“Playing music to premature babies ‘helps them sleep and improves their breathing’,” is the headline in the Daily Mail about research into the effects of ‘music therapy’ on premature babies.
While positive effects were found, it is still unclear whether this will lead to tangible health improvements.
The researchers in this study speculate that being born premature could be traumatic (from an acoustic perspective) for two reasons:
- the baby is prematurely separated from the sound of the mother’s heartbeat and the sounds they were accustomed to in the womb
- the baby is ‘plunged’ into the noisy environment of a neo-natal intensive care unit
Researchers wanted to see whether exposing premature babies to more comforting sounds could help compensate for these proposed sources of trauma.
They investigated three types of live music therapy, administered with the help of a certified music therapist:
- a lullaby or any other song chosen by the parent that was modified to be like a lullaby, preferably sung by a parent
- an instrument designed to replicate womb sounds
- an instrument that sounded like a heartbeat
The researchers found that the therapies were associated with slowing of infants’ heartbeats, calmer breathing, and improved feeding and sleep patterns. The therapies were also associated with decreased stress levels in the parents.
It is unclear whether music therapy does improve premature babies’ health outcomes. For example, if infants receiving music therapy are able to leave hospital earlier or have better long-term health outcomes.
Where did the story come from?
The study was carried out by researchers from the Beth Israel Medical Centre, New York and was funded by the Heather on Earth Music Foundation, a non-profit organisation that provides funding for music therapy programmes in children’s hospitals.
This research was well-covered by the Daily Mail. The paper also contains an aside (presumably included in an accompanying press release) that one parent chose to sing a ‘lullabied’ version of Marvin Gaye’s soul classic ‘I Heard It Through the Grapevine’ and another chose 70’s funk standard ‘Pick up the Pieces’ by Average White Band.
What kind of research was this?
This was a randomised crossover trial that aimed to determine whether three different live music interventions in premature infants could affect:
- physiological functions, such as heart and respiratory rates, oxygen saturation levels and activity levels
- developmental function such as sleep patterns, feeding behaviour and weight gain
The three interventions administered with the help of a certified music therapist were:
- a lullaby, either Twinkle, Twinkle Little Star or any other song chosen by the parent which was modified to be like a lullaby, preferably sung by a parent
- an ‘ocean disc’ musical instrument, which is a round disc containing metal beads that aims to replicate womb sounds
- a ‘gato box’, a 2- or 4-tone wooden box or drum that is played with the fingers to provide a rhythm in a manner that simulates the heartbeat sound that the baby would hear in the womb
The ocean disc and the gato box were played live and were coordinated to the infant’s breath rate. All infants received each of the three possible treatments (lullaby, gato box, ocean disc) as well as a control where no sound stimulation was given.
A randomised crossover trial is similar to a randomised control trial, but after a participant has received one treatment they are swapped over to another treatment arm, meaning that all participants received all three treatments and the control.
The trial design does have the disadvantage that the benefits obtained from one treatment might still be present when a second treatment is tested.
What did the research involve?
The researchers recruited 272 premature infants aged at least 32 weeks old with respiratory distress syndrome, clinical sepsis and/or small size for gestational age in neonatal intensive care units.
The infants received each of the three possible treatments (lullaby, gato box or ocean disc) or no explicit sound stimulation (to act as a control).
Each treatment was given twice during the two-week trial (three treatments per week). The day each treatment was given and the time of day (morning or afternoon) was randomised. If the infant received an intervention in the morning, the control was given in the afternoon and vice versa. The interventions were delivered by music therapists in conjunction with parents.
Heart rate, oxygen saturation, respiratory rate and activity level were measured at one-minute intervals during the 10-minute phase before the intervention, the 10-minute phase during, and the 10-minute phase after the intervention.
The researchers also analysed the infants’ vital signs, feeding behaviours, and sleep patterns daily during the two-week period.
In addition, self-perceived stress levels in parents of infants in neonatal intensive care were assessed before and after the two-week trial.
What were the basic results?
The percentage of ‘quiet-alert time’ (one of several states of alertness ascribed to newborns) increased during a lullaby. After the lullaby, it decreased.
All three interventions showed a significant effect over time (before, during, after) on heart rate. Heart rate decreased the most during the lullaby and gato box interventions, and after the ocean disc treatment.
The ocean disc also decreased the number of inspirations per minute during and after the treatment.
Use of the ocean disc was associated with increased ‘positive sleep patterns’ and ‘sucking pattern behaviour’ increased after the gato box treatment.
The music interventions were also associated with a decrease in parents’ perception of stress.
How did the researchers interpret the results?
The researchers conclude that the live sounds and lullabies applied by a certified music therapist can influence cardiac and respiratory function, may improve feeding behaviours and sucking patterns, and may increase prolonged periods of quiet-alert states. These interventions also decrease the stress felt by parents of premature infants.
This research has found that live music therapies may slow infants’ heartbeats, calm their breathing, improve sucking behaviour important for feeding, improve sleep patterns and promote states of quiet alertness.
Different interventions led to different patterns of improvement, but all three types of musical therapy appeared to have a positive effect on the infant. The therapies also seemed to help the parents of premature infants feel less stressed.
Although this research is interesting, it is still unclear whether music therapy can lead to tangible health improvements, for example, the researchers did not measure whether infants receiving music therapy were able to leave hospital earlier or had better long-term health outcomes.
There are also practical considerations in that access to musical therapists is likely to be limited.
Despite these limitations, the study seems to provide a degree of evidence that the deep-seated human instinct to sing lullabies to your baby does them good.
For more information, read Getting your baby to sleep
Analysis by Bazian
Edited by NHS Website
Links to the headlines
Daily Mail, 15 April 2013
Links to the science
Pediatrics. Published online April 15 2013