More Talking, Less Machine Noise Important To Infant Brain in NICUs Interview with:

Bobbi Pineda, PhD Assistant professor of occupational therapy and of pediatrics Washington University School of Medicine St. Louis

Dr. Bobbi Pineda

Bobbi Pineda, PhD
Assistant professor of occupational therapy and of pediatrics
Washington University School of Medicine
St. Louis What is the background for this study?

Response: We published findings in 2014 from a study in which we investigated differences in outcome among preterm infants hospitalized in an open ward NICU compared to those hospitalized in a NICU private room.  In this study, we found that infants who were in the open ward had differences in brain structure by the time they were discharged from the hospital, and by age 2 years they had significantly better language outcomes than those in private rooms.  The study NICU is located in an urban area and cares for families who have a high risk of social challenges, resulting in rates of parent engagement that were not optimal.  However, such findings made us question if the sensory exposure, specifically auditory stimulation, may be significantly reduced in the private room and could explain our findings.  What are the main findings?

Response:  So the current study set out to better understand the differences in the auditory environment in the open ward compared to the private room.  We measured sound exposure using the LENA device placed near the baby’s head,  and it was able  to tell us the amount of silence, noise, ambient noise, distant and meaningful language, and electronic noise,  It also measured the average intensity (in decibels) of sound and the peak decibel stimulus.  Measurements occurred over a 16 hour period and were done at 4 separate time periods; within 2 weeks of birth, at 30 and 34 weeks postmenstrual age, and again at term equivalent age.  We found that there were significant differences in sound exposure in the private room compared to the open ward, on average of almost 2 hours more silence in the 16 hour period in the private room.  Infants were exposed to very little meaningful language, at most 30-35 minutes per 16 hour period, and parent engagement in the NICU was related to more language exposure.  The noise levels were too high, higher than current recommendations from the AAP.  However medical equipment, such as ventilators, made up a lot of the noise in the early environment. What should readers take away from your report?

Response: It may be easy to jump to concluding that we should reduce sound, but it is not that simple.  Certainly reducing sound to the current recommendation by AAP at 45 decibels is needed, but medical equipment make up a lot of the noise at high decibels, and modifying necessary medical equipment poses challenges.  Working to reduce such non-natural sounds is appropriate, but the introduction of developmentally appropriate auditory exposures are related to more favorable outcomes.  Exposure to language and music can improve brain development and foster better outcomes, and when done at the appropriate sound intensity and when developmentally appropriate (based on the infant’s current level of maturity and based on their current medical status), it can have a profound impact.  Therefore, positive auditory stimulation should not necessarily be minimized, but just provided at the appropriate level of intensity and with appropriate timing.

Given that the private NICU room can potentially result in minimal auditory and other sensory exposure, especially when parents are not able to engage in care, it is important to implement a positive sensory exposure plan to ensure that all interaction with the infant (such as from heel sticks and procedures) is not negative, but that positive exposures are given to build networks in the brain and lay the foundations for later development.  Getting parents to engage in positive sensory exposures (such as kangaroo care, reading, singing, massaging) with their infants can also improve infant health, in addition to fostering early parent-child attachment, which can have lifelong implications. What recommendations do you have for future research as a result of this study?

Response: Future research can investigate the effects of positive sensory exposures on outcomes.  There are some studies that have investigated and reported on the effects of kangaroo care, music, language exposure, visual stimulation, and movement.  However, many of them are done for a short period of time and are not poised to provide an appropriate amount of such interventions each day of NICU hospitalization, which can be  3-5 months for infants born prematurely.  Our next step is to determine the effect of an intentional positive sensory exposure plan that is delivered throughout hospitalization, with the goal being to get the parents to deliver it.  

I have no disclosures. Thank you for your contribution to the community.


Roberta Pineda, Polly Durant, Amit Mathur, Terrie Inder, Michael Wallendorf, Bradley L. Schlaggar. Auditory Exposure in the Neonatal Intensive Care Unit: Room Type and Other Predictors. The Journal of Pediatrics, 2017; DOI: 10.1016/j.jpeds.2016.12.072

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on February 10, 2017 by Marie Benz MD FAAD