Language and sound exposure across neonatal intensive care hospitalization and relationships with early outcome

R Pineda; L J Woodward; Z A Vesoulis; C D Smyser; T E Inder; A M Mathur; B L Schlaggar

doi:10.1038/s41372-026-02623-y

Language and sound exposure across neonatal intensive care hospitalization and relationships with early outcome

J Perinatol. 2026 Mar 13:10.1038/s41372-026-02623-y. doi: 10.1038/s41372-026-02623-y. Online ahead of print.

Authors

R Pineda^{1

2

3

4}, L J Woodward⁵, Z A Vesoulis⁶, C D Smyser⁶, T E Inder⁷, A M Mathur^{6

8}, B L Schlaggar^{9

10}

Affiliations

¹ Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA. bobbi.pineda@chan.usc.edu.
² Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA. bobbi.pineda@chan.usc.edu.
³ Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA. bobbi.pineda@chan.usc.edu.
⁴ Program in Occupational Therapy, Washington University, St. Louis, MO, USA. bobbi.pineda@chan.usc.edu.
⁵ Faculty of Health, University of Canterbury, Christchurch, New Zealand.
⁶ Department of Neurology, Pediatrics, Radiology, Psychiatry, and Neurosurgery, Washington University, St. Louis, MO, USA.
⁷ Center for Perinatal and Infant Research, Children's Hospital of Orange County, Department of Pediatrics, University of California, Irvine, CA, USA.
⁸ Department of Pediatrics, St. Louis University, St. Louis, MO, USA.
⁹ Kennedy Krieger Institute, Baltimore, MD, USA.
¹⁰ Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

Objectives: Examine relationships between quantitative measures of language and sound exposure in the NICU and infant neurobehavior.

Study design: Sixty-four preterm infants (≤28 weeks of gestation) had language and sound exposure measured across four time points: within two weeks of birth and at 30, 34, and 35-41 weeks postmenstrual age (PMA). Neurobehavior was assessed at 35-41 weeks PMA using the NICU Network Neurobehavioral Scales.

Results: Higher average decibel levels in the NICU environment were associated with lower infant orientation scores (p = 0.04, β = -0.33). Higher peak decibel levels were associated with greater hypertonia (p = 0.01, β = 0.37). More electronic sound exposure was associated with less infant hypotonia (p = 0.047; β = -0.003). Increased silence was associated with greater infant hypertonia (p = 0.01; β = 0.001). Higher adult word counts were related to lower infant stress (p = 0.045, β = -1.37).

Conclusion: NICU sound exposures were related to neonatal neurobehavior near term age, highlighting the neurological impact of the auditory environment on preterm infants.

Abstract

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