Towards a quieter Neonatal Intensive Care Unit: Current approaches and design opportunities

Recent studies show that the well-being of patients and the performance of healthcare professionals in modern neonatal intensive care units (NICUs) are severely affected by the amount of auditory alarms and sound nuisance. This paper presents a semi-systematic review on the topic of environmental sound in the NICU, where current themes, insights, and limitations are highlighted. Furthermore, it outlines the results of an observation of the NICU environment and an interview with nurses at Erasmus Medical Center, in order to understand the users, their context, and the technology that can enable design interventions. The insights gathered from the literature and the users, together with a technology search, lead to potential design opportunities to be developed further. Based on these, we propose a technological solution towards a healthy sound environment in the NICU

Towards a quieter neonatal intensive care unit: evaluating and visualizing soundscapes to raise awareness on sound-producing events

A soundscape is the acoustic environment that is constantly surrounding us. Soundscapes in the neonatal intensive care unit (NICU) might adversely affect neonates, their families, and healthcare providers. In this unit, the number of alarms and nuisance is very high, and studies show that it negatively affects both the well-being of patients and the performance of healthcare professionals (Bliefnick, Ryherd, Jackson, & 2019). Additionally, elevated sound levels in the NICU may contribute to undesirable physiologic and behavioral effects in infants. Hearing impairment, heart rate, blood pressure, oxygen saturation, respiratory rate, and sleep were all deteriously affected (Zimmerman & Lahav, 2013).Sound studies within NICUs have only focused on short-term outcomes such as monitoring sound levels in decibels (dB) and reporting the results, with no further implication. Current market solutions give only feedback on high dB levels, limiting medical professionals’ complete understanding of the cacophonous environment. Additionally, they rely on counting sound in dB, discarding the effect of tone and frequency. Therefore, the problem with the dB measure is that it represents only one part of the complex sound taxonomy. Still, interpreting sound beyond dB is challenging to understand for people who are unfamiliar with the physics of sound.SOUNDscapes is a digital platform that maps and localizes sound events occurring at the NICU. It displays sound trends in real time and assesses the quality of the environment by having two main visualization pages: sound level trends and constellation map.The goal of providing real-time feedback is to make nurses aware of specific (sound) behaviours and their consequences. Additionally, they can assess and observe their collective impact on the unit. This dashboard motivates them to change their attitudes towards harmful sound events by ultimately triggering a behaviour change. The dashboard is a tool that will help nurses understand, assess and change their sound behaviour and patterns of harmful sound sources, ultimately having valuable feedback for reducing high sound levels at the unit.First, the proposed solution provides the first step for permanent sound monitoring, mapping, and visualising real-time sound-producing events. Additionally, supporting nurses and giving them the confidence to act upon harmful sound sources occurring at the NICU. Secondly, the suggested design, apart from advocating for a nurse’s sound quality, is also a tool that can go beyond their caring role. For the Neonatology department at ErasmusMC, this platform means a new source of data streams that healthcare developers can use for measuring and evaluating the care quality they are delivering. The new system provided opens new research possibilities in the future that will allow researchers to link the quality of the physical sound environment to physiological and psychological effects on listeners.Strategic Product Design | Medisig

X chromosome inactivation does not necessarily determine the severity of the phenotype in Rett syndrome patients

Rett syndrome (RTT) is a severe neurological disorder usually caused by mutations in the MECP2 gene. Since the MECP2 gene is located on the X chromosome, X chromosome inactivation (XCI) could play a role in the wide range of phenotypic variation of RTT patients; however, classical methylation-based protocols to evaluate XCI could not determine whether the preferentially inactivated X chromosome carried the mutant or the wild-type allele. Therefore, we developed an allele-specific methylation-based assay to evaluate methylation at the loci of several recurrent MECP2 mutations. We analyzed the XCI patterns in the blood of 174 RTT patients, but we did not find a clear correlation between XCI and the clinical presentation. We also compared XCI in blood and brain cortex samples of two patients and found differences between XCI patterns in these tissues. However, RTT mainly being a neurological disease complicates the establishment of a correlation between the XCI in blood and the clinical presentation of the patients. Furthermore, we analyzed MECP2 transcript levels and found differences from the expected levels according to XCI. Many factors other than XCI could affect the RTT phenotype, which in combination could influence the clinical presentation of RTT patients to a greater extent than slight variations in the XCI pattern