Standardised newborn care and sound in the NICU

Healthcare professional demonstrating a quiet gesture to support communication in care settings. © Pexels / Olly

Care in the neonatal intensive care unit can vary widely in how much sound, speech, and silence a preterm infant experiences. Consistent, standardised care matters because the auditory environment supports brain and behavioural development during a very sensitive period. This prospective observational study followed 64 infants born at or before 28 weeks of gestation in a Level IV NICU and measured sound exposure at four points during hospitalisation. The study showed that higher adult word exposure was linked with lower infant stress, while louder sound levels were linked with less favourable neurobehaviour near term age.

Preterm infants often spend many weeks in the NICU while the brain and auditory system are still developing. During this time, they may hear staff voices, family speech, alarms, equipment noise, music, and long periods of silence. The study highlights why standardised newborn care should include attention to the sound environment, not only medical treatment. It also shows that different sound exposures do not appear to relate to infant outcomes in the same way.

The researchers aimed to examine whether language and sound exposure during NICU hospitalisation related to infant neurobehaviour near discharge. They used repeated 16-hour recordings to measure adult words, silence, electronic sounds, and sound levels. They then assessed neurobehaviour between 35 and 41 weeks postmenstrual age. This approach allowed the team to compare different types of auditory exposure across the NICU stay.

Why standardised care for sound exposure matters

The main findings suggest that both too much harsh sound and too little positive sound may matter. Higher average decibel levels were associated with lower orientation scores, and higher peak decibel levels were associated with greater hypertonia. More silence was also associated with greater hypertonia. At the same time, higher adult word counts were linked with lower infant stress.

The paper also reports that more electronic sound exposure was associated with less hypotonia, but the authors caution that this finding is difficult to interpret. The recording device could not distinguish between potentially helpful sounds, such as music, and potentially disruptive sounds, such as alarms. The authors therefore do not suggest that electronic noise is beneficial. Instead, they argue for careful attention to the type, timing, and intensity of auditory input in the NICU.

What this means for parents and healthcare professionals

For parents, families, and healthcare professionals, the findings suggest that clearer standards around NICU sound may support more consistent, high-quality care. Care teams may need to reduce loud and unnatural noise. They also need to avoid an overly silent environment and make room for meaningful speech around the infant. The authors note that more research is needed, but this study supports practical discussion about how sound is managed in the NICU. Parents and professionals can ask how the unit supports a developmentally appropriate auditory environment. They can also use this evidence to encourage care practices that combine neuroprotection with responsive human interaction.

Paper available at: Journal of Perinatology

Full list of authors: Pineda, R; Woodward, LJ; Vesoulis, ZA; Smyser, CD; Inder, TE; Mathur, AM; Schlaggar, BL

DOI: 10.1038/s41372-026-02623-y