Abstract
Unbuffered stress levels may negatively influence preterm-infants’ autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm infants and their parents and enhance family-centered care. Accordingly, we aimed to compare the effects of combined MT and SSC and SSC alone on ANS stabilization in preterm infants. In a single-center, cluster-randomized trial design, ten two-month time-clusters were randomized to either combined MT and SSC or SSC alone. Families of preterm infants were offered two sessions of the allocated condition in the NICU, and a three-month follow up session at home. The primary outcome variable was stabilization of the ANS, defined by change in the high frequency (HF) power of heart rate variability (HRV) during the second session. Secondary outcomes included other HRV measures, parent–infant attachment, and parental anxiety at each session. Sixty-eight families were included. MT combined with SSC improved infants’ ANS stability, as indicated by a greater increase in HF power during MT compared to SSC alone (mean difference 5.19 m2/Hz, SE = 1.27, p < 0.001) (95% confidence interval 0.87 to 2.05). Most secondary outcomes were not significantly different between the study groups. MT contributes to preterm-infants’ autonomic stability, thus laying an important foundation for neuro-behavioral and psycho-emotional development. Studies evaluating longer-term effects of MT on preterm infants’ development are warranted.
Highlights
Neonatal stress exposure is common treating premature infants
In the entire sample, during the second session, high frequency (HF) power of the infants increased by 4.35 ms2 /Hz (SE = 0.96, p < 0.001), where in the music therapy (MT) condition it was further increased by
Increased heart rate variability (HRV), and HF-HRV power, indicate preterm infants’ autonomic nervous system (ANS) stability and ability to modulate stress, where decreased HRV can be correlated with pathological conditions [51]
Summary
The intense medical care, stimulating neonatal intensive care unit (NICU) environment, and parental separation are all major contributors to preterm infants’ stress experiences [1], leading to over stimulation during a critical period of neurodevelopment [2]. The preterm-birth and NICU conditions may lead parents to experience posttraumatic stress, anxiety, and depression [7], which affect parent–infant bonding processes and further impact infants’ developmental outcomes [1]. Combined skin-to-skin care (SSC) and music therapy (MT) may promote autonomic and physiologic stabilization in preterm infants [8], reduce stress in parents [9], and further contribute to their ability to handle the stressful effects of the NICU conditions
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