Neonatal incubators: a toxic sound environment for the preterm infant?*.
BACKGROUND
High sound pressure levels may be harmful to the maturing newborn. Current guidelines suggest that the sound pressure levels within a neonatal intensive care unit should not exceed 45 dB(A). It is likely that environmental noise as well as the noise generated by the incubator fan and respiratory equipment may contribute to the total sound pressure levels. Knowledge of the contribution of each component and source is important to develop effective strategies to reduce noise within the incubator.


OBJECTIVE
The objectives of this study were to determine the sound levels, sound spectra, and major sources of sound within a modern neonatal incubator (Giraffe Omnibed; GE Healthcare, Helsinki, Finland) using a sound simulation study to replicate the conditions of a preterm infant undergoing high-frequency jet ventilation (Life Pulse, Bunnell, UT).


METHODS
Using advanced sound data acquisition and signal processing equipment, we measured and analyzed the sound level at a dummy infant's ear and at the head level outside the enclosure. The sound data time histories were digitally acquired and processed using a digital Fast Fourier Transform algorithm to provide spectra of the sound and cumulative sound pressure levels (dBA). The simulation was done with the incubator cooling fan and ventilator switched on or off. In addition, tests were carried out with the enclosure sides closed and hood down and then with the enclosure sides open and the hood up to determine the importance of interior incubator reverberance on the interior sound levels


RESULTS
With all the equipment off and the hood down, the sound pressure levels were 53 dB(A) inside the incubator. The sound pressure levels increased to 68 dB(A) with all equipment switched on (approximately 10 times louder than recommended). The sound intensity was 6.0 × 10(-8) watts/m(2); this sound level is roughly comparable with that generated by a kitchen exhaust fan on high. Turning the ventilator off reduced the overall sound pressure levels to 64 dB(A) and the sound pressure levels in the low-frequency band of 0 to 100 Hz were reduced by 10 dB(A). The incubator fan generated tones at 200, 400, and 600 Hz that raised the sound level by approximately 2 dB(A)-3 dB(A). Opening the enclosure (with all equipment turned on) reduced the sound levels above 50 Hz by reducing the revereberance within the enclosure.


CONCLUSIONS
The sound levels, especially at low frequencies, within a modern incubator may reach levels that are likely to be harmful to the developing newborn. Much of the noise is at low frequencies and thus difficult to reduce by conventional means. Therefore, advanced forms of noise control are needed to address this issue.
Division of Pulmonary and Critical Care Medicine and Division of Medical and Experimental Ultrasound, Eastern Virginia Medical School, Norfolk, VA, USA. marikpe@evms.edu
Paul E
PE
Marik
Christopher
C
Fuller
Alexander
A
Levitov
Elizabeth
E
Moll
D004781:Environmental Exposure; D005583:Fourier Analysis; D006611:High-Frequency Jet Ventilation; D006801:Humans; D007186:Incubators, Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D009622:Noise; D012815:Signal Processing, Computer-Assisted; D013018:Sound Spectrography