Zhang Su He

National University Hospital
Singapore

Abstract Title: It is too loud for my tiny ears!

Biography: Ms Zhang Su He is a Senior Nurse Clinician and Advanced Practice Nurse in the Neonatal Intensive Care Unit at the National University Hospital, bringing over 25 years of specialised experience in neonatal nursing. A strong advocate for neurodevelopmental care, she pioneered the implementation of evidence-based Kangaroo Care practices in her unit, shaping standards that continue to benefit premature infants and their families. Ms Zhang earned her Master of Nursing (Paediatrics) from the National University of Singapore in 2017 and is the first paediatric-trained APN to serve in the Neonatal Unit. Her clinical work focuses on managing stable growing preterm infants, supporting complex care transitions, and providing follow-up for well babies in the outpatient setting. She also leads the Home Equipment Loan Programme, a quality improvement initiative that enhances the safety and efficiency of neonatal discharges. Ms Zhang is committed to improving outcomes for vulnerable newborns through compassionate, evidence-based, and family-centred care.

Research Interest: Background: The American Academy of Paediatrics recommends that noise levels in neonatal care settings should not exceed an average of 45 decibels (dB). High noise levels pose significant risks to the health and neurodevelopment of premature infants such as physiological stress, sleep interruption and behaviour instability. The noise levels in the Neonatal High Dependency unit are elevated due to high patient density, spatial constraints, and the unit's physical layout. Interventions such as music therapy can mitigate the impact of ambient noise by providing structured and developmentally appropriate auditory input that supports infant well-being and reduces maternal anxiety. Aim: This evidence-based quality improvement project aimed to reduce noise levels by 15%—from a baseline of 60–80 dB to 51–68 dB—through targeted noise-reduction interventions and the integration of music therapy. Methods: The project employed the Plan-Do-Study-Act methodology to design, test, and implement noise reduction interventions. Compliance with best practices was assessed using a pre–post design. Sound levels (in dB) were measured using a commercial digital sound level meter. Results: Interventions included: (1) education for healthcare personnel on the negative effects of noise on premature infants; (2) adjustment and standardisation of physiological monitor alarm settings to lower volumes; and (3) introduction of pre-recorded classical lullabies with dimmed lighting played routinely by nurses during each shift. Sound levels decreased by 28.7%, from 60–80 dB to 52–63 dB. Post-implementation audits showed 100% compliance among nurses in integrating music therapy into routine neonatal care. Conclusion: This initiative successfully increased awareness among healthcare workers and caregivers about the harmful effects of excessive noise on premature infants. Noise-reduction interventions, combined with music therapy, had synergistic effects in creating a calmer clinical environment. As a result, neonatal outcomes improved, and parents reported a more positive experience.