title: Noise in the Neonatal Intensive Care Unit: What Does the Evidence Tell Us?
abstract: BACKGROUND
  In 2014, more than 10% of all births in the United States were preterm (born at <37-weeks' gestation). These high-risk infants will often spend weeks to months within the neonatal intensive care unit (NICU), where noise levels can easily reach 120 decibels adjusted (dBA) on a regular and sometimes consistent basis. The American Academy of Pediatrics recommends that NICU sound levels remain below 45 dBA to promote optimal growth and development.
  
  
  OBJECTIVE
  The purpose of this evidence-based brief is to critically appraise the literature concerning preterm infant response to noise within the NICU as well as the use of noise interventions to improve health outcomes for the vulnerable preterm infant population.
  
  
  METHODS
  Systematic searches of databases included the Cochrane Library, CINAHL, PubMed, and Science Direct. Included studies were appraised and then synthesized into a narrative summary.
  
  
  RESULTS
  Twenty studies met inclusion criteria for this review. While there are numerous methods that have been shown to reduce noise levels within the NICU, most NICU noise levels remain consistently above the American Academy of Pediatrics recommendations. Studies that assessed interventions found that staff reeducation was critical to sustaining appropriate noise levels.
  
  
  CONCLUSIONS
  Implementing interventions with rigorous attention to initial and continued staff education with engagement and ownership is recommended. This review identifies gaps in intervention studies targeting vulnerable NICU populations.
  
  
  CONCLUSIONS
  While noise interventions show promise in the NICU, additional focused research is needed to further strengthen the evidence and inform clinical practice.
authors.affiliation: University of Connecticut, Storrs (Mss Casavant, Bernier, Andrews, and Bourgoin); Connecticut Children's Medical Center, Neonatal Intensive Care Unit (Ms Bernier); and Connecticut Children's Medical Center, Medical-Surgical 8 Unit (Ms Casavant).
authors.forename: Sharon G
authors.initials: SG
authors.lastname: Casavant
authors.forename: Katherine
authors.initials: K
authors.lastname: Bernier
authors.forename: Sheena
authors.initials: S
authors.lastname: Andrews
authors.forename: Allison
authors.initials: A
authors.lastname: Bourgoin
mesh_terms: D002657:Child Development / Q000502:physiology; D004781:Environmental Exposure / Q000517:prevention & control; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D009622:Noise / Q000517:prevention & control*; D010897:Pitch Discrimination