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Noise in the Neonatal Intensive Care Unit

What Does the Evidence Tell Us?

Casavant, Sharon G., BS, RN; Bernier, Katherine, BS, RN; Andrews, Sheena, BS, RN; Bourgoin, Allison, BS, RN

Section Editor(s): Gephart, Sheila

doi: 10.1097/ANC.0000000000000402
Evidence-Based Practice Briefs

Background: In 2014, more than 10% of all births in the United States were preterm (born at <37-weeks' gestation). These high-risk infants will often spend weeks to months within the neonatal intensive care unit (NICU), where noise levels can easily reach 120 decibels adjusted (dBA) on a regular and sometimes consistent basis. The American Academy of Pediatrics recommends that NICU sound levels remain below 45 dBA to promote optimal growth and development.

Purpose: The purpose of this evidence-based brief is to critically appraise the literature concerning preterm infant response to noise within the NICU as well as the use of noise interventions to improve health outcomes for the vulnerable preterm infant population.

Methods/Search Strategy: Systematic searches of databases included the Cochrane Library, CINAHL, PubMed, and Science Direct. Included studies were appraised and then synthesized into a narrative summary.

Findings/Results: Twenty studies met inclusion criteria for this review. While there are numerous methods that have been shown to reduce noise levels within the NICU, most NICU noise levels remain consistently above the American Academy of Pediatrics recommendations. Studies that assessed interventions found that staff reeducation was critical to sustaining appropriate noise levels.

Implications for Practice: Implementing interventions with rigorous attention to initial and continued staff education with engagement and ownership is recommended. This review identifies gaps in intervention studies targeting vulnerable NICU populations.

Implications for Research: While noise interventions show promise in the NICU, additional focused research is needed to further strengthen the evidence and inform clinical practice.

University of Connecticut, Storrs (Mss Casavant, Bernier, Andrews, and Bourgoin); Connecticut Children's Medical Center, Neonatal Intensive Care Unit (Ms Bernier); and Connecticut Children's Medical Center, Medical-Surgical 8 Unit (Ms Casavant).

Correspondence: Sharon G. Casavant, BS, RN, University of Connecticut, 231 Glenbrook Rd, U-2026, Storrs, CT 06269 (

This work was performed at University of Connecticut, Storrs, Connecticut.

The authors declare no conflicts of interest.

© 2017 by The National Association of Neonatal Nurses