Poster #77 - The Role of Visitation in the Distribution of Speech and Noise in the NICU

• In Event: Poster Session 01

Abstract

Preterm infants are at risk for developmental deficits such as memory issues, language and speech delays, and auditory impairment (Webb et al., 2015; Graven & Browne, 2008). Human auditory systems are functional at approximately 25 weeks gestation, providing needed stimulation including low-frequency sounds, while excessive noise is filtered through the uterine environment (Graven & Browne, 2008). When the infant is born preterm this protective uterine environment transitions to the Neonatal Intensive Care Unit (NICU), where high-frequency sounds including high pitched alarms and life-saving equipment are prevalent (Altuncu et al., 2009: Wachman & Lahav, 2011). Infants, already at risk for developmental delays secondary to prematurity are more vulnerable in this high-tech, low-touch environment. Experience with low-frequency sounds, such as the human voice has demonstrated protective qualities, promoting the development of healthy cognitive auditory pathways in the preterm infant (McMahon et al., 2012; Yan, 2003). The transition in NICU design from large open bays to single-family rooms to promote family engagement and limit exposure to noxious sounds has unintentionally resulted in a reduction in speech input to these at-risk infants (Vohr et al., 2017; White et al., 2008). In the current study, we examine the protective role that family visitation in the NICU plays in the distribution of noxious noise vs. language input to low-birthweight (LBW; ≤1800g) preterm infants (N=84; 24-32 weeks gestation). To capture word count information, a Language ENvironmental Analysis (LENA) device was placed inside the neonatal incubator. The LENA recorded speech input over a 16-hour period, which included 8 daytime and 8 nighttime hours. Average noise levels (A-weighted scale; dBA) were also collected during the same time periods. Overall, there was enormous variability in the quantity of words spoken in the infant’s environment (M= 2,785, SD= 3,483; range = 85-17,885). Although infants heard 2.5 times more speech per hour when visitors were in the room (Mvisitor=348; Mno-visitor=139), visitors were present in the room for less than 20% of the recording period. Thus, many infants appear to be getting limited access to speech throughout the day. Further, despite efforts to reduce noise in the NICU, the average noise levels (M= 52.3dB; range: 31.7-83.1) far exceeded the noise limit guidelines of 45 decibels (dBA) set by the American Academy of Pediatrics (AAP). Together these findings suggest that despite increased understanding of the importance of healthy auditory input for vulnerable preterm infants, the distribution of noxious noise to protective speech remains an issue in the NICU environment. Clinical relevance of these findings will be discussed with a focus on the role that hospital staff could play in promoting language input during times when families are unable to visit their infants.

Authors

• McKenzie Mullins Sheets, University of Tennessee - Knoxville
  Presenting Author

• Rebecca Robb Crum, University of Tennessee - Knoxville

• Daniela Santos Oliveira, University of Tennessee - Knoxville

• Katherine Newnam

• Jessica Hay, University of Tennessee, Knoxville