Children born preterm, especially those born very preterm (< 32 weeks gestational age, GA), are at risk for poor growth and adverse neurodevelopmental outcomes. Adverse growth and neurodevelopmental outcomes in preterm children have been attributed, in part, to the aversive sounds and relative speech paucity of the neonatal intensive care unit (NICU). Experimental studies that directly expose preterm infants to speech sounds in the NICU find significant improvements in health factors relevant for neurodevelopment. Few studies have examined whether natural variations in the speech environment of the NICU are related to short-term health outcomes in preterm infants. Such data are important for optimizing the sound environment of the NICU. Examine relations between the NICU speech environment and rate of weight gain during hospitalization. Participants were infants born very preterm (n = 20). The speech environment of each infant was assessed at 32-36 weeks postmenstrual age using an automatic speech-counting device. Average rates of weight gain (g/kg/day) were ascertained over the same period. Calories were derived from charted intake (kcals/kg/day). Linear regressions examined caloric intake and speech counts as predictors of infant weight gain. Infant weight gain was significantly predicted by caloric intake and speech exposure, each uniquely accounting for ~27% variance (Total R2 = 60.2%; p < .001). Speech counts were uncorrelated with rates of family visitation, time in incubator, or health acuity. While future research should establish causality and direction of effects, enhancing speech exposure in the NICU may be beneficial for physical growth. NICU care plans should consider opportunities to increase speech exposure.