Contents lists available at ScienceDirect Journal of Neonatal Nursing journal homepage: www.elsevier.com/locate/jnn Effects of two non-invasive continuous positive pressure devices on the acoustic environment of preterm infants Celine Richard a,1 , Ellyn Hamm a,1 , Lelia Emery a , Arnaud Jeanvoine a , Melissa Moore-Clingenpeel b , Brianna Sowers a , Nathalie L. Maitre a,c,* a Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital, Columbus, OH, USA b Biostatistics Core, Nationwide Children's Hospital, Columbus, OH, USA c Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA ARTICLE INFO Keywords: Non-invasive CPAP Bubble CPAP SiPAP Auditory environment NICU Recommended noise exposure levels Neonates' hearing ABSTRACT Background: Two non-invasive ventilation strategies, Bubble Continuous Positive Airway Pressure (Bubble CPAP) and standard nasal Continuous Positive Airway Pressure (nasal-CPAP), are commonly used to treat preterm infants in the NICU, differentially impacting their auditory environment and contributing to noise ex- posure above recommended safe levels. Aim: To compare differences in sound exposure for preterm infants receiving two types of non-invasive CPAP. Method: Prospective observational study of 108 preterm infants, receiving either Bubble-CPAP or nasal-CPAP, using repeated measures of sound exposure in single-patient rooms and semi-private bays. Results: Analyses with repeated measures demonstrated that both types of CPAP increase noise levels above the background of the NICU, and that non-invasive nasal-CPAP produces higher noise pollution compared to Bubble CPAP, regardless of the room type. Conclusion: While CPAP is a necessary treatment for many preterm infants, cumulative noise exposure in ex- tremely preterm infants may also be a care consideration. 1. Introduction The Neonatal Intensive Care Unit (NICU) environment may con- tribute to the poor outcomes of preterm infants (Almadhoob and Ohlsson, 2015). In particular, increased ambient noise is associated with worse auditory and language outcomes (Zimmerman and Lahav, 2013). To this effect, the American Academy of Pediatrics recommends keeping ambient noise to a minimum (hourly means < 45 dB(A) scale; Noise: a hazard for the fetus and newborn. American Academy of Pe- diatrics, 1997). While contributing to ambient noise, early CPAP sup- port can decrease bronchopulmonary dysplasia (BPD)-related mor- bidity. Bubble CPAP (Wung et al., 1975) and non-invasive nasal CPAP (Owen et al., 2013), two support systems not delivered through a ventilator, are commonly used for this reason in US NICU (Narendran et al., 2003; Nowadzky et al., 2009; Sadeghnia et al., 2016). Large clinical trials have demonstrated that early CPAP, sometimes starting in the delivery room, improves respiratory outcomes with decreased days on the ventilator (Morley et al., 2008; Narendran et al., 2003), and when combined with surfactant may even reduce the risk of BPD (Isayama et al., 2016). Often, preterm infants stay on CPAP for pro- longed durations (2–5 weeks), based on unit guidelines or physician preference (Bamat et al., 2016). Based on clinical observations in a unit using two different types of non-invasive CPAP, we hypothesized that Bubble CPAP (Fisher & Paykel© Healthcare; Bubble CPAP system con- nected to a Sechrist© 3500 HL oxygen mixer) would expose infants to lower noise levels compared to the Infant Flow nasal SiPAP System (Viasys© Healthcare system). We tested our hypothesis by comparing repeated measurements of noise levels between the two types of CPAP, controlling for various NICU rooming conditions at baseline. 2. Methods 2.1. Setting This prospective consecutive cohort study was conducted at a ter- tiary medical center's NICU (08/2016-08/2017). Inclusion criteria were https://doi.org/10.1016/j.jnn.2019.09.008 Received 6 August 2019; Received in revised form 21 September 2019; Accepted 30 September 2019 * Corresponding author. Center for Perinatal Research and Department of Pediatrics at Nationwide Children's Hospital, 700 Children's Drive, WB6225, Columbus, OH, 43205, USA. E-mail address: Nathalie.Maitre@nationwidechildrens.org (N.L. Maitre). 1 The first two authors contributed equally to the study. Journal of Neonatal Nursing xxx (xxxx) xxx–xxx 1355-1841/ © 2019 Published by Elsevier Ltd on behalf of Neonatal Nurses Association. Please cite this article as: Celine Richard, et al., Journal of Neonatal Nursing, https://doi.org/10.1016/j.jnn.2019.09.008