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Preterm infants with severe brain injury demonstrate unstable physiological responses during maternal singing with music therapy: a randomized controlled study

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Abstract

Preterm infants with severe brain injury are at high risk for poor outcomes and, therefore, may benefit from developmental care modalities such as music therapy (MT). In this prospective, randomized intervention, preterm infants with severe brain injury (grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia) who underwent skin-to-skin contact (SSC) with or without maternal singing during MT were evaluated for physiological responses, including autonomic nervous system stability (low frequency (LF)/high frequency (HF) power), heart rate, respiratory rate, oxygen saturation, and behavioral state. Maternal anxiety state and physiological data were also evaluated. A total of 35 preterm infants with severe brain injuries were included in the study analysis. Higher mean ± standard deviation (SD) LF/HF ratio (1.8 ± 0.7 vs. 1.1 ± 0.25, p = 0.01), higher mean ± SD heart rate (145 ± 15 vs. 132 ± 12 beats per minute, p = 0.04), higher median (interquartile range) infant behavioral state (NIDCAP manual for naturalistic observation and the Brazelton Neonatal Behavioral Assessment) score (3 (2–5) vs. 1 (1–3), p = 0.03), and higher mean ± SD maternal anxiety (state-trait anxiety inventory) score (39.1 ± 10.4 vs. 31.5 ± 7.3, p = 0.04) were documented in SSC combined with maternal singing during MT, as compared to SSC alone.

Conclusion: Maternal singing during MT for preterm infants with severe brain injury induces physiological and behavioral instability and increases maternal anxiety during NICU hospitalization. A unique MT intervention should be designed for preterm infants with severe brain injury and their mothers.

What is Known:

• Preterm infants with severe brain injury are at high risk for poor outcomes.

• Music therapy benefits brain development of preterm infants without severe brain injury, however it is unknown whether maternal singing during music therapy for preterm infants with severe brain injury is beneficial.

What is New:

• Maternal singing during music therapy for preterm infants with severe brain injury induces physiological and behavioral instability and increases maternal anxiety during NICU hospitalization.

• A unique music therapy intervention should be designed for preterm infants with severe brain injury and their mothers.

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Data availability

Data will be made available upon request.

Abbreviations

HF:

High frequency

HRV:

Heart rate variability

IVH:

Intraventricular hemorrhage

LF:

Low frequency

MT:

Music therapy

NICU:

Neonatal intensive care unit

NIDCAP:

Neonatal Individualized Developmental Care and Assessment Program

PVL:

Periventricular leukomalacia

SD:

Standard deviation

SSC:

Skin-to-Skin contact

STAI:

State-trait anxiety inventory

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Author information

Authors and Affiliations

  1. School of Creative Arts Therapies, University of Haifa, Haifa, Israel

    Shulamit Epstein & Cochavit Elefant

  2. Department of Neonatology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel

    Sofia Bauer, Orly Levkovitz Stern, Ita Litmanovitz, Dana Yakobson & Shmuel Arnon

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Sofia Bauer, Orly Levkovitz Stern, Ita Litmanovitz & Shmuel Arnon

  4. Doctoral program in Music Therapy, Aalborg University, Aalborg, Denmark

    Dana Yakobson

Authors
  1. Shulamit Epstein
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  2. Sofia Bauer
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  3. Orly Levkovitz Stern
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  4. Ita Litmanovitz
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Contributions

Shulamit Epstein contributed to the study conception, design, material preparation and data collection. Sofia Bauer contributed to the study conception. Orly Levkovits Stern contributed to the study design. Ita Litmanovitz contributed to the study methodology and outcome assessments. Cochavit Elefant contributed to the study conception and wrote the first draft. Dana Yakobson contributed to the study methodology and conducted the music therapy intervention. Shmuel Arnon contributed to the study design, data collection and analysis and manuscript preparation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shmuel Arnon.

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The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Institutional Review Board of Meir Medical Center and conducted in accordance with the ethical and humane principles of research established by the Declaration of Helsinki (trial registration number NCT 01427894).

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Written informed consent was obtained from all parents.

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Communicated by Daniele De Luca

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Epstein, S., Bauer, S., Levkovitz Stern, O. et al. Preterm infants with severe brain injury demonstrate unstable physiological responses during maternal singing with music therapy: a randomized controlled study. Eur J Pediatr 180, 1403–1412 (2021). https://doi.org/10.1007/s00431-020-03890-3

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  • DOI: https://doi.org/10.1007/s00431-020-03890-3

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