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Medical News & Perspectives
January 26, 2000

Music Hath Charms for Care of Preemies

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JAMA. 2000;283(4):468-469. doi:10.1001/jama.283.4.468-JMN0126-3-1

Washington—Music played in the neonatal intensive care unit gives premature infants a better chance at life. Recorded lullaby music in the infant's isolette or, even better, a mother's gentle crooning and massaging, improves oxygen saturation levels, increases weight gain, and shortens the duration of hospital stay.

These physiological benefits were reported here by Jayne M. Standley, PhD, director of the Center for Music Research at Florida State University in Tallahassee, at the Ninth World Congress of Music Therapy.

In a controlled study of 40 infants matched for gestational age, sex, and birth weight, 20 of them—once or twice a week until they were discharged—had lullabies sung to them and were massaged. The other 20 served as controls. The hospital stay was shortened by an average of 11 days for female infants and 1.5 days for male infants in the music and massage group compared with the control group. Infants of both sexes gained weight, although the amount was not statistically significant, Standley said (Pediatr Nurs. 1998;24:532-538).

Noting that all fetuses start as females and only later in gestational age develop male characteristics, she said, "The development also changes the configuration of the brain to a male brain, and this is close to the time when the ear is developing. There may be a correlation. Male babies may not be as ready to receive auditory stimulation as female babies," she said, adding, "This, of course, is speculation."

Tunes in the womb

Music is also a means of stimulating neonatal development, Standley said, citing nonnutritive sucking as an example. "Before 34 weeks' gestation, babies cannot suck and premature infants have to be fed by tube. In order to feed by mouth the baby has to suck, swallow the fluid, and breathe before the next suck. This takes neurologic coordination that is not present before the 34th week," she explained. Nonnutritive sucking is paired with the first emerging brain wave patterns, and "some theorize that this is the first rhythmic behavior that babies engage in and is also important for neurologic development," she said. It is important to encourage sucking even in tube-fed infants, Standley noted, because those who suck during feeding gain more weight than nonsucking infants who receive the same amount of formula. Nutritive sucking sometimes has to be taught to premature infants who have been tube fed for some time.

When a baby needs a pal

Because Standley believes music can help infants develop sustained feeding capability and a sucking response strong enough to allow them to gain adequate nutrition by mouth, she has developed a pacifier-activated lullaby (PAL) system that induces the sucking reflex. Essentially, when the infant sucks, the PAL plays a lullaby, and when the infant fails to suck, the device shuts off. After 3 or 4 minutes, the infant learns to keep the music on. Standley said a 1-month-old infant will learn as readily as an 8-month-old. She has shown that a prototype of this device reinforces nonnutritive sucking in infants at 30 weeks' gestational age and increases the sucking rate of poor feeders 34 to 36 weeks of age.

Studies will be initiated to see if older, mentally retarded infants can also learn to feed orally with the PAL system.

Standley has had the pacifier patented and 50 prototypes are being developed for field testing. Because the manufacturer intends to make health claims, such as that the device improves nonnutritive sucking and increases neurological development and weight gain, US Food and Drug Administration approval is required for marketing. She said the device should be available within a year after the prototype studies have been completed.

Nice and quiet nicu

Music can also play a role in holding down the noise level in neonatal intensive care units. Standley noted that changes in auditory stimulation are an alerting mechanism, and said sounds in the unit should be soothing, constant, stable, and relatively unchanging, with the volume in the 60- to 70-dB range.

Such is not always the case, she observed. "Every baby in the intensive care unit is monitored for heart rate, respiration, oxygen saturation; if any one falls below a set level, you get a high-pitched beeping sound that continues until the nurse turns it off. Sometimes you find that when one alarm goes off, they all go off. The reason is that the babies have been hyperstimulated, and when they hear that burst of sound, they stop breathing. So you want the neonatal unit to be as quiet as possible" (Pediatrics. 1997;100:724-727.)

Standley conducted a study showing that when music was piped into the room, the noise level dropped. "While the music was on, everything got quieter, and the babies didn't cry as much. We think that over time we might be able to get the staff to keep the volume level down, and we think music is a good way to do that," she concluded.