Music Therapy in the NICU

Music Therapy in the NICU

Over the last 16 years, there has been about a 21 % rise in the number of preterm infants born. About one-eight of all live births are preterm infants. However, although the number of pre-term live births is high and that facilities are available to nurse the pre-term babies, the infant mortality rates amongst the pre-term infants are high and a matter of huge concern. It is also a cause for several infant morbidities. The costs of caring for pre-term babies and meeting all medical treatments is also high, estimated to be about 15 billion dollars in the year 2002 (Neal, 2008). Neonatal have a low-body weight and hence it is important that methods of lowering stress in the neonatal be devised so that optimal function of neuro-behavior is encouraged.

Recently, statistics has suggested that there has been a drop in the number of disabilities associated with pre-term infants such as hearing problems, visual problems, learning difficulties, behavioral problems, etc. Previously, there were huge concerns regarding the noise that is present in the neonatal ICU. Studies have clearly shown that neonatal have serious problems with sounds and noises in the unit (Neal, 2008). Parents often express their concern that placing their baby into the foreign environment of the NICU for several months can negatively affect both the helath of the baby and the mother. However, there is also some amount of evidence saying that ambient sounds in the form of music and soothing rhythms may in fact be stimulating to the health of the neonatal in the ward. The use of music therapy in the NICU unit has been a newer idea. Practice-wise several NICU’s are using music therapy in their units (Hunter, 2006). Music can in fact help reduce stress and is both a cost-effective and an enjoyable measure which can be applied in the NICU settings (Arnon, 2006). Studies have even pointed out that playing soothing music in the NICU can help get closer to stimulating the environment existent in the womb (Arnon, 2006). This paper tries to investigate further the importance and the use of music in the NICU.

Article Citation

Neal et al 2008

Hunter et al 2008

Arnon et al 2006

Cevasco, 2008

The music intervention

Soothing, constant, stable female voice alone or with instruments, constant rhythm, low decibel

Live or recorded music,

31 babies randomly assigned

54 full term infants and

When it was used

Started after 28 weeks of pregnancy to pacify the baby and after 32 weeks for more of non-nutritive purposes

The music should be introduced before feeding; Some suggest using music during feeding as the experience is more enjoyable

It was used after 32 weeks of gestation when the baby was greater than 1500 grams in weight and having no active illness and hyper-responsiveness to music

Thirty six weeks age; weight for full term greater than 2500 grams, for preterm less than 2500 grams

How long was it played and how often

1.5 hours in total and each session of 20 to 30 minutes

15 minutes to 30 minutes per day, in one or two sessions

30 minutes a day for three consecutive days, played an hour after feeding

20 minutes a session 3 to 4 times a week

How the clients were introduced to the intervention

Music played after 28 weeks of gestation. At first music played was lullabies followed by live singing after 32 weeks

Play music live or recorded (babies respond faster to recorded music) for 30 minutes every day before feeding

Music was played after 32 weeks of gestation when the baby was in supine position

CD’s were played in the NICU containing recording of the mother’s voice singing lullabies, nursery rhymes and popular tunes

The nursing goal identified

The use of music for the sake of development of preterm infants

To improve the non-nutritive sucking, encouraging weight gain, lesser period of hospital stay and better growth and development of the neonatal

To improve the physiological and behavioral parameters in stable and preterm infants in the NICU

To Determine the effect on the mother’s singing on preterm and full term infants development

What outcomes were measured

Higher baseline O2 saturation; lesser episodes of apnea & bradycardia; lesser pain; quieter sleep; lower irritability; faster weight gain; better tolerance to stimulation; better food intake; faster discharge

Faster weight gain, shorter stay in the NICU and better feeding and non-nutritive sucking

Heart rate, respiratory rate, oxygen saturation, infants behavior state, infant state (sleep, drowsy, aroused, awake, etc), etc

Average stay in the hospital; mother-baby bonding; medical complications; value for msuci; time-spend singing; etc

What was measured and how was it done

Audio logical studies; discharge day; body weight; oxygen saturation; food intake

Hospital stay; body weight; etc

Effect on heart rate, respiration rate, oxygen saturation, behavior,

Average stay in the hospital; mother-baby bonding; medical complications; value for music; time-spend singing; etc; was measured mainly through post-test survey of the full-term and the preterm mother belonging to the experimental and control groups

Your recommendation

Use of music that is soothing, rhythm and has a soothing female voice; However, avoid overstimulation and observe initial reaction of the baby to music

Use of music for 30 minutes a day in two sessions before feeding; A sweet recorded or live female voice, which is has a low decibel level should be used

Live music which included a soothing lullaby, rhythmic, sung by a female has the best physiological and behavioral response

Mothers who have preterm mother value music more; use of music helps to reduce the hospital stay in preterm infants; Mothers in preterm group can be helped by knowing the fact that their infant listened to their singing when they stayed in the NICU

Other Comments

Female infants respond better to music compared to males

The music should be of the same nature as the baby would have heard during the prenatal period

Playing live music for 30 minutes a day in the NICU can help in the development of the preterm infant.

Use of music recording in both the full-term and preterm infants; use of music in mother with full-term delivery suffering from post-partum depression need to be studied.

Literature Review

In a study conducted by Neal et al (2008), several past studies regarding the use of music therapy in the ICU settings was analyzed. These included Cassidy 1995, Collins, 1991, Standley 1995, Butt 2000, Whipple 2000, Caine 1991 and Coleman 1997. Some of the studies demonstrated decreased physiological instability in the form of higher baseline oxygen saturations, lesser episodes of bradycardia and apnea, lesser pain, quieter sleep and reduced irritability. Other studies claimed better physiological functioning in the form of increased weight gain, better tolerance to stimulation, higher oxygen saturations, high food intake, and faster discharge. Neal et al strongly suggested the use of soothing, stable and female voice singing music after the 28th week of gestation. The rhythm of the music needs to be light and constant. If the vocal of the music were higher, then there was a chance of tachycardia. The decibel level of the music should be reasonably low. After 28 weeks, lullabies should be played, followed live singing lullabies.

In another study conducted by Hunter et al (2006), several previous studies were again analyzed to determine the effect of music therapy on neonatal. Arnon et al suggested a caution whilst introducing recorded music or live music in the neonatal ICU. The decibel level should be below 70 dB,

not played for more than 30 minutes a day and a sweet female lullaby should be introduced. Untrained or voluntary music should never be played in the NICU. Babies become easily used to recorded music compared to live music. Stewart et al noted that live singing was more advantageous as it brought about greater care and nurturing and ensured better responses from the baby. The family member could be used in nursing the baby. Arnon et al also suggested the use of music that the baby was accomplished to especially during the time spend in utero. Music played an important role in shorter period of stay in the ICU, faster weight gain, improved non-nutritive sucking, etc. Music should be administered before feeding. Hunter believed playing music throughout the day was not of much use and impractical. Some reports exist that during breastfeeding music played can make feeding more enjoyable.

Arnon Et al (2006) tried to study the neonatal responses to live music, recorded music and no music for over 3 consecutive days. The 31 babies which were included in the study were given music after 32 weeks of gestation and having a body weight of at least 1500 grams. The babies were given music for about 30 minutes a day for 3 consecutive days. The babies were checked for any hyper-responsiveness to music as well as DPOE tests. Several parameters including heart rate, respiratory rate, oxygen saturation levels, behavior etc, were monitored every 5 minutes during the music sessions. The music was played at a decibel level of 55 dB to 70 dB and a numerical score based on the infant’s state was assigned. During the therapy sessions the live music had no impact on the parameters, but at the end of the session, there was a decrease in heart rate, respiration rate and better behavior. There was no significant effect or recorded music or no music. Arnon et al strongly suggested the use of live music therapy in the NICU to help improve the physiological development of the neonatal.

Cevasco 2008 went a step beyond other studies to determine the effect of music sung by the mother on the preterm infant, but also on mother to know that the baby listened to her voice when it stayed in the NICU. In this study, both preterm and full-term babies and mothers were included. 54 full-term babies and mothers, and 16 preterm babies and 16 mothers (there were 4 twins) were ether placed in the case group or control group. Mothers in the experimental group recorded their voices in the CD as they sang and this was played to the preterm infant experimental group for 20 minutes, 3 to 5 times a week. The mothers of both groups were able to take a post-test survey. Mothers in the full-term and preterm experimental groups revealed a slightly greater number of complications and reduced bonding compared to the control group. The preterm mothers reported that they strongly believed that their babies in the NICU would listen to their voices. The babies in the experimental preterm group left the hospital 2 days earlier compared to the control group. The recording of the mother on the CD in case of preterm delivery helped them cope with the stay of the infant in the NICU.

Discussion and Recommendations

Studies have clearly demonstrated that a soothing rhythmic sweet female voice played to the preterm baby in the NICU for about 30 minutes daily would have a positive effect on the physiological and behavioral parameters of the infant. Studies have shown that the heart rate is reduced, oxygen saturation improves, rate of respiration reduces, faster weight gain, better feeding, improvement in the non-nutritive sucking, quieter sleep, lower irritability, better tolerance to stimulation and above all faster discharge from the hospital would be enabled. There was a decrease in heart rate and oxygen saturation especially at the end of the music playing session. Some of the studies reported that the female infants respond better and faster to music compared to the male infants. However, there needs to be certain precautions taken with the music played in the hospital. The music played should be within the limits of 55 to 65 dB and should not be played continuously. A new voice or instrument should not be tried out. Some studies point out that playing purely instrumental music may not benefit the infant. The ideal time to play the music would be half an hour before feeding or an hour after feeding. Some studies even point out that music played during feeding would provide an enjoyable experience to the infant. The music should not be played if the infant has certain hearing abnormalities or is hyper-responsive to music. Cevasco et al also demonstrated positive effects of music on the health of the mother post-partum as she was confident that the baby would listen to her singing in the NICU. Ideally live music of a female should be used. The music should ideally be of the same nature and culture the baby would have listened to when present in the womb of the mother during gestation.

Summary

Overall, the playing of music in the NICU for prematurely delivered babies would help the baby in its physiological and behavioral development and faster discharge from the ICU. However, precaution should be used over the loudness of the music played and the duration for which the music is played. Music therapy can also have a positive effect over mother who have delivered premature babies as they would be confident and happy that the baby is listening to their singing in the NICU. Live singing in which the mother or the nurse would be interacting with the baby has a better effect compared to recorded music or no music. Some experts even suggest playing music during the feeding of the infant as it would be an enjoyable experience.

References

Arnon, S. (2006). “Live Music Is Beneficial to Preterm Infants in the Neonatal Intensive Care Unit Environment” Birth, 33(2).

Cevasco, A. (2008). “The effects of mothers’ singing on full-term and preterm infants and maternal emotional responses.” Journal of Music Therapy, 45(3).

Hunter, B. C. (2006). “Music for Very Young Ears.” Birth 33(2).

Neal, D. O. (2008). “Music as a Nursing Intervention for Preterm Infants in the NICU.” Neonatal Network, 27(5).

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