Lärm auf der Neugeborenen-Intensivstation: randomisierte Studie zum Einfluss eines Gehörschutzes auf intermittierende Hypoxien und Bradykardien

Zusammenfassung

Hintergrund: Atemregulationsstörungen Frühgeborener, die mit Hypoxie und Bradykardie einhergehen, sind ein häufiges Problem mit unvollständig verstandener Pathophysiologie. Unruhe des Kindes, z.T. durch Umgebungslärm ausgelöst, ist möglicherweise ein Einflussfaktor. Wir wollten wissen, ob ein Gehörschutz die Häufigkeit von Hypoxien bei Frühgeborenen mindestens halbiert.

Patienten und Methoden: In einer randomisiert-kontrollierten Interventionsstudie mit Cross-Over Design wurde bei 31 Frühgeborenen (14 männlich; mittleres [min.-max.] Geburtsgewicht und Gestationsalter: 1 323 g [560–1 990] und 30^1/7 Wochen [25^5/7–33^0/7]) der Effekt eines Gehörschutzes auf die Häufigkeit von Sauerstoffentsättigungen auf<80% SpO₂ und Bradykardien auf<80 Schläge/min untersucht. Die Frühgeborenen wurden zuerst für 2 Stunden mit und dann für 2 Stunden ohne Gehörschutz untersucht oder umgekehrt, während mit einem Schallpegelmessgerät der Dauerschallpegel sekündlich aufgezeichnet wurde.

Ergebnisse: Der mediane Dauerschallpegel im Inkubator oder Wärmebett betrug 46,8 dB_A. Der Gehörschutz zeigte in Vorstudien eine Geräuschreduktion von 7,2 dB. Hypoxien wurden bei 19 Kindern mit insgesamt 474 Ereignissen beobachtet. Im Median (25.–75. Perzentile) trat in der Phase ohne Gehörschutz 1 (1–10,5) und in der Phase mit Gehörschutz 1 (1–10) Hypoxie auf. Der Anteil der Kinder mit wenigstens einer Hypoxie war in beiden Studienphasen gleich. Insgesamt traten nur 7 Bradykardien auf.

Schlussfolgerung: Der Gehörschutz hatte bei den untersuchten Frühgeborenen in einem relativ ruhigen Umfeld keinen Effekt auf das Auftreten von Hypoxien.

Abstract

Background: Irregular breathing causing hypoxia and bradycardia is a common problem of preterm infants but its pathophysiology is incompletely understood. Agitation provoked by environmental noise may play a role. We wanted to know if earmuffs can at least halve the rate of intermittent hypoxia in premies.

Patients and Methods: In this randomized controlled trial 31 infants (14 male; median [min.-max.] birth weight and gestational age: 1 323 g [560–1 990] and 30^1/7 weeks [25^5/7–33^0/7]) had the effect of earmuffs on the frequency of pulse oximeter desaturations (SpO₂ <80%) and bradycardia events (<80 beats per minute) tested, documented via a standard home monitor. Infants were measured 2 h each with or without earmuffs; the sequence of intervention was randomised. Measurement conditions were kept constant while a noise meter recorded sound pressure levels at a 1 Hz sampling rate.

Results: Median sound pressure level was 46.8 dB_A. In a pre-study, ear muffs yielded a sound reduction by 7.2 dB. 19 infants had a total of 474 desaturations. The median (25.–75. percentile) number of desaturations was 1 (1–10.5) without, and 1 (1–10) with earmuffs. The amount of infants with at least one desaturation was equal in both treatment protocols. Only 7 bradycardias occurred.

Conclusion: The earmuffs had, in a rather quiet environment, no effect on intermittent hypoxia in these infants.

Schlüsselwörter

Hypoxie - Bradykardie - Frühgeburt - neonatale Intensivstation - Gehörschutz

Key words

hypoxia - bradycardia - prematurity - neonatal intensive care unit - earmuffs

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