الفهرس 
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Abstract
In the last two decades, there has been an increasing interest in the impact of sound environment on the preterm infant’s health. The deleterious effects of early noise exposure on the health of premature infants, the sources of noise in the NICU, and the role of the incubator both as a barrier to external noise and as a generator of noise.
Newborns hospitalized in the NICU are exposed to continuous noise, without intervening quiet periods. Since the maturation of auditory pathways continues in the postnatal period, the exposure of these newborns to noise may adversely affect the development and maturation of the sense of hearing.
Many studies concluded that noise levels in NICU seem to be influenced by non-human related sources such as NICU equipment. While noisy behavior of NICUs staff considered an important source of stress to newborns and it might be reduced by a modification of staff behavior.
There are studies that clarified that many adverse health effects have been observed in preterm babies exposed to noise in NICU, particularly somatic effects (tachycardia, tachypnea, apnea, oxygen desaturation and sudden increase in mean arterial blood pressure), hearing loss and sleep disturbance.
Due to the possible consequences of noise exposure on premature infants, the American Academy of Pediatrics has provided guidelines which require monitoring SPLs in all NICUs and within incubators and maintaining the noise level <45 dB(A).
In this study sound levels were measured for at least twice during the day shift (7:00AM: 7:00PM) and during the night shift (7:00PM: 7:00AM) all over 3 days in each of the participating NICUs.
Sound levels measured inside the incubators in condition of absence and presence any of different devices who exposed to newborns in NICUs as (mechanical ventilators, CPAP, nasal O2 blender, nasal O2 prong, O2 head box, O2 incubators ) ,(photo, bill sphere), (infusion and syringe pump), monitor, nebulizer, suction.
It has been clarified that the sound levels with a modern incubator may reach levels that may possibly be harmful to the developing newborn.
Environmental, human behaviors, other devices (especially nebulizer, suction) exposed to infants and site of incubators in NICUs have a meaningful impact on elevating the noise levels within the incubator above the recommended levels by the US Environmental Protection Agency. Day shift was noisy comparable by night shift, although both shifts were noisy. While type of incubators (their country of made, brand, model) and years in function have no effect on noise level.
Also in this study, was demonstrated that high noise levels affect HR and RR of newborns. While occurrence of apnea in preterm and full-term infants had no relation to noise levels during day and night shifts. Fluctuation in HR and O2 saturation were related to gestational age but had no relation to noise level exposed to infants in NICUs.
Further efforts are needed to minimize the exposure of the newborns in NICU to elevated noise levels. Designing ‘‘quiet NICUs’’, sensitizing the NICU staff to adopt a low-noise behavior, using low-noise incubators and devices, and managing alarms correctly may be effective measures for this purpose.