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Sound and the developing infant in the NICU: conclusions and recommendations for care
1Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard, Tampa, FL 33612, USA.
Insights
Protecting fetal and infant hearing requires careful sound management. Pregnant women should limit exposure to loud, low-frequency noise, and neonatal intensive care units (NICUs) must control noise levels to support infant development and well-being.
Area of Science:
- Neonatal care and audiology
- Maternal-fetal medicine
- Environmental health in healthcare settings
Background:
- Sound exposure significantly impacts fetal and infant development.
- Neonatal Intensive Care Units (NICUs) present unique acoustic challenges.
- Evidence-based guidelines are needed to optimize the auditory environment for high-risk infants.
Purpose of the Study:
- To establish recommendations for managing sound exposure in pregnant women and high-risk infants.
- To synthesize current evidence on the effects of sound on auditory development.
- To guide clinical practice in neonatal intensive care units regarding noise control.
Main Methods:
- A multidisciplinary expert group reviewed existing literature on sound's effects.
- Recommendations were developed based on the best available scientific evidence.
- An Expert Review Panel validated the conclusions and recommendations.
Main Results:
- Pregnant women should avoid prolonged exposure to low-frequency sounds above 65 dB(A).
- NICUs should implement noise assessment and control programs, aiming for specific decibel limits (e.g., hourly Leq of 50 dB(A)).
- Direct auditory stimulation for fetuses is not recommended; parental voice is sufficient. Use of earphones or audio devices for infants is discouraged.
Conclusions:
- Adhering to these recommendations can create a protective auditory environment.
- This environment supports infant sleep, vital sign stability, and speech intelligibility.
- Recommendations aim to mitigate adverse effects on auditory development in high-risk infants.
Objective:
To present the conclusions and associated recommendations for care developed by the Physical and Developmental Environment of the High-Risk Infant Center, Study Group on Neonatal Intensive Care Unit (NICU) Sound, and the Expert Review Panel.
Study Design:
A multidisciplinary group of clinicians and researchers reviewed the literature regarding the effect of sound on the fetus, newborn, and preterm infant and developed recommendations based on the best evidence. An Expert Review Panel reviewed the data and conclusions.
Results:
The following recommendations are developed from the review of the literature and are clarified in the body of the article. (1) Women should avoid prolonged exposure to low-frequency sound levels (< 250 Hz) above 65 dB(A) during pregnancy. (2) Earphones or other devices for sound production should not be used directly attached to the pregnant woman's abdomen. (3) The voice of the mother during normal daily activities, along with the sounds produced by her body and those present in her usual surroundings, is sufficient for normal fetal auditory development. The fetus does not require supplemental stimulation. Programs to supplement the fetal auditory experience cannot be recommended. (4) Infant intensive care units should incorporate a system of regular noise assessment. (5) Sound limit recommendations are to maintain a nursery with an hourly Leq of 50 dB(A), an hourly L10 of 55 dB(A) and a 1-second Lmax of 70 dB(A), all A-weighted, slow response scale. (6) Infant intensive care units should develop and maintain a program of noise control and abatement in order to operate within the recommended permissible noise criteria. (7) Care practices must provide ample opportunity for the infant to hear parent voices live in interaction between parent and infant at the bedside. (8) Earphones and other devices attached to the infant's ears for sound transmission should not be used at any time. (9) There is little evidence to support the use of recorded music or speech in the environment of the high-risk infant. Audio recordings should not be used routinely or left unattended in the environment of the high-risk infant.
Conclusion:
The recommendations, if followed, should provide an environment that will protect sleep, support stable vital signs, improve speech intelligibility for the infant, and reduce potential adverse effects on auditory development.