Being early is usually a good thing – except when it comes to being born.
Babies born prematurely or preterm (before 37 weeks) are at risk for serious health problems. Given that about 12 percent of babies in the United States are born preterm, with a full 6 percent born at less than 28 weeks, it is not a condition to be taken lightly.

Fortunately, advances in obstetrics and neonatology, the branch of pediatrics that deals with newborns, have improved the chances for survival for even the earliest arrivals. Although there are hundreds of neonatal intensive care units (NICU’s) across the country, one of the most notable
advances has been the creation of the family-centered single-room NICU.

This specialized unit not only offers a combination of high-tech resources and expert professionals, including neonatologists, nurses and respiratory care therapists, who concentrate solely on caring
for premature infants, it also offers private or semi-private rooms for each sick baby and family. The number of these rare specialized units has increased rapidly, from just 10 a couple of years ago to almost 30 today.

The NICU at Elliot Hospital, a 296-bed acute care facility in Manchester, NH, has gained a reputation as being among the most advanced Level III NICU’s in the state. The unit offers private and semi-private rooms that provide a quiet, calm, nurturing environment for babies and their families. Ultimately, the goal of the NICU at Elliot Hospital was to create a comforting environment for the baby and the parents.

“Every baby has a different gestational age and, as a result, every baby has different needs,” said Liz Castrogiovanni, MS, RN, department director of the NICU and Pediatric/Adolescent Unit at Elliot
Hospital. “Consequently, each room can be changed or customized so that it is environmentally and developmentally appropriate for each child that stays there.”

“Some babies are born full-term, but because of an infection or low blood sugar, they might still require constant nursing care, complicated procedures, continual respiratory support or other intensive interventions. These babies would also be prime candidates for our NICU.”

Regardless of their specific diagnoses, all preemies need to be protected from high noise levels. Because preemies are not protected in their mother’s womb for the complete nine months, they are more susceptible to harm caused by high noise levels than babies who are delivered at full-term. Preemies that are not exposed to such noise levels experience tangible benefits, including:
• Longer, deeper sleep;
• More rapid growth;
• A decrease in time spent on ventilators; and
• Earlier discharge from the hospital.

The need to minimize noise is so critical that it is one of the 24 Recommended Standards for Newborn ICU Design, adopted at the Fifth Consensus Conference on Newborn ICU Design. Compiled by a team of medical and building professionals, including obstetricians, neonatologists, nurses and architects, the standards outline two dozen recommendations that should be incorporated into new NICU construction.

Although these are not mandatory, they are intended to “optimize design within the constraints of available resources and to facilitate excellent health care for the infant in a setting that supports the cen­tral role of the family and the needs of the staff.”

Castrogiovanni explained that each patient room in the NICU has a SL120 mounted directly on the head wall, next to the noisiest equipment and close to the baby’s head for optimal safety. If a noise level higher than 60 decibels occurs, it is detected by the microphone and sent to the monitor, which displays an over-limit indication and triggers a remote amber light. The light is covered by a dome, al­lowing a glow that is bright enough to be seen by the NICU staff but soft enough not disturb the babies.

Castrogiovanni, who has had 15 SL120’s installed in the NICU, stated that the SL120’s have been instrumental in helping the staff perform its noise abate­ment procedures. “If a NICU does not have these products, they are doing their patients, hospital and staff a disservice,” she said.

Considering the sheer volume of equipment that the NICU requires to op­erate, as well as the number of medical professionals who staff it, lowering the noise level by even one decibel presents a formidable challenge.

“After we started measuring noise lev­els, we began to realize that literally everything within a room makes noise,” she said. “In fact, one of our nurses went around one of the rooms and shut or moved everything in it. If the meter went off, she adjusted the object that was too loud. Essentially, we had to fine-tune every item in the room: the doors, every cabinet, all the linen carts, and the chart­ing racks. We bought little bumpers or rubber stoppers and attached them to anything that generated too much noise.”

“We had one room at the end of the hallway where the light kept coming on because the air handling system was not adjusted correctly. It’s an ongoing effort, but we’ve already reduced the noise levels substantially.”

Interestingly, Castrogiovanni highlighted the fact that the actual medical equipment didn’t present as much of a problem as it might have in years past.

“Equipment manufacturers are mak­ing their equipment much less noisy,” she said. “As an example, we put the sound meter inside an older model in­cubator and measured its noise level against the newer ones. The newer ones generate substantially less noise.”

“It’s tough to say with absolute cer­tainty, but my suspicion is that this is a re­sult of the medical device engineers talking with nurses and neonatologists, and understanding that the reduction of noise – in fact, the creation of the calmest environment possible – is the best possible approach for premature infants.”

According to Castrogiovanni, the meters have had the desired effect on the staff as well.

“Every ancillary group, whether it’s en­vironmental services, dietitians, therapists, or the nursing staff, is fully aware of the reduced-noise environment,” she said. “If someone from one of these groups is working or talking in an NICU patient room and the decibel meter is triggered, they will immediately lower their voice or change their behavior.”

Soon-to-be parents have displayed the most noticeable approval for the devices.

“When our nurses show prospective moms and dads around the rooms, they see the meters and they think they’re great,” she said. “The parents who have had previous experience in an NICU are especially enthusiastic, since many NICU’s don’t have these devices.”

Certainly, reducing noise levels in the NICU is not a com­plete solution for ensuring that preemies develop into normal, healthy babies. But if it can have even the slightest positive impact, few would argue against it. And if a small improve­ment in a baby’s health is the result, then the SL120 meters in the Elliot NICU are worth making some noise about. FSM

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