The Case
A baby girl who is born at 30 weeks of gestation was admitted to your unit 12 hrs. ago. Baby is put under radiant warmer with an intranasal oxygen and an IV cannula for medication. An OG tube is placed for feeding. The newborn is agitated and vital signs keep fluctuating. You are about to conduct your timely nursing care.
The environment
The baby is lying down on 2-fold of towels, no boundaries around the newborn
The radiant warmer is not functional and is alarming every 5 minutes
The light for the examination on the radiant warmer is still turned on
People in the unit are speaking loudly
Mother is standing by the warmer worried
Case Study Questions
What will you assess for, in your routine neurodevelopmental care?
A - Signs of pain and stress
B - The Environment
C - Feeding condition
D - A & C
Why is it so important to provide neurodevelopmental care for this newborn?
A - The gestational age is 30 weeks
B - The newborn requires protection and support
C - The newborn is separated from her mother
D - All
Which signs will you look for in your assessment to identify if the newborn is in stress?
A - Newborn’s hand brought to lip
B - Fingers splaying
C - Flexion of extremities
D - Stable vital signs
Evidence Corner
Topic: Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants
Author: Sibrecht, G., Wroblewska-Seniuk, K., Bruschettini, M. (2024)
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010333.pub4/full?highlightAbstract=noise%7Cnois%7Clevel
Author conclusion:
Via this Cochrane Review it was demonstrated that no studies were able to reduce the sound levels below 45 dB across the neonatal unit. The author found one study that demonstrated the use of silicone earplugs versus no earplugs in newborns less than 1500 grams. The evidence presented was uncertain and could not demonstrate that the earplugs were effective at reducing noise and preventing consequences such as cerebral palsy.
Plain Language:
What is known is noise in neonatal intensive care units are louder than what is experienced in homes and most work environments. The noise is most likely very harmful for premature babies, disturbing their development and often leading to hearing impairment. The American Academy of Pediatrics recommends decreasing noise levels to below 45 decibels (dB) the WHO recommends less than 30 dB. Both are very difficult to achieve. What is known is that 2% to 10% of preterm infants are diagnosed with hearing loss compared to 0.1% of the general child population.
Citation:
ID: CD010333
AU: Sibrecht G
AU: Wróblewska-Seniuk K
AU: Bruschettini M
TI: Noise or sound management in the neonatal intensive care unit for preterm or very low birth weight infants
SO: Cochrane Database of Systematic Reviews YR: 2024 NO: 5 PB: John Wiley & Sons, Ltd SN: 1465-1858 KY: Infant, Premature [growth & development]; Infant, Very Low Birth Weight [growth & development]; Intensive Care Units, Neonatal; Noise [adverse effects]; *Randomized Controlled Trials as Topic; Bias; Ear Protective Devices; Hearing Loss, Noise-Induced [prevention & control]; Humans; Infant, Newborn; Sound DOI: 10.1002/14651858.CD010333.pub4 US: https://doi.org//10.1002/14651858.CD010333.pub4
Interested
A sound ear helps to assess and analyse the environmental sounds .This can be included as a project to improve the quality of care .Even opening the port holes of Incubator creates more than 45 DB. By keeping quiet hours of 2-3 hours in the day and night helps to reduce noise level exposure . Reduce bright light exposure.Dark environment promotes sleep and release of growth hormone. Day and night cycle exposure also can keep in practice to improve neurodevelopmental outcomes.All sensory stimulus and environment needs to be monitored and implementation of necessary restrictions can be helpful.