1. Beal, Judy DNSc, PNP, RN

Article Content

Byers, J. F., Waugh, W. R., & Lowman, L. B. (2006). Neonatal Network: The Journal of Neonatal Nursing, 25(1), 25-32.


Every nurse working in a neonatal intensive care unit (NICU) worries about how noisy environments affect infant stability and long-term outcomes. The physiological changes of apnea, bradycardia, and sleep-wake disturbances are well documented as related to high noise levels; several studies have reported significant high noise levels in most NICUs. The AAP Committee on Environmental Health recommends that infants in the NICU should not be exposed to a loudness equivalent (Leq) of greater than 50 A-weighted decibels. Most NICU equipment well exceeds this.


This descriptive and comparative study with a convenience sample of 134 infants in a 78-bed level III NICU in a large southeastern medical center was a quality performance project. The primary research questions explored (a) whether sound levels differ between a standard NICU room and a developmentally family-centered renovated NICU room and (b) whether sound levels differ between newer and older incubators and radiant warmers. Sound levels were measured using valid and reliable technologies by trained investigators who followed consistent protocols. The renovated NICU was designed according to the developmental standards of care (Als, 1998; Aspaugh & Leick-Rude, 1999; National Association of Neonatal Nurses, 2000) including sound-absorbing floors, wall panels, ceiling tiles, and privacy curtains. All staff in the renovated unit participated in developmental training that included education on noise reduction. The original and control NICU had no physical renovations or staff training.


Findings revealed that the renovated NICU on average was 4-6 dB quieter than the control NICU (p = .000). Despite the renovations and staff education, sound levels remained higher than recommended. Fussy infants, respiratory equipment, and staff conversation were most significant in raising noise levels. Although limited by the one site and the nature of performance evaluation, as well as the descriptive approach (which shows no cause and effect), this study has important implications for nursing. Nurses can play an instrumental role in decreasing noise levels in the NICU by enforcing quiet talking, limiting visitation, turning off unnecessary equipment, and setting alarms at reasonable volumes, which further enforce the standards of developmentally centered care. Further research needs to be conducted in multiple centers with randomly selected larger samples.


Judy Beal




Als, H. (1998). Developmental care in the newborn intensive care unit. Current Opinion in Pediatrics, 10(2), 138-142. [Context Link]


Aspaugh, A., & Leick-Rude, M. K. (1999). Developmental care teams in the neonatal intensive care unit: Survey on current status. Journal of Perinatology, 19(1), 48-52. [Context Link]


National Association of Neonatal Nurses. (2000). Infant and family centered developmental care: Guidelines for practice. Des Plaines, IL: Author. [Context Link]