A protocol of environmental noise reduction was developed and tested over a 14-month period in a 70-bed tertiary care neonatal intensive care unit (NICU). Evidence-based research and a detailed sound assessment guided the development of the protocol. Modifications of caregiving activities and categorized changes in the physical environment were specific to the NICU tested; however, guidelines for adapting the protocol to other NICUs are explained as well as methods for implementation to promote staff awareness and cooperation are reviewed.