Effect of music by Mozart on energy expenditure in growing preterm infants

Effect of premature infant oral motor intervention [PIOMI] combined with music therapy on feeding progression of preterm infants: a randomized control trial

Prematurity may produce long-term complications in the physical and cognitive development of infants. There is a need for interventions that can improve feeding and reduce the length of NICU stay and separation time between the infant and mother. This study aimed to explore the clinical effect of premature infant oral motor intervention [PIOMI] combined with music therapy [MT] on feeding progression in premature infants.Premature infants with gestational ages between 26 and 30 weeks were included in the study. Fifty-two participants were randomly divided into intervention and control groups. All infants received PIOMI, and the intervention group received additional MT. The participants of the two groups were compared based on weight gain, feeding progression, Preterm Oral Feeding Readiness Scale [POFRAS], milk volume, and length of hospitalization. The data were analyzed using independent sample t-tests, covariance tests, and repeated measure ANOVA used to compare three group means.The intervention group reached independent oral feeding 8 days earlier [P = .018] than the control group. Length of hospitalization was 6 days shorter [P = .224] for the intervention group, and the mean volume of milk on the 10th day was 215.38 ± 56.4 in the intervention group and 155.69 ± 68.9 in the control group, respectively [P = .001]. The mean score of the POFRAS scale on the 10th day was 28.65 ± 3.0 in the intervention groups and 20.96 ± 3.3 in the control groups, retrospectively [P = .001]. There was no difference in weight gain between the two groups [P = .522].Conclusion: PIOMI combined with MT was effective for the feeding progression of premature infants, and infants who received both these interventions were discharged sooner than control infants. Thus, MT should be considered part of feeding interventions for preterm infants with gestational ages between 26 and 30 weeks.Trial registration: Clinical trial registration number: IRCT20210502051155N1 on 18/9/2021 What is Known -- What is New: • There is numerous study about the eff ect of music therapy or oral motor interventi on. However, premature Infants havenot been yet studied to determine whether music therapy and oral motor interventi ons may synergize to aid their feedingprogression.

Effects of music exposure during pregnancy on maternal behavior in mother rats

Several studies have demonstrated the possibility of positive effects of exposure to music during pregnancy on mental function in humans and animals. Although there remains a core belief in the positive effects of music during pregnancy, the underlying neurobehavioral mechanisms of these effects remain unknown. In this study, we aimed to clarify the relationship between maternal nurturing behavior and the oxytocinergic system to elucidate the effect of music on mental health during pregnancy in an experimental investigation using animal models. Pregnant rats were exposed to Mozart sonatas, and their nurturing behavior after delivery was assessed using behavioral analyses. The neural activities of the oxytocinergic system, which are associated with nurturing behavior, were investigated using FosB immunohistochemistry. Music during pregnancy significantly increased the licking behavior of mothers towards pups, which is representative of positive nurturing behavior. In contrast, this alteration in maternal behavior was shown to have no marked effect on the structure or activity of the oxytocinergic system. This study provided possible evidence that exposure to music during pregnancy had a positive effect on postnatal maternal behavior. The results also suggest that the oxytocinergic system, considered a strong candidate for the neural system that regulates maternal behavior, may not be associated with this behavioral change. Understanding the relationship between other neural systems, physiological responses, and nurturing behaviors will provide a more comprehensive explanation of the mechanisms by which music exposure during pregnancy has a positive effect on mental health.

•

Pregnant rats were exposed to Mozart sonatas and their nurturing behavior was investigated.

•

Exposure to music during pregnancy has a positive effect on postnatal maternal behavior.

•

Maternal behavior had no marked effect on the structure or activity of the oxytocinergic neurons.

The effect of environmental noise isolation on bronchiolitis severity in hospitalised children

AIM

Bronchiolitis is an infectious disease, with no effective treatment. Music and Mozart's works specifically are known to have a positive effect on physiological parameters, while noise is considered harmful. We aim to evaluate the short-term effect of environmental noise detachment and/or music listening on the course of bronchiolitis in hospitalised children.

METHODS

This is a prospective, double-blinded randomised controlled trial. Patients were divided into three intervention groups: 1-Mozart's Sonata, 2-instrumental music, 3-silence. Music was heard via media players and soundproof headphones. Disease severity was evaluated before and after intervention using the Modified Tal score.

RESULTS

Seventy music sessions were included in the analysis (Mozart n = 23, instrumental n = 22, silence n = 25). A one-point drop in the average bronchiolitis severity score was observed in all three groups from 7.1 (CI 95%, 5 to 9.2) to 6.1 (CI 95%, 4.3 to 7.9), p < 0.001. No significant difference was found between the three groups with respect to change in the severity score before and after the intervention.

CONCLUSION

Isolation from disturbing sounds heard in paediatric departments could be considered a simple non-invasive intervention in children hospitalised with bronchiolitis. Further studies are warranted to evaluate long-term effects of this intervention and the specific effect of music.

Comparison of Effects of Mothers' and Mozart's Lullabies on Physiological Responses, Feeding Volume, and Body Weight of Premature Infants in NICU

Objectives

The purpose of this study was to compare the effects of mothers' and Mozart's lullabies on physiological parameters, feeding volume, and body weight of premature infants in a neonatal intensive care unit (NICU).

Methods

This study used a non-equivalent control group, non-synchronized design as a quasi-experimental study. Two intervention groups (recorded mother's lullaby and Mozart's lullaby) and a control group were formed from a total of 65 premature infants: a mother's lullaby group of 22 infants, a Mozart's lullaby group of 22 infants, and a control group of 21 infants not provided with any lullabies. Their physiological parameters included heart rate, blood pressure, respiratory rate, and O2 saturation. The infants' feeding volume and body weight were measured as indicators related to the growth of premature infants. The mother's and Mozart's lullabies were played on a speaker in an incubator for 15 min for 7 consecutive days per group.

Results

There were significant differences in the mean difference before and after intervention in neonatal heart rate (χ2 = 45.03, P < 0.001), systolic pressure (F = 43.29, P < 0.001), diastolic pressure (χ2 = 33.01, P < 0.001), respiratory rate (F = 76.06, P < 0.001), and O2 saturation (χ2 = 40.82, P < 0.001) between the three groups. The mean differences of both mother's and Mozart's lullaby groups were significantly higher than those of the routine care group in all physiological parameters, and those of the mother's lullaby group was significantly higher when compared with the Mozart's lullaby group. In repeated-measures ANOVA, there was a significant interaction between time and group in feeding volume (F = 2.46, P = 0.041). However, body weight did not significantly differ in an interaction between time and group (F = 1.75, P = 0.151).

Conclusion

This study showed beneficial effects of mother's lullaby and Mozart's lullaby on physiological parameters. Especially, the mother's lullaby was found to significantly improve all physiological parameters and feeding volume of premature infants in the NICU compared to Mozart's lullaby group. Therefore, we recommend the regular integration of the mother's lullaby into supportive care of premature infants in the NICU, as this intervention highlights the need for mothers to participate in their care.

Trial Registration

ClinicalTrials.gov, identifier: KCT0004842 (https://cris.nih.go.kr).

Clinical benefits of music-based interventions on preterm infants' health: A systematic review of randomised trials

AIM

This systematic review aimed to differentiate and isolate the results of different music-based interventions used with preterm infants in the neonatal intensive care unit and explore their clinical benefits.

METHODS

The last search was performed on 5 July 2021 on Web of Science, Scopus, EMBASE, PsycINFO, CINAHL, LILACS and CENTRAL. Only randomised clinical trials that explored the health benefits of music-based interventions were considered.

RESULTS

A total of 39 studies were included. All music-based interventions were divided into music medicine and music therapy. The overall results suggested that music medicine interventions were associated with a significant improvement in pain relief; in turn, improvements in cardiac and respiratory function, weight gain, eating behaviour, and quiet alert and sleep states were more consistent in studies that followed a music therapy approach with the presence of a music therapist.

CONCLUSION

This review supports the beneficial effects of music-based interventions on the health of preterm infants in a neonatal intensive care unit; however, it also offers suggestions for future studies in order to increase the number of interventions with music therapists, since the results of music therapy approaches were more consistent for physiological and behavioural outcomes.

Utilising recorded music to reduce stress and enhance infant neurodevelopment in neonatal intensive care units

AIM

This paper summarises published evidence on the use of recorded music in high-risk infants to reduce stress and improve neurodevelopment, forming recommendations for proposed clinical applications in neonatal intensive care units.

METHODS

We searched two comprehensive library catalogues and two databases for articles evaluating the impact of recorded music interventions on hospitalised preterm infants. Original and review papers published in English in the 10 years prior to this search were selected if the study included a component of recorded music interventions.

RESULTS

Most original studies (80.95%) and all literature reviews (100%) reported positive effects of recorded music interventions for preterm infants, primarily in the short term. No negative effects were reported. Evidence is emerging regarding the neurobiological mechanisms of recorded music on longer-term effects on preterm infant neurodevelopment. Clinical applications were suggested drawing upon available evidence. Due to generally small sample sizes and variability in study design, unanswered questions remain.

CONCLUSION

Carefully designed recorded music interventions appear to be safe, feasible and effective in reducing stress and improving neurodevelopment of hospitalised infants. Additional rigorous, well-powered trials with relevant outcomes are needed to further refine specific elements for recorded music interventions to better inform practice.

Awareness of maternal stress, consequences for the offspring and the need for early interventions to increase stress resilience

Experimental and clinical studies suggest that prenatal experiences may influence health trajectories up to adulthood and high age. According to the hypothesis of developmental origins of health and disease exposure of pregnant women to stress, nutritional challenges, infection, violence, or war may "program" risks for diseases in later life. Stress and anxieties can exist or be provoked in parents after fertility treatment, after information or diagnosis of fetal abnormalities and demand simultaneous caring concepts to support the parents. In vulnerable groups, it is therefore important to increase the stress resilience to avoid harmful consequences for the growing child. "Enriched environment" defines a key paradigm to decipher how interactions between genes and environment change the structure and function of the brain. The regulation of the fetal hippocampal neurogenesis and morphology during pregnancy is one example of this complex interaction. Animal experiments have demonstrated that an enriched environment can revert consequences of stress in the offspring during critical periods of brain plasticity. Epigenetic markers of stress or wellbeing during pregnancy might even be diagnosed by fragments of placental DNA in the maternal circulation that show characteristic methylation patterns. The development of fetal senses further illustrates how external stimulation may impact individual preferences. Here, we therefore not only discuss how maternal stress influences cognitive development and resilience, but also design possibilities of non-invasive interventions for both mothers and children summarized and evaluated in the light of their potential to improve the health of future generations.

Can Mozart Improve Weight Gain and Development of Feeding Skills in Premature Infants? A Randomized Trial

OBJECTIVE

 The study aimed to assess in a prospective randomized study the effect of Mozart's music on time to regain birth weight (BW) and development of oral feeding skills in babies born between 28^0/7 and 31^6/7 weeks of gestation.

STUDY DESIGN

 Healthy premature infants born between 28^0/7 and 31^6/7 completed weeks of gestation were randomized within 3 days of birth to either music or no music exposure. Infants in the music group were exposed to Mozart's double piano sonata twice per day for 14 days. The primary outcome was time to regain birth weight. The secondary outcome was development of oral feeding skills as evaluated by a speech/language pathologist blinded to the intervention. We hypothesized that exposure to Mozart's double piano sonata would decrease time to regain BW and improve feeding skills. A total of 32 newborns were needed to detect a 3-day difference in time to regain BW.

RESULTS

 Forty infants were enrolled and randomized. There were no significant differences between the two groups regarding the time to regain BW (p = 0.181) and the time to achievement of full oral feeds (p = 0.809).

CONCLUSION

 Exposure to Mozart's double piano sonata for 14 days after birth did not significantly improve time to regain BW or time to achieve full oral feedings in very premature infants. It is possible that Mozart's music has no effect or that the duration of music exposure was not sufficient to have a physiologic effect on growth and oral feeding skills.

KEY POINTS

· Classical music improves the medical condition of adults.. · Music decreases neonatal resting energy expenditure.. · Music exposure did not significantly impact weight gain.. · This clinical relevance warrants further evaluation..

[Prematurity and music therapy: harmonic encounters?]

Premature birth can cause complications of varying nature and intensity in the child's development. The developmental care given to babies born prematurely is of major importance to their physical and psychological development. After clinical assessment, music therapy can be integrated into this care. It is a source of observed benefits.

Evaluating physiologic outcomes of music interventions in the neonatal intensive care unit: a systematic review

Music is widely used in the neonatal intensive care unit. The objectives of this systematic review are: (1) clarify the current literature in regards to the impact of music on neonatal physiologic parameters, (2) highlight the variability in definitions utilized for music interventions, and (3) provide a foundation for future music therapy research focused on influencing neonatal physiology. A systematic literature review was conducted in accordance with PRISMA guidelines, with search terms including "music," "music therapy," "neonates," "newborn," and "NICU." Four hundred and fifty-eight studies were reduced to 16 clinical trials divided based on methodological description of music intervention. Our review highlights variability in the existing literature specifically on neonatal physiological impact of music. Future studies should focus on consistent and well-defined data collection, utilization of standardized definitions for music interventions, and consideration of more sensitive markers of physiology, such as heart rate variability, to enhance study rigor and reproducibility.

Effect of Personalized Music Intervention in Mechanically Ventilated Children in the PICU: A Pilot Study

OBJECTIVES

To determine the feasibility of a personalized music intervention with mechanically ventilated patients in the PICU.

DESIGN

Pilot study with a quasi-experimental design.

SETTING

Tertiary children's hospital in China with a 40-bed PICU.

PATIENTS

Children, 1 month to 7 years, with mechanical ventilation were recruited and assigned to music group (n = 25) and control group (n = 25).

INTERVENTIONS

Children in the music group received their own favorite music and listened for 60 minutes three times a day. The control group receive routine care without music.

MEASUREMENTS AND MAIN RESULTS

Primary outcome measure was comfort measured with the COMFORT Behavior scale 5 minutes before and after the music. Secondary outcome measures were physiologic variables; heart rate, respiration, blood pressure, oxygen saturation. Mechanical ventilation time, length of stay, and sedation medication were also collected. Qualitative analysis revealed that nurses had a positive attitude in delivering the interventions and identified improvements for the main trial. Children in the music group had lower COMFORT Behavior scores (15.7 vs 17.6; p = 0.011). Children in the music group had better physiologic outcomes; heart rate (140 vs 144; p = 0.039), respiration rate (40 vs 43; p = 0.036), systolic blood pressure (93 vs 95 mm Hg; p = 0.031), oxygen saturation (96% vs 95%; p < 0.001), diastolic blood pressure was not significantly (52 vs 53 mm Hg; p = 0.11). Children in the music group had a shorter ventilation time (148.7 vs 187.6; p = 0.044) and a shorter length of stay, but not significant (11.2 vs 13.8; p = 0.071). Children in the control group had higher total amount of on-demand midazolam (29 vs 33 mg; p = 0.040).

CONCLUSIONS

Our pilot study indicates that personalized music intervention is feasible and might improve the comfort of children with mechanical ventilation. Further studies are needed to provide conclusive evidence in confirming the effectiveness of music interventions comforting critically ill children in PICUs.

The Effectiveness of Prone and Supine Nesting Positions on Changes of Oxygen Saturation and Weight in Premature Babies

Introduction: Stress experienced by the baby will affect the body’s function by increasing the body’s metabolism. Nesting is used to reduce stress in premature babies. Nesting can be done in a supine or prone position. Few studies have examined the effects of body position on body weight and oxygen saturation. The objective of the study was to determine the difference in oxygen saturation and weight change on the use of nesting in the prone and supine positions in premature babies.Methods: The research used a quasi-experimental design. The sample consisted of 30 premature babies, which was obtained using a consecutive sample technique. The independent variables were nesting positioning (supine and prone), and the dependent variables were oxygen saturation and body weight. The data of oxygen saturation and the baby’s weight were collected using pulse oximetry; the baby’s weight scale used observation sheets. The data was analysed using the t-test, Wilcoxon Sign Ranks Test, and Mann Whitney U Test.Results: The results showed that there was a difference in oxygen saturation before and after the use of nesting in the supine (p=0.001) and prone position (p=0.000). There was a weight difference before and after the use of nesting in both supine (p=0.000) and prone position (p=0.000). There was no difference in oxygen saturation value and infant weight, before or after, between the supine position and the prone position (p=0.18; p=0.9).Conclusion: The use of nesting in both positions (supine or prone) can increase oxygen saturation and infant weight. Researchers recommend the use of nesting with supine or prone positions routinely in premature babies.

The effect of patient-selected or preselected music on anxiety during cesarean delivery: a randomized controlled trial

Background: Women undergoing cesarean delivery may have significant anxiety prior to surgery. Nonpharmacological approaches to anxiety reduction are favored in this patient population.Objective: The aim of this study was to determine the effects of patient-selected or preselected music on anxiety in parturients undergoing scheduled cesarean delivery.Materials and methods: This is a prospective, randomized controlled trial (IRB protocol #2015P002043; ClinicalTrials.gov, NCT02732964), of 150 parturients undergoing elective cesarean delivery. Parturients were randomized to patient-selected music (Pandora^®), preselected music (Mozart), or no music (control). The primary outcome was anxiety after music exposure (versus no music) in the preoperative holding room. Secondary outcomes included postoperative anxiety, postoperative pain, and patient satisfaction.Results: Baseline anxiety and anxiety following preoperative exposure did not differ in the Pandora versus control group (3.8 ± 2.4 versus 4.6 ± 2.6, mean difference -0.8 [95% CI -1.8 to 0.2], p = .12), but was lower in the Mozart group versus control group (3.5 ± 2.5 versus 4.6 ± 2.5, mean difference -1.1 [95% CI -2.2 to -0.1], p = .03). Postoperative anxiety did not differ in the Pandora versus control group (1.0 ± 1.4 versus 1.3 ± 2.0, mean difference -0.3 [95% CI -1.0 to 0.4], p = .43), or in the Mozart versus control group (0.8 ± 1.3 versus 1.3 ± 2.0, mean difference -0.5 [95% CI -1.2 to 0.2], p = .15). Postoperative pain was not different in the Pandora group versus control group (0.8 ± 1.5 versus 1.4 ± 1.9, mean difference -0.6 [95% CI -1.3 to 0.1], p = .10), but was lower in the Mozart versus control group (0.6 ± 1.3 versus 1.4 ± 1.9, mean difference -0.8 [95% CI -1.4 to -0.1], p = .03). Total patient satisfaction scores were not different among the control, Pandora, and Mozart groups.Conclusion: While preselected Mozart music results in lower anxiety prior to cesarean delivery, patient-selected Pandora music does not. Further investigation to determine how music affects patients, clinicians, and the operating room environment during cesarean delivery is warranted.Clinical trial registration: NCT02732964.

The reassuring role of music associated with the personality traits of children during dental care: a randomized clinical trial

AIM

The objective of this study was to analyze the reassuring role of music associated with the personality traits of children during dental care.

METHOD

The study involved a randomized crossover clinical trial with 34 children, aged from 4 to 6 years, who exhibited two carious lesions on the occlusal surfaces of the molars. The children were divided into two groups: (G1) first tooth restoration intervention session with music, second session without music; and (G2) first tooth restoration intervention session without music, second session with music. The first consultation was to perform a clinical examination, and the second and third to perform modified Atraumatic Restorative Treatment (mART). Symphony No. 40 by Mozart was played via headphones. Pulse rate (PR) was measured using a pulse oximeter. The Brazilian version of the Eysenck Personality Questionnaire-Junior (EPQ-J) was used to measure the children's personality. For statistical analysis, descriptive, Chi-square, and Wilcoxon tests were carried out.

RESULTS

The G1 group exhibited a lower PR at the time of the intervention during the second consultation compared to the third consultation (p = 0.012). The G2 group exhibited a lower PR at the time of the intervention during the third consultation compared to the first consultation (p = 0.002). The majority of the children with a low level of extraversion presented with higher PR (p = 0.005).

CONCLUSION

Music could reduce the PR among children during dental intervention. Children with low extraversion showed a tendency towards a higher PR without music during dental care.

Emergent Prophylactic, Reparative and Restorative Brain Interventions for Infants Born Preterm With Cerebral Palsy

Worldwide, an estimated 15 million babies are born preterm (<37 weeks' gestation) every year. Despite significant improvements in survival rates, preterm infants often face a lifetime of neurodevelopmental disability including cognitive, behavioral, and motor impairments. Indeed, prematurity remains the largest risk factor for the development of cerebral palsy. The developing brain of the preterm infant is particularly fragile; preterm babies exhibit varying severities of cerebral palsy arising from reductions in both cerebral white and gray matter volumes, as well as altered brain microstructure and connectivity. Current intensive care therapies aim to optimize cardiovascular and respiratory function to protect the brain from injury by preserving oxygenation and blood flow. If a brain injury does occur, definitive diagnosis of cerebral palsy in the first few hours and weeks of life is difficult, especially when the lesions are subtle and not apparent on cranial ultrasound. However, early diagnosis of mildly affected infants is critical, because these are the patients most likely to respond to emergent treatments inducing neuroplasticity via high-intensity motor training programs and regenerative therapies involving stem cells. A current controversy is whether to test universal treatment in all infants at risk of brain injury, accepting that some patients never required treatment, because the perceived potential benefits outweigh the risk of harm. Versus, waiting for a diagnosis before commencing targeted treatment for infants with a brain injury, and potentially missing the therapeutic window. In this review, we discuss the emerging prophylactic, reparative, and restorative brain interventions for infants born preterm, who are at high risk of developing cerebral palsy. We examine the current evidence, considering the timing of the intervention with relation to the proposed mechanism/s of action. Finally, we consider the development of novel markers of preterm brain injury, which will undoubtedly lead to improved diagnostic and prognostic capability, and more accurate instruments to assess the efficacy of emerging interventions for this most vulnerable group of infants.

High-risk follow-up: Early intervention and rehabilitation

Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and supports parents. In this chapter, first we summarize the best-available tools for accurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy, developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impairment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidence for inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence base for: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focused on inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichment interventions in the neonatal intensive care and community settings, and (e) parent-child interaction interventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatment options at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosis enables early intervention, which improves child and parent outcomes. We now know which interventions provide the biggest gains and the information can be used to help inform parental decision making when designing treatment plans for their children.

Physiological and perceptual effects of self-selected and classical relaxing music on resting metabolic rate: a crossover trial

BACKGROUND

A common recommendation for assessing resting metabolic rate (RMR) is that measurements be undertaken while avoiding activities like reading and listening to music. Listening to music, however, is sometimes used to reduce boredom or keep subjects awake, although it remains unclear whether music significantly alters RMR.

METHODS

This randomized crossover trial enrolled 32 subjects and examined the impact of relaxing music during RMR tests. Indirect calorimetry was used to quantify RMR, oxygen consumption, carbon dioxide production (VCO2), ventilation (VE), respiratory rate, and respiratory exchange ratio (RER); the Karolinska Sleepiness Scale (KSS) and boredom-excitement scale (BES) assessed perceptual responses. Subjects were randomized to three 15-minute conditions in a counter-balanced order: control (no music), classical relaxing music, and self-selected relaxing music.

RESULTS

There was no significant effect of music on RMR (ANOVA, F[2,60] =2.4, P=0.10). The difference in RMR between control and classical conditions was 9 kilocalories (95% confidence interval [CI], -33 to 51), while the difference between control and self-selected conditions was 34 kilocalories (95% CI: -5 to 73). Compared to control, both music conditions caused small, statistically significant increases in most cardiorespiratory parameters (VCO2, VE, respiratory rate, RER, heart rate) and reduced boredom on BES. No effects on the KSS were found. VE and BES ratings were slightly higher with self-selected music than classical music.

CONCLUSIONS

Listening to relaxing music elicits small changes in physiological and perceptual responses during RMR testing but does not likely cause clinically meaningful fluctuations in RMR.

Resting energy expenditure in infants with congenital diaphragmatic hernia without respiratory support at time of neonatal hospital discharge

BACKGROUND

Infants with congenital diaphragmatic hernia (CDH) are at risk for growth failure because of inadequate caloric intake and high catabolic stress. There is limited data on resting energy expenditure (REE) in infants with CDH.

AIMS

To assess REE via indirect calorimetry (IC) in term infants with CDH who are no longer on respiratory support and nearing hospital discharge with advancing post-conceptional age and to assess measured-to-predicted REE using predictive equations.

METHODS

A prospective cohort study of term infants with CDH who were no longer on respiratory support and nearing hospital discharge was conducted to assess REE via IC and caloric intake. Baseline characteristics and hospital course data were collected. Three day average caloric intake around time of IC testing was calculated. Change in REE with advancing post-conceptional age and advancing post-natal age was assessed. The average measured-to-predicted REE was calculated for the cohort using predictive equations [22].

RESULTS

Eighteen infants with CDH underwent IC. REE in infants with CDH increased with advancing postconceptional age (r2 = 0.3, p < 0.02). The mean REE for the entire group was 53.2 +/- 10.9 kcal/kg/day while the mean caloric intake was 101.2 +/- 17.4 kcal/kg/day. The mean measured-to-predicted ratio for the cohort was in the normal metabolic range (1.10 +/- 0.17) with 50% of infants considered hypermetabolic and 11% of infants considered hypo-metabolic.

CONCLUSIONS

Infant survivors of CDH repair who are without respiratory support at time of neonatal hospital discharge have REE, as measured by indirect calorimetry, that increases with advancing post-conceptional age and that is within the normal metabolic range when compared to predictive equations.

LEVEL OF EVIDENCE

III.

Music reduces pain perception in healthy newborns: A comparison between different music tracks and recoded heartbeat

OBJECTIVES

To assess the effect of 3 musical interventions, as compared to no music, on the physiological response of healthy newborns undergoing painful medical procedures (Guthrie test and/or intramuscular antibiotic injections).

METHODS

Prospective study of 80 full-term newborns, aged 1 to 3 days, randomly allocated to exposure to Mozart's Sonata for two pianos K.448, Beethoven's Moonlight Sonata, heartbeat sound recordings (70 bpm) or no music. Pain perception (evaluated using the Neonatal Infant Pain Scale), heart rate and oxygen saturation were measured 10 min before (T0), during (T1), 10 (T2) and 20 (T3) minutes after the interventions.

RESULTS

Infants who were exposed to the three music interventions displayed a significant reduction in heart rate and in pain perception and an increase in oxygen saturation, as compared to the control group, which showed less modifications on stress measurements after painful medical procedures (F_(3,76) = 6.40, p = .001, partial η² = 0.20).

CONCLUSIONS

Exposure to music and heartbeat sound recordings changes short-term physiological parameters in healthy newborns undergoing potentially painful procedures. The similar effect shown by the 3 interventions might be explained by the common characteristics of the sound shared by the various tracks. Further research is needed to investigate the impact of different types of music used in intervention, in order to develop guidelines and include music as a part of evidence-based strategies to promote the outcome for neonates.

Music stimuli lead to increased levels of nitrite in unstimulated mixed saliva

Concentration of salivary nitrate is approximately 10-fold to that of serum. Many circumstances such as acute stress could promote salivary nitrate secretion and nitrite formation. However, whether other conditions can also be used as regulators of salivary nitrate/nitrite has not yet been explored. The present study was designed to determine the influence of exposure to different music on the salivary flow rate and nitrate secretion and nitrite formation. Twenty-four undergraduate students (12 females and 12 males) were exposed to silence, rock music, classical music or white noise respectively on four consecutive mornings. The unstimulated salivary flow rate and stimulated salivary flow rate were measured. Salivary ionic (Na⁺, Ca²⁺ Cl^-, and PO₄^3-) content and nitrate/nitrite levels were detected. The unstimulated salivary flow rate was significantly increased after classical music exposure compared to that after silence. Salivary nitrite levels were significantly higher upon classical music and white noise stimulation than those under silence in females. However, males were more sensitive only to white noise with regard to the nitrite increase. In conclusion, this study demonstrated that classical music stimulation promotes salivary nitrite formation and an increase in saliva volume was observed. These observations may play an important role in regulating oral function.

Infants born preterm, stress, and neurodevelopment in the neonatal intensive care unit: might music have an impact?

AIM

The neonatal intensive care unit (NICU) provides life-saving medical care for an increasing number of newborn infants each year. NICU care, while lifesaving, does have attendant consequences which can include repeated activation of the stress response and reduced maternal interaction, with possible negative long-term impacts on brain development. Here we present a neuroscientific framework for considering the impact of music on neurodevelopment in the NICU of infants born preterm and evaluate current literature on the use of music with this population to determine what is most reliably known of the physiological effects of music interventions.

METHOD

Using online academic databases we collected relevant, experimental studies aimed at determining effects of music listening in infants in the NICU. These articles were evaluated for methodological rigor, ranking the 10 most experimentally stringent as a representative sample.

RESULTS

The selected literature seems to indicate that effects are present on the cardio-pulmonary system and behavior of neonates, although the relative effect size remains unclear.

INTERPRETATION

These findings indicate a need for more standardized longitudinal studies aimed at determining not only whether NICU music exposure has beneficial effects on the cardio-pulmonary system, but also on the hypothalamic-pituitary-adrenal axis, brain structures, and cognitive behavioral status of these children as well.

WHAT THIS PAPER ADDS

Provides a neuroscience framework for considering how music might attenuate stress in neonatal intensive care unit (NICU) infants. Considers how repeated stress may cause negative neurodevelopmental impacts in infants born preterm. Posits epigenetics can serve as a mechanistic pathway for music moderating the stress response.

Does Music Matter? A Look at the Issues and the Evidence

Does music matter? Judging from the ever-diminishing support for music education in public funding, the message is that it is just a frill to be cast aside for more pressing needs. The pleasure of listening to music is worthy in itself and reason enough for support, but what happens when people are more deeply engaged, such as when they learn to read music and play an instrument? Can more material rewards follow for cognition, language, and emotion, and for social and physical well-being? This essay presents an overview of issues and evidence from a broad range of disciplines and age groups.

The Cardiovascular Effect of Musical Genres

BACKGROUND

The effect of different musical styles on serum cortisol levels, blood pressure, and heart rate is currently unknown.

METHODS

60 subjects were randomly assigned to three groups that listened to various compositions by W. A. Mozart, J. Strauss Jr., or ABBA for 25 minutes. Their serum cortisol concentrations, heart rate, and blood pressure were measured before and after the listening session. The same variables were measured in a control group of 60 subjects who did not listen to music but rested in silence.

RESULTS

Music by Mozart and Strauss markedly lowered the subjects' blood pressure (systolic: -4.7 mm Hg, 95% confidence interval [-6.9; -2.5] and -3.7 mm Hg [-6.1; -1.4]; diastolic: -2.1 mm Hg [-3.8; -0.4] and -2.9 mm Hg [-4.9; -0.9], p<0.001), while music by ABBA did not (systolic: -1.7 mm Hg [-3.9; 0.6]; diastolic: -0.1 mm Hg [-2.0; 1.8]). Similar findings were made with respect to heart rate. There were no such changes in the control group. Serum cortisol levels decreased in all groups (Mozart: -4.56 μ/dL [-5.72; -3.39], Strauss: -4.76 μg/dL [-5.94; -3.58], ABBA: -3.00 μg/dL [-5.28; -2.69], silence: -2.39 μg/dL [-3.26; -1.52], p*lt;0.001). The observed effects were not correlated with the style of music individually preferred by the subjects.

CONCLUSION

Music by Mozart and Strauss lowered the subjects' blood pressure and heart rate, while music by ABBA did not. Mozart's music had the strongest effect; the piece used was his Symphony No. 40 in g minor (KV 550).

Olfactory stimulation may promote oral feeding in immature newborn: a randomized controlled trial

Premature newborns have an increased mortality and morbidity due to respiratory immaturity and inefficient oral feeding performance. Transient assistance with feeding tubes until oral performance improves is required with consequent hospital admission. Based on a controlled and randomized study, we tested whether olfactory stimulation compared to odorless stimulation could accelerate the switch from feeding tube to satisfactory oral feeding. Fifty newborns were included and randomly assigned to either odorless or olfactory stimulation with anise or cinnamon. The main outcome measurement was the duration of the hospital stay. The odor-stimulated group could be discharged from hospital on average 3.4 days earlier than the control group (p = 0.12). When including only more mature newborns into the analysis (n = 39), the difference was statistically significant (p < 0.05). This trend emphasizes that olfaction may have its place in early feeding stimulation.

Effects of prenatal music stimulation on fetal cardiac state, newborn anthropometric measurements and vital signs of pregnant women: A randomized controlled trial

BACKGROUND

Music has been used for medicinal purposes throughout history due to its variety of physiological, psychological and social effects.

OBJECTIVE

To identify the effects of prenatal music stimulation on the vital signs of pregnant women at full term, on the modification of fetal cardiac status during a fetal monitoring cardiotocograph, and on anthropometric measurements of newborns taken after birth.

MATERIAL AND METHOD

A randomized controlled trial was implemented. The four hundred and nine pregnant women coming for routine prenatal care were randomized in the third trimester to receive either music (n = 204) or no music (n = 205) during a fetal monitoring cardiotocograph. All of the pregnant women were evaluated by measuring fetal cardiac status (basal fetal heart rate and fetal reactivity), vital signs before and after a fetal monitoring cardiotocograph (maternal heart rate and systolic and diastolic blood pressure), and anthropometric measurements of the newborns were taken after birth (weight, height, head circumference and chest circumference).

RESULTS

The strip charts showed a significantly increased basal fetal heart rate and higher fetal reactivity, with accelerations of fetal heart rate in pregnant women with music stimulation. After the fetal monitoring cardiotocograph, a statistically significant decrease in systolic blood pressure, diastolic blood pressure and heart rate in women receiving music stimulation was observed.

CONCLUSION

Music can be used as a tool which improves the vital signs of pregnant women during the third trimester, and can influence the fetus by increasing fetal heart rate and fetal reactivity.

Preterm infants exhibited less pain during a heel stick when they were played the same music their mothers listened to during pregnancy

AIM

Playing music during painful procedures has shown inconsistent benefits for preterm infants. This study observed preterm infants during a heel stick procedure to assess whether listening to the music their mothers listened to during pregnancy had any impact on their pain and physiological and behavioural parameters.

METHODS

We randomly exposed 42 preterm infants, with a mean gestational age of 31.8 ± 2.79 weeks, to the music their mothers listened to during pregnancy, recorded lullabies and no music, before, during and after a heel stick. Pain responses were measured using the Neonatal Pain, Agitation and Sedation Scale (N-PASS), and physiological and behavioural responses were recorded by a nurse blinded to the intervention.

RESULTS

N-PASS pain scores were lowest during mothers' music, with a mean of 1.40 (±1.28), compared to 2.33 (±1.64) for no music and 1.62 (±2.27) for the lullabies [F(3/121) = 4.86, p = 0.009]. Physiological parameters were not significantly different between the conditions. During the mothers' music, infants spent more time in a quiet alert state, with a significant decrease in their respiratory rates.

CONCLUSION

The music mothers listened to during pregnancy was more beneficial for preterm infants, as it decreased pain and improved behavioural states during a heel stick.

Do Hospitalized Premature Infants Benefit from Music Interventions? A Systematic Review of Randomized Controlled Trials

Objective

Neonatal intensive care units (NICU) around the world increasingly use music interventions. The most recent systematic review of randomized controlled trials (RCT) dates from 2009. Since then, 15 new RCTs have been published. We provide an updated systematic review on the possible benefits of music interventions on premature infants’ well-being.

Methods

We searched 13 electronic databases and 12 journals from their first available date until August 2016. Included were all RCTs published in English with at least 10 participants per group, including infants born prematurely and admitted to the NICU. Interventions were either recorded music interventions or live music therapy interventions. All control conditions were accepted as long as the effects of the music intervention could be analysed separately. A meta-analysis was not possible due to incompleteness and heterogeneity of the data.

Results

After removal of duplicates the searches retrieved 4893 citations, 20 of which fulfilled the inclusion/exclusion criteria. The 20 included studies encompassed 1128 participants receiving recorded or live music interventions in the NICU between 24 and 40 weeks gestational age. Twenty-six different outcomes were reported which we classified into three categories: physiological parameters; growth and feeding; behavioural state, relaxation outcomes and pain. Live music interventions were shown to improve sleep in three out of the four studies and heart rate in two out of the four studies. Recorded music improved heart rate in two out of six studies. Better feeding and sucking outcomes were reported in one study using live music and in two studies using recorded music.

Conclusions

Although music interventions show promising results in some studies, the variation in quality of the studies, age groups, outcome measures and timing of the interventions across the studies makes it difficult to draw strong conclusions on the effects of music in premature infants.

The effect of music on weight gain of preterm infants older than 32 weeks: a randomized clinical trial

Objective: To evaluate the effect of recorded music with multimodal stimulation on the weight gain of preterm infants included in the Kangaroo-Mother Program. Methods: Randomized clinical trial with 61 premature infants, of both sexes, with postconceptional age greater or equal to 32 weeks and at least ten days of life, without detected abnormalities in the visual and hearing systems, and hospitalized in the Kangaroo-Mother Unit. Patients were randomized in two groups: of 31 preterm infants received multimodal stimulation with music daily, for seven days; 30 preterm infants received only multimodal stimulation. The following characteristics were evaluated: weight gain, energy consumption, heart rate and respiratory rate, stress signs and feeding method. Comparison between groups was made by Student’s t-test, Mann Whitney test and chi-square test, being significant p<0.05. Results: The two groups did not present significant differences in relation to the feeding method and energy consumption (p=0.46); however, weight gain was greater in the Experimental Group (p=0.002), which also presented better stability in cardiac and respiratory rates (p<0.001) and a significant reduction of stress signs (p=0.007), compared with the Control Group. Conclusions: The recorded music with multimodal stimulation is associated with a greater gain in body weight of hospitalized preterm infants as well as presents a positive influence on vital and stress signs (Clinical Trials Registry - UTN: U1111-1153-9301).

Early exposure to maternal voice: effects on preterm infants development

BACKGROUND

Preterm infants complete their development in Neonatal Intensive Care Unit being exposed to environmental stimuli that lead to the early maturation of the sensory systems. It is known that the fetus perceives sounds and reacts to them with movements since the 26th-28th week of gestational age. Maternal voice represents a source of sensory stimulation for the fetus.

AIMS

To investigate the effect of the exposure to maternal voice, administered by bone conduction, on preterm infants autonomic and neurobehavioral development.

STUDY DESIGN

Longitudinal, explorative, case control study.

SUBJECTS

71 preterm infants with birth weight <1500g, born adequate for gestational age

OUTCOME MEASURES

vital and neurobehavioral parameters at term, neurofunctional assessment at 3 and 6months of corrected age.

RESULTS

Infants in the treatment group had lower heart rate values and a higher proportion of stable skin color at each study point as compared to the control group. The scores in the visual attention performance and in the quality of the general movements at term were better in the treatment group than in the control one. Neurofunctional assessment score at 3months of corrected age was higher in the treatment group whereas no difference between the two groups was detected at 6months of corrected age.

CONCLUSIONS

Early exposure to maternal voice exerts a beneficial effect on preterm infants autonomic and neurobehavioral development.

Bach music in preterm infants: no 'Mozart effect' on resting energy expenditure

OBJECTIVE

To study whether Johan Sebastian Bach music has a lowering effect on resting energy expenditure (REE) similar to that of Wolfgang Amadeus Mozart music.

STUDY DESIGN

Prospective, randomized clinical trial with cross-over in 12 healthy, appropriate weights for gestational age (GA), gavage fed, metabolically stable, preterm infants. Infants were randomized to a 30-min period of either Mozart or Bach music or no music over 3 consecutive days. REE was measured every minute by indirect calorimetry.

RESULT

Three REE measurements were performed in each of 12 infants at age 20±15.8 days. Mean GA was 30.17±2.44 weeks and mean birthweight was 1246±239 g. REE was similar during the first 10-min of all three randomization periods. During the next 10-min period, infants exposed to music by Mozart had a trend toward lower REE than when not exposed to music. This trend became significant during the third 10-min period. In contrast, music by Bach or no music did not affect significantly REE during the whole study. On average, the effect size of Mozart music upon REE was a reduction of 7.7% from baseline.

CONCLUSION

Mozart music significantly lowers REE in preterm infants, whereas Bach music has no similar effect. We speculate that 'Mozart effect' must be taken into account when incorporating music in the therapy of preterm infants, as not all types of music may have similar effects upon REE and growth.

Mozart K.448 listening decreased seizure recurrence and epileptiform discharges in children with first unprovoked seizures: a randomized controlled study

BACKGROUND

Increasing numbers of reports show the beneficial effects of listening to Mozart music in decreasing epileptiform discharges as well as seizure frequency in epileptic children. There has been no effective method to reduce seizure recurrence after the first unprovoked seizure until now. In this study, we investigated the effect of listening to Mozart K.448 in reducing the seizure recurrence rate in children with first unprovoked seizures.

METHODS

Forty-eight children who experienced their first unprovoked seizure with epileptiform discharges were included in the study. They were randomly placed into treatment (n = 24) and control (n = 24) groups. Children in the treatment group listened to Mozart K.448 daily before bedtime for at least six months. Two patients in the treatment group were excluded from analysis due to discontinuation intervention. Finally, forty-six patients were analyzed. Most of these patients (89.1%) were idiopathic in etiology. Seizure recurrence rates and reduction of epileptiform discharges were compared.

RESULTS

The average follow-up durations in the treatment and control groups were 18.6 ± 6.6 and 20.1 ± 5.1 months, respectively. The seizure recurrence rate was estimated to be significantly lower in the treatment group than the control group over 24 months (37.2% vs. 76.8%, p = 0.0109). Significant decreases in epileptiform discharges were also observed after 1, 2, and 6 months of listening to Mozart K.448 when compared with EEGs before listening to music. There were no significant differences in gender, mentality, seizure type, and etiology between the recurrence and non-recurrence groups.

CONCLUSIONS

Although the case number was limited and control music was not performed in this study, the study revealed that listening to Mozart K.448 reduced the seizure recurrence rate and epileptiform discharges in children with first unprovoked seizures, especially of idiopathic etiology. We believe that Mozart K.448 could be a promising alternative treatment in patients with first unprovoked seizures and abnormal EEGs. Further large-scaled study should be conducted to confirm the effect.

TRIAL REGISTRATION

NCT01892605, date: June-19-2013.

Nonpharmacological Techniques to Reduce Pain in Preterm Infants Who Receive Heel-Lance Procedure: A Randomized Controlled Trial

Introduction: The heel-lance (HL) method for blood collection from the newborn is controversial for the pain it causes. This is the first randomized controlled trial on the management and reduction of pain using the music of Wolfgang Amadeus Mozart (“Sonata K. 448”) in premature infants hospitalized in a neonatal intensive care unit (NICU). This study has compared nonpharmacological techniques with standard procedure for reducing pain during HL procedure. Methods: Thirty-five premature infants were enrolled, each for 3 HL procedures, of which each was randomized to 1 of the 3 study arms. Arms were then compared in terms of the Premature Infant Pain Profile (PIPP) changes by analysis of variance (ANOVA). Results: One hundred five HL procedures were available for analysis (35 standard procedure, 35 music, 35 glucose). Median baseline PIPP was 3, and median PIPP after the HL procedure was 5. PIPP scale change was +3 in the control arm, +1 in the glucose arm, +2 in the music arm (p = .008). Discussion: Both glucose and music were safe and effective in limiting pain increase when compared to standard procedure in HL procedures in preterm infants.

Is silence golden? Effects of auditory stimuli and their absence on adult hippocampal neurogenesis

We have previously hypothesized that the reason why physical activity increases precursor cell proliferation in adult neurogenesis is that movement serves as non-specific signal to evoke the alertness required to meet cognitive demands. Thereby a pool of immature neurons is generated that are potentially recruitable by subsequent cognitive stimuli. Along these lines, we here tested whether auditory stimuli might exert a similar non-specific effect on adult neurogenesis in mice. We used the standard noise level in the animal facility as baseline and compared this condition to white noise, pup calls, and silence. In addition, as patterned auditory stimulus without ethological relevance to mice we used piano music by Mozart (KV 448). All stimuli were transposed to the frequency range of C57BL/6 and hearing was objectified with acoustic evoked potentials. We found that except for white noise all stimuli, including silence, increased precursor cell proliferation (assessed 24 h after labeling with bromodeoxyuridine, BrdU). This could be explained by significant increases in BrdU-labeled Sox2-positive cells (type-1/2a). But after 7 days, only silence remained associated with increased numbers of BrdU-labeled cells. Compared to controls at this stage, exposure to silence had generated significantly increased numbers of BrdU/NeuN-labeled neurons. Our results indicate that the unnatural absence of auditory input as well as spectrotemporally rich albeit ethological irrelevant stimuli activate precursor cells—in the case of silence also leading to greater numbers of newborn immature neurons—whereas ambient and unstructured background auditory stimuli do not.

Enriched environments and motor outcomes in cerebral palsy: systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Neuroplasticity evidence from animals favors an early enriched environment for promoting optimal brain injury recovery. In infants, systematic reviews show environmental enrichment (EE) improves cognitive outcomes but the effect on motor skills is less understood. The objective of this review was to appraise the effectiveness evidence about EE for improving the motor outcomes of infants at high risk of cerebral palsy (CP).

METHODS

A systematic review was conducted. Cochrane Central Register of Controlled Trials (PubMed), Cumulative Index to Nursing and Allied Health Literature, Education Resource Information Center, SocINDEX, and PsycINFO databases were searched for literature meeting inclusion criteria: randomized controlled trials; high risk of /diagnosis of CP; >25% participants ≤2 years; parent or infant interventions postdischarge; and motor outcomes reported. Data were extracted using the Cochrane protocol regarding participants, intervention characteristics, and outcomes. Methodological quality was assessed using risk of bias assessment and GRADE.

RESULTS

A total of 226 studies were identified. After removing duplicates and unrelated studies, 16 full-text articles were reviewed, of which 7 studies met inclusion criteria. The risk of bias varied between studies with the more recent studies demonstrating the lowest risk. Enrichment interventions varied in type and focus, making comparisons difficult. A meta-analysis was conducted of studies that compared enrichment to standard care (n = 5), and totaled 150 infants. A small positive effect for enrichment was found; standardized mean difference 0.39 (95% confidence interval 0.05-0.72; I(2) = 3%; P = .02) CONCLUSIONS: EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required.

The effects of music therapy on vital signs, feeding, and sleep in premature infants

OBJECTIVES

Recorded music risks overstimulation in NICUs. The live elements of music such as rhythm, breath, and parent-preferred lullabies may affect physiologic function (eg, heart and respiratory rates, O2 saturation levels, and activity levels) and developmental function (eg, sleep, feeding behavior, and weight gain) in premature infants.

METHODS

A randomized clinical multisite trial of 272 premature infants aged ≥32 weeks with respiratory distress syndrome, clinical sepsis, and/or SGA (small for gestational age) served as their own controls in 11 NICUs. Infants received 3 interventions per week within a 2-week period, when data of physiologic and developmental domains were collected before, during, and after the interventions or no interventions and daily during a 2-week period.

RESULTS

Three live music interventions showed changes in heart rate interactive with time. Lower heart rates occurred during the lullaby (P < .001) and rhythm intervention (P = .04). Sucking behavior showed differences with rhythm sound interventions (P = .03). Entrained breath sounds rendered lower heart rates after the intervention (P = .04) and differences in sleep patterns (P < .001). Caloric intake (P = .01) and sucking behavior (P = .02) were higher with parent-preferred lullabies. Music decreased parental stress perception (P < .001).

CONCLUSIONS

The informed, intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function. Entrained with a premature infant's observed vital signs, sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet-alert states. Parent-preferred lullabies, sung live, can enhance bonding, thus decreasing the stress parents associate with premature infant care.

Respostas fisiológicas de recém-nascidos pré-termo submetidos à musicoterapia clássica

OBJETIVO: Avaliar o efeito da musicoterapia nas respostas fisiológicas de recém-nascidos pré-termo hospitalizados. MÉTODOS: Ensaio clínico não controlado realizado com 12 recém-nascidos pré-termo, com idade gestacional <36 semanas, em respiração espontânea. Os pacientes foram submetidos a sessões de musicoterapia durante 15 minutos duas vezes ao dia, nos períodos matutino e vespertino, por três dias consecutivos. As variáveis: frequências cardíaca e respiratória, saturação de oxigênio, pressões arteriais sistólica e diastólica e temperatura corporal foram analisadas antes e imediatamente após a sessão de musicoterapia. RESULTADOS: Observou-se a diminuição da frequência cardíaca imediatamente após a segunda sessão de musicoterapia (t pareado; p=0,002) e o aumento ao final da terceira sessão, em relação ao início (t pareado; p=0,005). A frequência respiratória diminuiu após a musicoterapia na quarta e quinta sessões (t pareado; p=0,01 e 0,03, respectivamente). Em relação à saturação de oxigênio, houve aumento após a quinta sessão de musicoterapia (p=0,008). A análise de variância realizada entre as seis sessões, após o cálculo da média das diferenças entre os parâmetros iniciais e finais, demonstrou que o ganho médio de saturação de oxigênio na quinta sessão foi maior do que na sexta (teste de Tukey após análise de variância; p=0,04). CONCLUSÕES: A musicoterapia pode modificar em curto prazo as respostas fisiológicas de recém-nascidos pré-termo hospitalizados.

Expectations associated with the use of music in neonatal intensive care: a survey from the viewpoint of parents

PURPOSE

The purpose of this study was to describe parents' expectations concerning the use of music in a neonatal intensive care unit (NICU) and to reveal any related background factors.

DESIGN AND METHODS

A cross-sectional, descriptive, and correlational design guided a survey of 197 parents from five NICUs in Finland.

RESULTS

Most parents agreed that the preferred music could have positive effects on the infants, staff, and parents in the NICU.

PRACTICE IMPLICATIONS

When nurses consider making use of music in the NICU, it is also important to take into account the parents' viewpoints.

Music therapy research in the NICU: an updated meta-analysis

PURPOSE

To provide an overview of developmental and medical benefits of music therapy for preterm infants.

DESIGN

Meta-analysis.

SAMPLE

Empirical music studies with preterm infants in the neonatal intensive care unit (NICU).

MAIN OUTCOME

Evidence-based NICU music therapy (NICU -MT ) was highly beneficial with an overall large significant effect size (Cohen's d = 0.82). Effects because of music were consistently in a positive direction.

RESULTS

Results of the current analysis replicated findings of a prior meta-analysis and included extended use of music.(1) Benefits were greatest for live music therapy (MT ) and for use early in the infant's NICU stay (birth weight <1,000 g, birth postmenstrual age <28 weeks). Results justify strong consideration for the inclusion of the following evidence-based NICU -MT protocols in best practice standards for NICU treatment of preterm infants: music listening for pacification, music reinforcement of sucking, and music pacification as the basis for multilayered, multimodal stimulation.