Case Report

Measurement of Noise Levels in a Hospital Neonatal Unit in Costa Rica

Juan Carlos Olmo*, Paula Soto Calderon and Carolina Moya Navarro

Department of audiologist, Clinicas Audiciòn, San Jose Costa Rica, USA

Submission: February 20, 2019; Published: March 11, 2019

*Corresponding author: Juan Carlos Olmo, Department of audiologist, Clinicas Audiciòn, San Jose Costa Rica, USA

How to cite this article: Juan C O, Paula S C, Carolina M N. Measurement of Noise Levels in a Hospital Neonatal Unit in Costa Rica. Glob J Oto, 2019; 19(4): 556018. DOI: 10.19080/GJO.2019.19.556018

Introduction

The present investigation refers to the issue of the measurement of the noise levels that correspond to the neonatology unit, this is due to the intention to discard or confirm if said unit exceeded the noise levels recommended by the American Academy of Paediatrics (AAP). The effects on hearing of premature babies can be of slow appearance and often go unnoticed. It should be remembered that neonates under 1500 g will remain in these units for a long time due to their weight and gestational age conditions, which makes them susceptible to further damage. In the preterm neonate there is greater sensitivity to noise, due to physiological immaturity and the vulnerability they have when facing the extra uterine environment, studies have confirmed that the neonate’s brain is still immature to record and process all sensory information, which makes them extremely sensitive to noise and other stimuli from the external environment, so that at a younger gestational age their sensory and cerebral development is further compromised.

Auditory sensory stimulation can occur from the 32nd week of pregnancy and begins with sounds related to the mother´s cardiovascular, respiratory, intestinal and laryngeal activity, so these stimuli are omitted in preterm infants born before this week. Preterm births do not present specific or well-organized auditory responses, unlike a term neonate. Term neonates are at greater risk for certain effects of noise when they present high-risk factors (low birth weight situations, hyperbilirubinemia). The Neonate on the other hand is exposed to stress in the Neonatal unit due to noise, poor tactile stimulation by the parents, for example the lack of caresses that transmit security, or the excessive tactile stimulation by the doctors when performing procedures invasive and not less important stress transmitted from parents to newborns because parents face feelings of pain, fear of loss, anxiety among others.

Justification

This study aims to know the intensity of existing noise levels and through a professional analysis to raise awareness of whether these levels are harmful or not for the neonates admitted to the neonatal ward. The results of this investigation could be applicable in other areas of health, because the solutions provided can be applicable in any environment of sonic contamination, which threatens the auditory health of other patients of variable ages [1-4].

Background and Definitions

In Costa Rica, only the research carried out by the audiologist Rodríguez is documented, since 2010 the issue of noise in the neonatology units began to be treated more seriously. Academy of Paediatrics (AAP): dedicates its efforts and resources to the health, safety and well-being of infants, children, adolescents and young adults.

Purpose of the Investigation

Review the available evidence and answer the question What are the possible factors that cause the high level of noise in a hospital neonatal unit?

Design of the Investigation

A descriptive research is carried out, making measurements in three different shifts, in two visits made during two days in 2015 performing the calibration prior to taking samples with an acoustic calibrator series 036757 according to the manufacturer’s protocol recording the sound level with a S PCE-322 A sound level meter, in a Frequency rating on dBA and FAST in a measurement range of 50 ~ 100 dB, is placed on a tripod with a 45 degree angulation in different corridors and units of the Neonatology area, collecting thus the noise made by the staff in their different tasks, changes of shift as well as the noise in general that occurs in the unit [5-8].

Used Materials

i. Type 2 sound level meter from American National Standard Institute (ANSI). S mark PCEGROUP, model322 A, series 12087542.

ii. Acoustic Calibrator series 036757, certified number TS12 / 10216.

iii. Acer branded computer, Intel Atom N570, Windows7.

iv. Tripod brand ALPHA 2500 DESIGN

v. Pencils and pencils.

vi. White leaves.

Analysis of the Results

Note that all measurements exceed the maximum permissible noise levels according to the American Academy of Paediatrics. (1) 45 dB during the day, and 35 dB for the night.

Note that all measurements exceed the maximum permissible noise levels according to the American Academy of Paediatrics. (1) 45 dB during the day, and 35 dB for the night. In this unit, it should meet an average of 45 dB allowed during the day, while approximately it was possible to reach up to 69dB of noise present in several measurements, recorded from different areas of the research site, such as noise caused by monitors, sinks, telephone noises, staff conversing, poorly maintained equipment, air conditioning, high noise changes during staff shift changes, medical visits and visits from parents.

In the research carried out, it was found that the existing noise levels in the neonatology area of the hospital clearly exceed the permitted and standardized noise levels mentioned above with surpluses of 4 dB at 34 dB on Friday Table 1 and on

Saturday with surpluses of 3dB at 26dB Table 2. Analyzing the results, it is found greater intensity of noise in the afternoon hours and less noise during the morning hours, it was observed that during the shift changes of the nursing staff the noise levels were increased. It is found as maximum peak in the morning hours of 60dB, in the afternoon of 71dB, and minimum peak in the morning hours of 49dB, and in the afternoon of 50dB, on Friday, it is found for Saturday in the hours of the morning a maximum peak of 59dB, and in the afternoon 71 dB and as a minimum peak in morning and afternoon hours of 48 dB at 49dB (Tables 1 & 2). The stress caused to babies by noise can cause damage to their development at the neurological level. In summary according to the research carried out if a noise level higher than the normal standards for a neonatology area was found, which will give the necessary recommendations for the personnel that work and information that some are unaware of (Table 3).

Note that all measurements exceed the maximum permissible noise levels according to the American Academy of Paediatrics. (1) 45 dB during the day, and 35 dB for the night since this can happen at any time of the day.

Conclusion

The noise levels found in the neonatal unit are above the levels recommended by the American Paediatric Association (45 dB in the day and 35 dB in the night). Inform the staff of neonatology area about the effects of noise in neonates hearing problems should be detected as early as possible for a timely intervention, taking advantage of the plasticity of the sensory system under development, before three months of life to prevent any type of delays in the acquisition of language and other problems, this through screening (neonatal auditory screening) and audiological evaluations that may allow timely diagnosis, we cannot know at present about the hearing status of neonates who are in the ICU of the Hospital, so these do not have neonatal hearing screening. Make a noise map showing the areas where there is more noise, where it is possible to see that the neonatology unit exceeds the limits allowed by the AAP. In the investigation, it was determined that the noise levels generated in the area do not exceed eighty decibels, so it is not considered that they can damage children’s hearing. Even when the noise levels generated do not have the potential intensity to cause noise-induced loss (they do not exceed eighty decibels), they have the potential to affect the development of babies and exceed the levels recommended by the AAP.

References

1. Noise: A Hazard for the Fetus and New-born (1997) American Academy of Pediatrics 100(4).
2. Diana Lorena Fajardo SY (2007) Noise levels in the Neonatal Intensive Care Unit «CIRENA» of the Hospital Universitario del Valle, Cali, Colombia 48(3): 120-125.
3. Dra, Josefina Gallegos-Martínez DJH (2011) Noise index in the neonatal unit. Its impact on newborns.
4. Dras, Iris T, Schapira NA (2015) Stress In New borns Internships (NICU): Proposals to Minimize its Effects.
5. Germán Trinidad VA (2009) Recomendaciones de la Comisión para la Detección Precoz de Hipoacusias (CODEPEH) para 2010 p. 1-6.
6. M García del Ríoa MS (2007) Review of the standards and recommendations for the design of a neonatology unit. Spanish Association of Pediatrics.
7. Patricia Fernández DNC (2006) Effects of Noise in Neonatal Hospital Environment.
8. Werner AF (2006) Afecciones Auditivas de Origen Ocupacional. Buenos Aires, Argentina: Dosyuna ediciones.