Low sound levels are important for the normal neurological development of preterm infants. The American Academy of Pediatrics recommends an average noise level of 45 dB for premature infants. However, as a consequence of the nature of the care involved, an infant in a neonatal intensive care unit (NICU) is exposed to average ambient noise levels ranging from 50 to 88 dB, with peaks of more than 100 dB at times. Sharp noises induce physiological changes in heart rate, respiratory rate, and oxygen, saturation increasing apneic episodes and prolonging length of stay. Noise alters the sleep states of infants, leading to unnecessary stress that can affect infant development. Although some loud noise in the NICU is unavoidable, we decided to institute interventions to decrease noise levels in our busy level‐3 NICU. The purpose of the study was to effectively reduce noise in a level‐3 NICU of a major teaching hospital.


Sound levels at baseline were obtained in all NICU patient areas (inside and outside the babies' isolettes) and near the central nursing station. Surveys were collected from those on the nursing staff to understand their perceptions of noise in the NICU. Sequential noise reduction strategies were introduced including: (1) staff education lecture series; (2) quiet time hours, which limited noise, light, physical examinations, and procedures, 3 times a day for 1 hour each; (3) noise indicator lights that turned from green to yellow to red if noise rose above set decibel levels; and (4) reminder signs at the entrances of rooms. Readings 1 month after the introduction of all interventions were obtained to assess program efficacy. Statistical analysis was performed using the unpaired t test.


Average high and low noise levels at baseline were 78.34 ± 8.19 and 49.60 ± 3.46 dB, respectively. The corresponding averages postintervention were 62.95 ± 7.52 and 46.19 ± 3.84 dB, respectively. We were able to demonstrate significant decreases in the average high and low decibel readings of 15.39 and 3.41 dB, respectively (both P < .001).

Simple, cost‐effective interventions can alter noise levels in the NICU. We are in the process of implementing further changes and examining patient care effects on an ongoing basis.

Author Disclosure:

S. Gupta, None; D. Baranek, None; C. Catania, None; J. E. Larson, None.