Environmental health and noise levels in neonatal intensive care units: an integrative review





Noise Monitoring; , Neonatal Intensive Care; Noise Efects; Newborn; Continuing Education; Noise control.


Introduction: The neonatal intensive unit is a place for patients at risk, which demands attention from the team and requires adequate conditions to ensure safety, especially concerning neonatal acoustic comfort. OBJECTIVE: Identify environmental noise level in neonatal intensive care units and verify their compliance with the recommendations. Methods: This integrative review was conducted based on a question: What are the levels of environmental noise found in neonatal intensive care units? Data were collected on portal Biblioteca Virtual em Saúde and PubMed, “noise” and “neonatal intensive care” were the keywords and articles published from January 2015 to December 2021 were included in the study. A total of 44 articles were selected. Results: All noise measurements showed sound pressure levels above those recommended by the American Academy of Pediatrics. Continued education was cited as the best strategy for noise reduction, and should include the care team and parents, allowing for the implementation of more permanent changes. Conclusion: It is necessary to give importance to noise control and solutions to avoid it, and to spread awareness that the professional team is also a noise-producing agent. Research should be encouraged to reduce noise and implement strategies for reducing it.


Ahamed, M. F., Campbell, D., Horan, S., & Rosen, O. (2018). Noise Reduction in the Neonatal Intensive Care Unit: A Quality Improvement Initiative. Am J Med Qual, 33(2), 177–184. https://doi.org/10.1177/1062860617711563

Aita, M., Robins, S., Charbonneau, L., Doray-Demers, P., & Feeley, N. (2021). Comparing light and noise levels before and after a NICU change of design. J Perinatol, 41(9), 2235–2243. https://doi.org/10.1038/s41372-021-01007-8

Aita, M., Stremler, R., Feeley, N., Nuyt, A. M., & Lavallée, A. (2019). Acceptability to nurses of reducing NICU light and noise levels during skin-to-skin care: A pilot study. Applied Nursing Research, 47(March), 29–31. https://doi.org/10.1016/j.apnr.2019.03.001

Albers, C. A., & Grieve, A. J. (2007). Test Review: Bayley, N. (2006). Bayley Scales of Infant and Toddler Development– Third Edition. San Antonio, TX: Harcourt Assessment. Journal of Psychoeducational Assessment, 25(2), 180–190. https://doi.org/10.1177/0734282906297199

AMERICAN ACADEMY OF PEDIATRICS Noise: A Hazard for the Fetus and Newborn. (1997). www.aappublications.org/news

Andrade, K. P., Oliveira, L. L. A. de, Souza, R. de P., Matos, I. M. de, Andrade, K. P., Oliveira, L. L. A. de, Souza, R. de P., & Matos, I. M. de. (2016). Medida do nível de ruído hospitalar e seus efeitos em funcionários a partir do relato de queixas. Revista CEFAC, 18(6), 1379–1388. https://doi.org/10.1590/1982-0216201618619815

Bardin, L. (2011). Análise de Conteúdo (70th ed.).

Barsam, F. J. B. G., Barbosa, C. L. S., Oliveira, C. R. de, Lima, L. C. de S., Ferreira, D. D. O., Silva, M. S. de S., & Camargo, F. C. (2019). Management of Changes for Noise Control in Neonatal Intensive Therapy: Experience Report. Reme Revista Mineira de Enfermagem, 23, 1–6. https://doi.org/10.5935/1415-2762.20190001

Barsam, F. J. B. G., Silva, N. Y. E. B. da, Uramoto, L. C. L., Teixeira, C. L. S. B., Camargo, F. C., & Zullo, S. A. (2019). Identificação do ruído ao longo dos turnos na terapia intensiva neonatal de hospital de ensino. Journal of Nursing and Health, 9(2), 1–10. https://doi.org/10.15210/jonah.v9i2.16201

Basner, M., Babisch, W., Davis, A., Brink, M., Clark, C., Janssen, S., & Stansfeld, S. (2014). Auditory and non-auditory effects of noise on health. The Lancet, 383(9925), 1325–1332. https://doi.org/10.1016/S0140-6736(13)61613-X

Berglund, B., Lindvall, T., & Schwela, D. H. (2000). New Who Guidelines for Community Noise. Noise & Vibration Worldwide, 31(4), 24–29. https://doi.org/10.1260/0957456001497535

Bertsch, M., Reuter, C., Czedik-Eysenberg, I., Berger, A., Olischar, M., Bartha-Doering, L., & Giordano, V. (2020). The “Sound of Silence” in a Neonatal Intensive Care Unit—Listening to Speech and Music Inside an Incubator. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.01055

Biabanakigoortani, A., Namnabati, M., Abdeyazdan, Z., & Badii, Z. (2016). Effect of peer education on the noise management in Iranian neonatal intensive care unit. Iran J Nurs Midwifery Res, 21(3), 317–321. https://doi.org/10.4103/1735-9066.180392

Bremmer, P., Byers, J. F., & Kiehl, E. (2003). Noise and the Premature Infant: Physiological Effects and Practice Implications. Journal of Obstetric, Gynecologic & Neonatal Nursing, 32(4), 447–454. https://doi.org/10.1177/0884217503255009

Calikusu Incekar, M., & Balci, S. (2017). The effect of training on noise reduction in neonatal intensive care units. J. Spec. Pediatr. Nurs, 22(3). https://doi.org/10.1111/jspn.12181

Campos, C. J. G., & Turato, E. R. (2009). Content analysis in studies using the clinical-qualitative method: application and perspectives. Revista Latino-Americana de Enfermagem, 17(2), 259–264. https://doi.org/10.1590/S0104-11692009000200019

Cardoso, S. M. S., Kozlowski, L. de C., Lacerda, A. bender M. de, Marques, J. M., & Ribas, A. (2015). Newborn physiological responses to noise in the neonatal unit. Braz. j. otorhinolaryngol. (Impr.), 81(6), 583–588. https://doi.org/10.1016/j.bjorl.2014.11.008

Carvalhais, C., Santos, J., da Silva, M. V., & Xavier, A. (2015). Is There Sufficient Training of Health Care Staff on Noise Reduction in Neonatal Intensive Care Units? a Pilot Study From Neonoise Project. J Toxicol Environ Health A, 78(13–14), 897–903. https://doi.org/10.1080/15287394.2015.1051204

Casey, L., Fucile, S., Flavin, M., & Dow, K. (2020). A two-pronged approach to reduce noise levels in the neonatal intensive care unit. Early Hum Dev, 146(May), 105073. https://doi.org/10.1016/j.earlhumdev.2020.105073

Chawla, S., Barach, P., Dwaihy, M., Kamat, D., Shankaran, S., Panaitescu, B., Wang, B., & Natarajan, G. (2017). A targeted noise reduction observational study for reducing noise in a neonatal intensive unit. J Perinatol, 37(9), 1060–1064. https://doi.org/10.1038/jp.2017.93

Chen, L., Huang, L.-H. H., Xing, M.-Y. Y., Feng, Z.-X. X., Shao, L.-W. W., Zhang, M.-Y. Y., & Shao, R.-Y. Y. (2017). Using the Delphi method to develop nursing-sensitive quality indicators for the NICU. J Clin Nurs, 26(3–4), 502–513. https://doi.org/10.1111/jocn.13474

Degorre, C., Ghyselen, L., Barcat, L., Dégrugilliers, L., Kongolo, G., Leké, A., & Tourneux, P. (2017). Nuisances sonores en réanimation néonatale : impact d’un outil de monitorage. Archives de Pediatrie, 24(2), 100–106. https://doi.org/10.1016/j.arcped.2016.10.023

Disher, T. C., Benoit, B., Inglis, D., Burgess, S. A., Ellsmere, B., Hewitt, B. E., Bishop, T. M., Sheppard, C. L., Jangaard, K. A., Morrison, G. C., & Campbell-Yeo, M. L. (2017). Striving for Optimum Noise-Decreasing Strategies in Critical Care: Initial Measurements and Observations. J Perinat Neonatal Nurs, 31(1), 58–66. https://doi.org/10.1097/JPN.0000000000000229

Feeley, N., Robins, S., Charbonneau, L., Genest, C., Lavigne, G., Lavoie-Tremblay, M., Dowling, D., & Thibeau, S. (2019). NICU Nurses’ Stress and Work Environment in an Open Ward Compared to a Combined Pod and Single-Family Room Design. Advances in Neonatal Care, 19(5), 416–424. https://doi.org/10.1097/ANC.0000000000000603

Garrido Galindo, A. P., Camargo Caicedo, Y., & Velez-Pereira, A. M. (2017). Noise level in a neonatal intensive care unit in Santa Marta - Colombia. Colombia Medica (Cali, Colombia), 48(3), 120–125. https://doi.org/10.25100/cm.v48i3.2173

Garrido Galindo, A. P., Camargo Caicedo, Y., & Vélez-Pereira, A. M. (2015). Nivel continuo equivalente de ruido en la unidad de cuidado intensivo neonatal asociado al síndrome de burnout. Enfermeria Intensiva, 26(3), 92–100. https://doi.org/10.1016/j.enfi.2015.03.002

Garrido Galindo, A. P., Camargo Caicedo, Y., & Vélez-Pereira, A. M. (2016). Noise level in intensive care units of a public university hospital in Santa Marta (Colombia). Med Intensiva, 40(7), 403–410. https://doi.org/10.1016/j.medin.2015.11.011

Gomes, E. L. de F. D., Santos, C. M. dos, Santos, A. da C. S., Silva, A. G. da, França, M. A. M., Romanini, D. S., Mattos, M. C. V. de, Leal, A. F., & Costa, D. (2019). Respostas autonômicas de recém-nascidos prematuros ao posicionamento do corpo e ruídos ambientais na unidade de terapia intensiva neonatal. Rev. bras. ter. intensiva, 31(3), 296–302. https://doi.org/10.5935/0103-507x.20190054

Graven, S. N. (2000). Sound and the Developing Infant in the NICU: Conclusions and Recommendations for Care. Journal of Perinatology, 20, S88–S93. https://doi.org/10.1038/sj.jp.7200444

Hasegawa, Y., Ryherd, E., Ryan, C. S., & Darcy-Mahoney, A. (2020). Examining the Utility of Perceptual Noise Categorization in Pediatric and Neonatal Hospital Units. HERD, 13(4), 144–157. https://doi.org/10.1177/1937586720911216

Hawksley, E. J., & Helliwell, F. (2017). Noise in the NICU. Introducing a noise reduction policy to southmead neonatal intensive care unit: primary results from a 3 month service improvement project. Journal of Pediatric and Neonatal Individualized Medicine, 6(2), 34. https://doi.org/10.7363/060248

Hernández-Salazar, A. D., Gallegos-Martínez, J., & Reyes-Hernández, J. (2020). Level and Noise Sources in the Neonatal Intensive Care Unit of a Reference Hospital. Invest. Educ. Enferm, 38(3), [e13]-[e13]. https://doi.org/10.17533/udea.iee.v38n3e13

Jordão, K. R., Pinto, L. de A., Proença, Machado, L. R., Costa, L. B. V. de L., & Trajano, E. T. L. (2016). Possible stressors in a neonatal intensive care unit at a university hospital. Rev Bras Ter Intensiva, 28(3), 310–314. https://doi.org/10.5935/0103-507X.20160041

Jordão, M. M., Costa, R., Santos, S. V., Locks, M. O. H., Assuiti, L. F. C., & Lima, M. M. de. (2017). Ruídos na unidade neonatal: identificando o problema e propondo soluções. Cogitare enferm, 22(4), 1–8. https://doi.org/http://dx.doi.org/10.5380/ce.v22i4.51137

Joshi, R., Straaten, H. Van, Mortel, H. Van De, Long, X., Andriessen, P., & Pul, C. Van. (2018). Does the architectural layout of a NICU affect alarm pressure? A comparative clinical audit of a single-family room and an open bay area NICU using a retrospective study design. BMJ Open, 8(6), e022813–e022813. https://doi.org/10.1007/s10029-018-1794-0

Lahav, A. (2015). Questionable sound exposure outside of the womb: frequency analysis of environmental noise in the neonatal intensive care unit. Acta Paediatr, 104(1), e14-9. https://doi.org/10.1111/apa.12816

Mendes, K. D. S., Silveira, R. C. de C. P., & Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto - Enfermagem, 17(4), 758–764. https://doi.org/10.1590/s0104-07072008000400018

Nieto-Sanjuanero, A., Quero-Jiménez, J., Cantú-Moreno, D., Rodríguez-Balderrama, I., Montes-Tapia, F., Rubio-Pérez, N., Treviño-Garza, C., & de la O-Cavazos, M. (2015). Evaluation of strategies aimed at reducing the level of noise in different areas of neonatal care in a tertiary hospital. Gaceta medica de Mexico, 151(6), 741–748.

Oliveira, S. F. de, Cunha, A. J. L. A. da, Trajman, A., Teixeira, C., Gomes, M. K., & Halfoun, V. (2017). Perception about the Medical Internship at Federal University of Rio de Janeiro by the Service’s Preceptors in Primary Health Care: a Case Study. Revista Brasileira de Educação Médica, 41(2), 320–326. https://doi.org/10.1590/1981-52712015v41n2rb20160031

OMS. (2017). Descritores em Ciências da Saúde: DeCS. BIREME / OPAS / OMS. https://decs.bvsalud.org/

Paiva, T.; Reis, C.; Feliciano, A.; Canas-Simião, H.; Machado, M.A.; Gaspar, T.; Tomé, G.; Branquinho, C.; Silva, M.R.; Ramiro, L.; et al. (2021). Sleep and Awakening Quality during COVID-19 Confinement: Complexity and Relevance for Health and Behavior. International Journal of Environmental Research and Public Health, 18, 3506. https://doi.org/10.3390/ijerph18073506

Parra, J., de Suremain, A., Berne Audeoud, F., Ego, A., & Debillon, T. (2017). Sound levels in a neonatal intensive care unit significantly exceeded recommendations, especially inside incubators. Acta Paediatr, 106(12), 1909–1914. https://doi.org/10.1111/apa.13906

Passos, P. S., & Fiorini, A. C. (2022). Perception and effects of noise in employees of a university hospital. Research, Society and Development, 11(2), e51211225998–e51211225998. https://doi.org/10.33448/RSD-V11I2.25998

Pineda, R., Durant, P., Mathur, A., Inder, T., Wallendorf, M., & Schlaggar, B. L. (2017). Auditory Exposure in the Neonatal Intensive Care Unit: Room Type and Other Predictors. 183, 56-66.e3. https://doi.org/10.1016/j.jpeds.2016.12.072

PRISMA_2020_flow_diagram_new_SRs_v1.docx. (n.d.). Retrieved October 8, 2019, from https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.prisma-statement.org%2F%2Fdocuments%2FPRISMA_2020_flow_diagram_new_SRs_v1.docx&wdOrigin=BROWSELINK

Ramm, K., Mannix, T., Parry, Y., & Gaffney, M. P. C. C. (2017). A Comparison of Sound Levels in Open Plan Versus Pods in a Neonatal Intensive Care Unit. HERD, 10(3), 30–39. https://doi.org/10.1177/1937586716668636

Ramos, A. C. F. S. (2018). Perceção dos profissionais de saúde sobre o ruído em neonatologia TT - Perception of health professionals on noise in neonatology (p. 225). http://hdl.handle.net/10400.19/4943

Rocha, A. D., Sá, P. M., Reis, D. B. C., & Costa, A. C. C. (2020). “Horário do Soninho”: uma estratégia para reduzir os níveis de pressão sonora em uma unidade de terapia intensiva neonatal. Enfermagem em Foco, 11(1), 114–117. https://doi.org/10.21675/2357-707X.2020.v11.n1.2698

Roman, A. R., & Friedlander, M. R. (1998). Revisão integrativa de pesquisa aplicada à enfermagem. Cogitare Enferm, 3(2), 109–112. https://revistas.ufpr.br/cogitare/article/view/44358/26850

Santana, L. da S. R., Silva, L. S. da, Silva, R. R. da, Carvalho, J. E., Santana, W. S., Rossi-Barbosa, L. A. R., & Ruas, E. de F. G. (2015). Measurement of Acoustic Noise Levels in a Neonatal Intensive Care Unit. REME: Revista Mineira de Enfermagem, 19(2), 27–31. https://doi.org/10.5935/1415-2762.20150023

Santos, B. R. dos, Orsi, K. C. S. C., Balieiro, M. M. F. G., Sato, M. H., Kakehashi, T. Y., & Pinheiro, E. M. (2015). Efeito do horário do soninho para redução de ruído na unidade de terapia intensiva neonatal. Esc. Anna Nery Rev. Enferm, 19(1), 102–106. https://doi.org/10.5935/1414-8145.20150014

Santos, J., Carvalhais, C., Xavier, A., & Silva, M. V. (2018). Assessment and characterization of sound pressure levels in Portuguese neonatal intensive care units. Arch Environ Occup Health, 73(2), 121–127. https://doi.org/10.1080/19338244.2017.1304883

Shimizu, A., & Matsuo, H. (2016). Sound Environments Surrounding Preterm Infants Within an Occupied Closed Incubator. J Pediatr Nurs, 31(2), e149-54. https://doi.org/10.1016/j.pedn.2015.10.011

Shoemark, H., Harcourt, E., Arnup, S. J., & Hunt, R. W. (2016). Characterising the ambient sound environment for infants in intensive care wards. J Paediatr Child Health, 52(4), 436–440. https://doi.org/10.1111/jpc.13084

Silva, A. P. B., Prado, M. A. do, Silva, L. C. S., Andrade, L. Z., Pascoa, H., Bastos, L. R. R., Santos, K. C. P. dos, Santos Junior, P. S., Arantes, E. H., Campos, J. da S., Nascimento, J. C. C. do, Barbosa, M. A., Brasileiro, M. E., & Bezerra, A. L. Q. (2021). O espaço de trabalho da enfermagem em Unidades Neonatal e os riscos laborais: revisão integrativa. Research, Society and Development, 10(13), e566101321701. https://doi.org/10.33448/rsd-v10i13.21701

Silva, E., Ramos, A., Duarte, J., & Silva, D. (2019). Noise in neonatology: perception of health professionals. Revista de Enfermagem Referência, IV Série(No 20), 67–76. https://doi.org/10.12707/RIV18078

Smith, S. W. S. W., Ortmann, A. J., Clark, W. W., J., O. A., Clark, W. W., Ortmann, A. J., & Clark, W. W. (2018). Noise in the neonatal intensive care unit: a new approach to examining acoustic events. Noise Health, 20(95), 121–130. https://doi.org/10.4103/nah.NAH_53_17

Soares, C. B., Hoga, L. A., Peduzzi, M., Sangaleti, C., Yonekura, T., Silva, D. R. A. D., Dutra, V. F. D., Oliveira, R. M. P., Zoltowski, A. P. C., Costa, A. B., Teixeira, M. A. P., Koller, S. H. S. H., Grau, D. E. F. E., Evidência, D. E. R. D. E., Souza, M. T. De, Dias, M., Carvalho, R. De, Ercole, F. F., Melo, L. S. de, … Trevizan, M. A. (2010). Revisão Integrativa versus Revisão Sistemática. Reme: Revista Mineira de Enfermagem, 8(1), 102–106.

Swathi, S., Ramesh, A., Nagapoornima, M., Fernandes, L. M., Jisina, C., Rao, P. N. S., & Swarnarekha, A. (2014). Sustaining a culture of silence in the neonatal intensive care unit during nonemergency situations: A grounded theory on ensuring adherence to behavioral modification to reduce noise levels. International Journal of Qualitative Studies on Health and Well-Being, 9(1). https://doi.org/10.3402/qhw.v9.22523

Terzi, B., Azizoğlu, F., Polat, Ş., Kaya, N., İşsever, H., Azizoglu, F., Polat, S., Kaya, N., Issever, H., Azizoğlu, F., Polat, Ş., Kaya, N., İşsever, H., Azizoglu, F., Polat, S., Kaya, N., Issever, H., Azizoğlu, F., Polat, Ş., … Issever, H. (2019). The effects of noise levels on nurses in intensive care units. Nurs Crit Care, 24(5), 299–305. https://doi.org/10.1111/nicc.12414

Vera, S. O. da, Gouveia, M. T. de O., Dantas, A. L. B., & Rocha, S. S. da. (2018). Fontes estressoras em pacientes de unidade de terapia intensiva neonatal. Rev Rene (Online), 19, e3478–e3478. https://doi.org/Fontes estressoras em pacientes de unidade de terapia intensiva neonatal

Waterson, J., & Bedner, A. (2019). Types and frequency of infusion pump alarms and infusion-interruption to infusion-recovery times for critical short half-life infusions: Retrospective data analysis. JMIR Human Factors, 6(3), e14123–e14123. https://doi.org/10.2196/14123

Willis, V. (2018). The Relationship Between Hospital Construction and High-Risk Infant Auditory Function at NICU Discharge: A Retrospective Descriptive Cohort Study. HERD: Health Environments Research & Design Journal, 11(2), 124–136. https://doi.org/10.1177/1937586717742123



How to Cite

BRINGEL, J. M. de A. .; ABREU, I. M. C. de .; MUNIZ , M. C. M. C. .; SILVA, M.-R. G. . Environmental health and noise levels in neonatal intensive care units: an integrative review. Research, Society and Development, [S. l.], v. 11, n. 14, p. e437111436263, 2022. DOI: 10.33448/rsd-v11i14.36263. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/36263. Acesso em: 7 jun. 2023.



Health Sciences