studies report long term effects regardless of the length of exposure to the experimental stimulus. A consistent problem is that the ambient sound in the nursery research setting is neither described nor considered as a facet of the auditory stimulus yet all reports of ambient nursery sound show high levels without respite periods of quiet. Therefore, unless other documentation is provided, ambient nursery noise is likely an unreported confounding variable in these studies. The clinician is cautioned, therefore, to carefully evaluate any finding before implementing an intervention program of sound stimulation with preterm infants. There are many reports of efforts to reduce nursery noise by changing staff behavior but none describes more than marginal success. Given this general failure of noise reduction through behavior change, an alternative is proposed of achieving quiet by changing the crowded, reverberant nature of the physical space. Recommendations for care that can be drawn from this literature include measuring and reducing nursery noise, facilitating parents' efforts to talk and sing to their own babies, and limiting purposefully added sound stimulation to quite specific clinical situations.