OBJECTIVE: Very preterm infants hospitalized in the neonatal intensive care unit (NICU) experience alterations in sensory experiences. Defining types, timing and frequency of sensory-based interventions that optimize outcomes can inform environmental modifications. The objective of this study was to conduct an integrative review on sensory-based interventions used with very preterm infants in the NICU to improve infant and parent outcomes.
STUDY DESIGN: The data sources include MEDLINE, CINAHL, Cochrane Library and Google Scholar. Studies were identified that used sensory-based interventions in the NICU with preterm infants born ⩽32 weeks gestation, were published in a peer-reviewed journal between 1995 and 2015, and measured outcomes related to infant and parent outcomes. Studies were extracted from electronic databases and hand-searched from identified reference lists.
RESULTS: Eighty-eight articles were identified (31 tactile, 12 auditory, 3 visual, 2 kinesthetic, 2 gustatory/olfactory and 37 multimodal). There was evidence to support the use of kangaroo care, music and language exposure, and multimodal interventions starting at 25 to 28 weeks postmenstrual age. These interventions were related to better infant development and lower maternal stress, but not all findings were consistent. Limitations included lack of consistent outcome measures, study quality and gaps in the literature.
CONCLUSIONS: Most research identified interventions that were done for short periods of time. It is unclear what the potential is for improving outcomes if positive sensory exposures occur consistently throughout NICU hospitalization. Until more research defines appropriate sensory-based interventions to use with infants born very preterm in the NICU, information from this review can be combined with expert opinion and parent/family values to determine best practice.Journal of Perinatology advance online publication, 20 October 2016; doi:10.1038/jp.2016.179.
CONTEXT: Given the recent expansion of research in the area of music therapy (MT) for preterm infants, there is a need for an up-to-date meta-analysis of rigorously designed studies that focus exclusively on MT. OBJECTIVE: To systematically review and meta-analyze the effect of MT on preterm infants and their parents during NICU hospitalization and after discharge from the hospital. DATA SOURCES: PubMed/Medline, PsycINFO, Embase, Cochrane Database of Systematic Reviews, CINAHL, ERIC, Web of Science, RILM. STUDY SELECTION: Only parallel or crossover randomized controlled trials of MT versus standard care, comparison therapy, or placebo were included. DATA EXTRACTION: Independent extraction by 2 reviewers, including risk of bias indicators. RESULTS: From 1803 relevant records, 16 met inclusion criteria, of which 14 contained appropriate data for meta-analysis involving 964 infant participants and 266 parent participants. Overall, random-effects meta-analyses suggested significant large effects favoring MT for infant respiratory rate (mean difference, –3.91/min, 95% confidence interval, −7.8 to −0.03) and maternal anxiety (standardized mean difference, –1.82, 95% confidence interval, −2.42 to −1.22). There was not enough evidence to confirm or refute any effects of MT on other physiologic and behavioral outcomes or on short-term infant and service-level outcomes. There was considerable heterogeneity between studies for the majority of outcomes. Limitations: This review is limited by a lack of studies assessing long-term outcomes. CONCLUSIONS: There is sufficient evidence to confirm a large, favorable effect of MT on infant respiratory rate and maternal anxiety. More rigorous research on short-term and long-term infant and parent outcomes is required. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
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.
This review presents a systematic integrative summary of research that has been focused on the effects of music, auditory stimulation, or music therapy provided to premature infants in the neonatal intensive care unit (NICU). Studies were included in the review if they met the following criteria: (A) included premature infants (less than 37 weeks gestational age at birth) in the NICU, and (B) evaluated the effects of music on the infant's physiologic or behavioral responses during the infant's stay in the NICU. Studies were identified through a search of Medline and CINAHL databases from 1970 to 2010. The final sample of 35 studies varied in sample size and characteristics, behavioral and physiologic dependent variables, procedures for selection of study participants, design, and methods of data analysis. Areas of consistency and inconsistency in the findings across these studies, and proposed recommendations for future research are identified. Future research should compare the effects of different types of live and recorded music, presented over different frequencies, durations, and decibel levels, and should examine differences in response to the music based on infant characteristics such as gestational age, morbidity level, and behavioral state.
Objective: To conduct a systematic review of the efficacy of music for medical indications in term or preterm neonates. Methods: We searched 17 electronic databases, subject bibliographies, reference lists and trials registries. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. Meta-analysis was not feasible due to heterogeneity in outcomes so a qualitative analysis is presented. Results: Nine randomised trials were included. The methodological quality was generally poor (median Jadad score=1). The outcomes most commonly reported were physiological measures (heart rate (HR), respiratory rate, oxygen saturation (SaO2)), behavioural state and pain. Six studies evaluated music for the painful procedures circumcision (three trials) and heel prick (three trials). For circumcisions, one high quality pilot study (n=23) showed benefits of music for the outcomes of HR, SaO2 and pain, while two low quality studies showed no difference. For heel prick, three low quality studies provided some evidence that music may be beneficial primarily for measures of behaviour and pain. The remaining studies evaluated the use of music in preterm infants to improve physiological and behavioural parameters (n=31; benefits observed for behavioural parameters), to reinforce non-nutritive sucking via use of a pacifier activated lullaby (n=32; significant increase in feeding rates), and to influence physiological stability and behaviours in infants with chronic lung disease (n=22; no significant differences for outcomes assessed). Conclusions: The heterogeneity in study populations, interventions and outcomes precludes definitive conclusions around efficacy. There is preliminary evidence for some therapeutic benefits of music for specific indications; however, these findings need to be confirmed in methodologically rigorous trials.
Very preterm infants hospitalized in the neonatal intensive care unit (NICU) experience alterations in sensory experiences. Defining types, timing and frequency of sensory-based interventions that optimize outcomes can inform environmental modifications. The objective of this study was to conduct an integrative review on sensory-based interventions used with very preterm infants in the NICU to improve infant and parent outcomes.
STUDY DESIGN:
The data sources include MEDLINE, CINAHL, Cochrane Library and Google Scholar. Studies were identified that used sensory-based interventions in the NICU with preterm infants born ⩽32 weeks gestation, were published in a peer-reviewed journal between 1995 and 2015, and measured outcomes related to infant and parent outcomes. Studies were extracted from electronic databases and hand-searched from identified reference lists.
RESULTS:
Eighty-eight articles were identified (31 tactile, 12 auditory, 3 visual, 2 kinesthetic, 2 gustatory/olfactory and 37 multimodal). There was evidence to support the use of kangaroo care, music and language exposure, and multimodal interventions starting at 25 to 28 weeks postmenstrual age. These interventions were related to better infant development and lower maternal stress, but not all findings were consistent. Limitations included lack of consistent outcome measures, study quality and gaps in the literature.
CONCLUSIONS:
Most research identified interventions that were done for short periods of time. It is unclear what the potential is for improving outcomes if positive sensory exposures occur consistently throughout NICU hospitalization. Until more research defines appropriate sensory-based interventions to use with infants born very preterm in the NICU, information from this review can be combined with expert opinion and parent/family values to determine best practice.Journal of Perinatology advance online publication, 20 October 2016; doi:10.1038/jp.2016.179.
