title: Noise levels of neonatal high-flow nasal cannula devices--an in-vitro study.
abstract: BACKGROUND
  Excessive ambient noise levels have been identified as a potential risk factor for adverse outcome in very preterm infants. Noise level measurements for continuous positive airway pressure (CPAP) devices demonstrated that these constantly exceed current recommendations. The use of high-flow nasal cannula (HFNC) as an alternative non-invasive ventilation modality has become more popular in recent years in neonatal care.
  
  
  OBJECTIVE
  To study noise levels of two HFNC devices commonly used in newborns. As a comparison, noise levels of a continuous flow CPAP device were also studied.
  
  
  METHODS
  In-vitro study. The noise levels of two contemporary HFNC devices (Fisher & Paykel NHF™ and Vapotherm Precision Flow®) and one CPAP device (Dräger Babylog® 8000 plus) were measured in the oral cavity of a newborn manikin in an incubator in a quiet environment. HFNC flows of 4-8 l/min and CPAP pressures of 4-8 cm H2O were applied. The CPAP flow was set at 8 l/min as per unit practice.
  
  
  RESULTS
  Vapotherm HFNC generated the highest noise levels, measuring 81.2-91.4 dB(A) with increasing flow. Fisher & Paykel HFNC noise levels were between 78.8 and 81.2 dB(A). The CPAP device generated the lowest noise levels between 73.9 and 77.4 dB(A).
  
  
  CONCLUSIONS
  Both HFNC devices generated higher noise levels than the CPAP device. All noise levels were far above current recommendations of the American Academy of Pediatrics. In light of the long duration of non-invasive respiratory support of very preterm infants, less noisy devices are required to prevent the potentially adverse effects of continuing excessive noise exposure in the neonatal intensive care unit.
authors: Department of Paediatrics, Mercy Hospital for Women, Melbourne, Vic., Australia. kaikonig@gmail.com
authors: Kai
authors: K
authors: König
authors: Ellen L
authors: EL
authors: Stock
authors: Melanie
authors: M
authors: Jarvis
mesh_terms: D002408:Catheters, Indwelling / Q000009:adverse effects*; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000295:instrumentation; D004784:Environmental Monitoring; D004867:Equipment Design; D006801:Humans; D015931:Intensive Care, Neonatal; D008348:Manikins; D008422:Materials Testing; D009622:Noise; D063087:Noninvasive Ventilation / Q000009:adverse effects* / Q000295:instrumentation*