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The Effects of Environmental Noise and Infant Position on Cerebral Oxygenation

Elser, Heather E. PhD, RN, NNP-BC, CNS; Holditch-Davis, Diane PhD, RN, FAAN; Levy, Janet PhD; Brandon, Debra H. PhD, RN, CCNS, FAAN

Advances in Neonatal Care:
doi: 10.1097/ANC.0b013e31826853fe
Developmental Care

PURPOSE: To assess how different infant positions and peak sound levels affected cerebral oxygen saturation over time.

SUBJECTS: Twenty-four premature infants who were born less than 32 weeks' gestational age without congenital cardiac, neurologic, and gastrointestinal anomalies.

DESIGN: Repeated-measures design with the first observation between 2 and 48 hours of life; once again between 49 and 96 hours of life; on day of life 7; and every 7 days thereafter until discharge home, transfer to another hospital, or 40 weeks postmenstrual age, whichever came first.

METHODS: Continuous sound levels (decibels) were obtained and 2 infant positions were performed while measuring cerebral oxygen saturation during 40-minute observation periods.

MAIN OUTCOME MEASURES: Effect of peak sound and differences in infant position on cerebral oxygen saturation.

RESULTS: Peak sound levels 5 dB above the average ambient sound level did not significantly change cerebral oxygen saturation values. Differences in cerebral oxygenation were significantly less when infants were changed from a supine, head midline position to a right lateral, 15° head elevation compared with a left lateral, 0° elevation position.

CONCLUSIONS: Aspects of the current neonatal intensive care unit environment do not appear to affect cerebral oxygen saturation.

Author Information

Duke University School of Nursing, Durham, North Carolina.

Correspondence: Heather E. Elser, PhD, RN, NNP-BC, CNS, Duke University School of Nursing, DUMC 3322, Durham, NC 27710 (

The preparation of this article was supported by grant F31NR011269 from the National Institute for Nursing Research, National Institutes of Health, and the American Association of Critical-Care Nurses/Sigma Theta Tau. CAS Medical Systems loaned the FORE-SIGHT Cerebral Oximeter and provided free cerebral oximeter probes.

The authors declare no conflict of interest.

© 2012 National Association of Neonatal Nurses