Neonatal Network
July/August 2007
Vol. 26, No. 4

ABSTRACTS

Effect of Environmental Changes on Noise in the NICU
Debra H. Brandon, PhD, RN, CCNS
Donna J. Ryan, RN, MSN
Angel H. Barnes, RN, BSN

Purpose: To evaluate the effect of changes in the NICU environment on sound levels.
Design: A prospective quasi-experimental design evaluated sound levels in a 43-bed NICU. Decibel levels were monitored utilizing a data-logging dosimeter for 24 hours weekly over 12 months. Sound levels were also measured inside four different incubator models.
Sample: forty-four 24-hour decibel recordings were obtained in one of eight randomly selected four-bed pods. In addition, a single 1-hour recording was obtained in four different models of vacant incubators.
Main Outcome Variable: Ambient sound levels.
Results: Decibel levels were analyzed to identify changes in noise levels following alterations in the NICU environment. Installation of motion-sensing motorized paper towel holders significantly increased levels at beds closest to the towel dispensers, as did the trial of a new communication system. Decibel levels in four different incubators revealed varying noise levels. This study suggests that all environmental changes must be monitored to ensure that they reduce rather than increase noise levels.

Neonatal Subgaleal Hemorrhage
Julie Reid, RNC, MSN, NNP

Subgaleal hemorrhages, although infrequent in the past, are becoming more common with the increased use of vacuum extraction. Bleeding into the large subgaleal space can quickly lead to hypovolemic shock, which can be fatal. Understanding of anatomy, pathophysiology, risk factors, differential diagnosis, and management will assist in early recognition and care of the infant with a subgaleal hemorrhage.

Roles of Long-Chain Polyunsaturated Fatty Acids in the Term Infant: Developmental Benefits
Susan Hazels Mitmesser, PhD
Craig L. Jensen, MD

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are two long-chain polyunsaturated fatty acids (LCPUfAs) found naturally in human milk. DHA and ARA have been receiving increased attention from health care professionals and the public. Research suggests that DHA intake and status have a significant impact on visual and cognitive development in breastfed infants. for formula-fed infants, studies have shown mixed results from DHA or DHA plus ARA supplementation. There are several important differences among LCPUfA studies with term infants that may contribute to the differing results, including levels of LCPUfA added to the formula, variations in test methods, ages of infants evaluated, and sources of LCPUfA. Nevertheless, several expert groups recommend that infant formulas be supplemented with DHA and ARA. Recommendations for term infants for DHA and ARA range from 0.2 percent to 0.4 percent and from 0.35 percent to 0.7 percent of the fatty acids, respectively.

Fetal Nutrition and Adult Hypertension, Diabetes, Obesity, and Coronary Artery Disease
Joan Nalani Thompson, RNC, MSN, NNP

The fetal-origins-of-adult-disease hypothesis describes an adaptive phenomenon of in utero reprogramming of the undernourished fetus that predisposes the infant to increased morbidity as an adult. Studies have identified a positive association between indicators of fetal undernutrition such as low birth weight and chronic adult diseases like hypertension, diabetes, obesity, and coronary artery disease. Current research is focusing on determining other factors that may contribute to these chronic adult diseases.