Preterm birth is on the rise causing neonatal mortality and is a major determinant of early childhood mortality and morbidity in the United States. Numerous preterm infants suffer from neurological disability including cerebral palsy; visual and hearing impairments; learning difficulties; and, psychological, behavioral, and social problems. This increasing incidence of prematurity, prevalence of significant morbidity, and burden to society, both personal and cost-related, make it imperative to identify developmental care strategies such as music that might reduce this burden.
This study integrates the work of music therapy, neuroscience, audiology, and medicine with nursing to address the uncertainty regarding the effect of music as a holistic health patterning modality and discover if preterm infant physiological and neurobehavioral state responses to music and ambient noise are different. The goal of this study was to establish a foundation for further research related to the use of music with preterm infants and to address the issue of safety in providing music as a health patterning modality for this population.
Forty-one clinically stable, non-ventilated, appropriate-for-gestational-age (AGA) preterm infants from 32 to 35 weeks gestation in a large, urban Midwest Children's Hospital NICU were included in this study. An interrupted time-series design with repeated measures was used to explore the health patterning responses of preterm infants to an intentionally designed music intervention of recorded piano music. The effect of the music was measured every 30-seconds before, during, and after the sound condition of music or ambient noise by observing the oxygen saturation, heart rate, and behavioral state of randomly assigned preterm infants in the NICU in relation to a control group in which no music (only standard NICU care with recorded ambient noise) was provided.
Mixed modeling was used to look at how preterm infant responses varied over time as well as changes between music and ambient noise groups of infants. Although there were no significant differences between group responses over the three time periods, there were significant changes in individual infant oxygen saturations, heart rates, and behavioral states over time. Infant oxygen saturations did not change significantly in the 10 minutes before the sound (p = .97) or during the 20 minutes of sound (p = .75); however, preterm oxygen saturation decreased significantly in the 10 minutes after presentation of the sound conditions (p = .004). Infant heart rates did not change significantly before the sound (p = .71) or during the sound (p = .54); however, preterm heart rate changes after the sound conditions approached significance by increasing during the 10 minutes after the sound conditions (p = .07). Infant behavioral states changed significantly before the sound as infants went from a state of active sleep to quiet sleep (p = .04) and after the sound as infants became slightly more aroused going from quiet sleep to active sleep (p = .05). There were no significant preterm infant behavioral state changes over the time period during the sound conditions (p = .22).
Infants listening to music and those listening to ambient noise recorded from the inside of an incubator all exhibited changes in oxygen saturations, heart rates, and behavioral states during the three time periods and variability in those changes; however, these responses remained within normal limits. Findings from this study demonstrated that preterm infants in a NICU did not have adverse reactions to a carefully designed music intervention.