Summary of Research Findings

Increases in: O2 saturations levels, weight gain, nutritive suckingbaby with healing music

Decreases in: BP, distress behaviors

Other: stronger heartbeats, masks ICU noise

Mothers’ Sounds Are Building Block for Babies’ Brains By DOUGLAS QUENQUA
A study with premature infants demonstrated that a mother’s voice and heartbeat may help the developing brain grow.

Flawed Research Invalidates: “Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants”. M. Kathleen Philbin Philbin, RN, PhD, Infant Development Specialist  Pragmatix

Excellent review of the study which caught the attention of the press in 2013. Shows how easy it is to accept data, particularly if in a journal, that has numerous flaws, i.e. irrelevant citations, no inter-rater reliability between all of the sites, background sound levels were not measured, meaningless data found significant, and others. What was shown to be effective, was singing to the infant while monitoring the rhythm, timbre and melody.

The Effects of Music Therapy by Mozart on Vital Signs and Weight gain in Preterm Infants
Esther Pozo Garcia, MD. Dept. of Pediatrics. Hospital Universitario Nuestra Senora de Candlaria  5/13/2013 http://pediatrics.aappublications.org/content/131/5/902.abstract/reply#content-block

Baby Mozart CD was used in study with 43 preterm infants who received 2 hours of music therapy: significant lower heart rate than controls. Weight gain at the end was significantly higher.

Fetus to Mom: You’re Stressing Me Out!
WebMD Feature   http://www.medicinenet.com/script/main/art.asp?articlekey=51730

A growing number of studies are confirming what used to be considered just an old wives’ tale — that stress really isn’t good for pregnant women. It not only increases the risk of pre-term labor, but possibly a host of other problems for babies after birth.

“Stress is a silent disease,” says Dr. Hobel, director of maternal-fetal medicine at Cedars Sinai and a professor of obstetrics/gynecology and pediatrics at University of California, Los Angeles (UCLA). “Pregnant women need to be educated in recognizing when they have stress, the consequences and some of the simple things they can do to make a difference.”

Pre-term births and low birth weight are among the most recognized effects of maternal stress during pregnancy, established over nearly two decades of animal and human research. Recent studies by Dr. Wadhwa and colleagues suggest that women who experience high levels of psychological stress are significantly more likely to deliver pre-term.

Pre-term babies are susceptible to a range of complications later, including chronic lung disease, developmental delays, learning disorders and infant mortality. There’s even compelling evidence from epidemiological studies and animal research that babies who experience stress in utero are more likely to develop chronic health problems as adults, such as heart disease, high blood pressure and diabetes.

Most recently, some studies are suggesting that stress in the womb can affect a baby’s temperament and neurobehavioral development. Infants whose mothers experienced high levels of stress while pregnant, particularly in the first trimester, show signs of more depression and irritability. In the womb, they also are slower to “habituate” or tune out repeated stimuli — a skill that, in infants, is an important predictor of IQ.

“Who you are and what you’re like when you’re pregnant will affect who that baby is,” says Janet DiPietro, a developmental psychologist at Johns Hopkins University. “Women’s psychological functioning during pregnancy — their anxiety level, stress, personality — ultimately affects the temperament of their babies. It has to … the baby is awash in all the chemicals produced by the mom.”

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Music Listening in Neonatal Intensive Care Units: Fried Schwartz, M.D., Ruthann Ritchie, MT-BC

Excellent, lengthy article on the research in Piedmont Hospital, Atlanta GA including how to set up a music program.  Click Here to read article.

Maternal deprivation induces a rapid decline in circulating leptin levels and sexually dimorphic modifications in hypothalamic trophic factors and cell turnover María-Paz Viverosa, Francisca Díazb, Beatriz Mateosa, Noé Rodrígueza, Julie A. Chowen

Hormones and Behavior  Volume 57, Issues 4–5, April 2010, Pages 405–414

This study points out the importance of keeping the baby with the birthmother…OR, if impossible, at least having a recording of the mother’s voice in the isolette.

Pathological outcomes, including metabolic and endocrine disturbances, of maternal deprivation (MD) in Wistar rats depend on gender and the timing of deprivation during development. We analyzed the effect of MD between postnatal days 9 and 10, a critical period in hypothalamic development, on circulating hormones and local production of trophic factors involved in this process, as well as on markers of cell turnover and maturation. Males and females were studied 12 and 24 h after MD and 12 h (MD36) after returning the dam to her pups. Circulating corticosterone levels were increased and glucose and leptin levels decreased throughout the study in both sexes. Hypothalamic mRNA levels of leptin receptor increased significantly at MD24 in both sexes, normalizing in females at MD36, but not in males. In male rats insulin-like growth factor mRNA levels were significantly decreased at MD24 and brain derived neurotrophic factor mRNA levels decreased at MD12 and MD24, with both trophic factors unaffected in females. In males cell proliferation was significantly decreased at MD36, as were the glial structural proteins, glial fibrillary acidic protein and vimentin. In females, nestin levels decreased significantly at MD24. These results indicate that MD differently affects trophic factors and cell-turnover in the hypothalamus of males and females, which may underlie the sex differences seen in the endocrine and metabolic outcome.

Study Brings Mothers’ Voices to Incubators
July 15, 2010 BWH Bulletin

At Brigham and Women’s Hospital in Boston MA small speakers perch in the corners of a 26 week old premature baby. The baby hears a personalized soundtrack consisting of his/her mother’s voice and heartbeat. ‘We now have the technology and skilled caregivers to ensure that most preemies will survive, but too often the still have neurodevelopmental problems. There is increasing evidence that some of these may be due to the impact of environment on the developing brain, “ said Steven Ringer, MD, PhD, chief of the Division of Newborn Medicine. “The potential of this study is enormous because it begins to explore how we might modify the NICU into a more supportive and appropriate environment, retaining some of the positive benefits of the womb”.

Infants enrolled in his study are exposed to 45 minutes of maternal sounds, four times per day, throughout their NICU hospitalization. Each infant receives a personalized soundtrack—consisting of his or her mother’s voice and heartbeat—that is played into the incubator via a specialized micro audio system designed by Lahav. Infants will undergo three MRI brain scans before discharge to determine the effects of soothing maternal sounds.

Effects of Music on PHysiological and Behavioral Indices of Acute Pain and Stress in Premature Infants
Tramo, J., Lense, M., Van Ness, C., et al. Music and Medicine, April 2011; vol. 3, 2: pp72-83

Infants in intensive care units often undergo medically necessary heel-stick procedures. Because the risks of administering analgesics and anesthetics are often thought to outweigh the benefits, there remain no proven means of ameliorating the pain and stress these infants suffer, particularly during procedures. This study examined the controlled use of recorded vocal music to attenuate physiological and behavioral responses to heel stick in 13 premature infants via an experimental design. In both instances, infants exposed to music and infants in the control group, heart rate, and respiration rate increased during the heel-stick procedure (P’s = .02) and nearly all infants cried. During a 10-minute recovery following the heel stick, heart rate, and crying significantly decreased in infants exposed to music (P = .02) but not in unexposed infants. Controlled music stimulation appears to be a safe and effective way to ameliorate pain and stress in premature infants following heel sticks.

Music Therapy in the PICU
Maria Jesus del Olmo, Cintia Rodriguez Garrido, Francisco Ruza Tarrfo. Music and Medicine, July 2010; vol. 2,3:pp 158-166

This article describes a live-music therapy intervention on the heart rate, oxygen saturation, and respiratory rate of infants in a pediatric intensive care unit. The infants in this study were hospitalized in a large teaching hospital in Madrid, Spain, where they were born in high-risk circumstances. This study highlights the importance of considering musical elements in the infant-adult interaction, using live music as a semiotic mediator in this interaction. In a random sample of 100 interventions with 0- to 6-month-old infants, data for heart rate and oxygen saturation were collected during six different periods: before, during, and after an interaction with live music and before, during, and after an interaction without live music. The music sessions included a keyboard and guitar as the main sources of harmonic support.

Music Therapy in the Care of the Premature Newborn

Neonates, like adults in critical-care settings, react adversely to the stressful environment of modern intensive-care units. This is reflected in heart rate variations, decreased oxygen saturation levels, wide fluctuations in blood pressure, and increased levels of agitation. Additional negative reactions may include increased myocardial oxygen consumption, cardiac arrhythmias, and reduction in peripheral and renal perfusion.

High levels of ambient light, along with loud noises and sleep interruption, are now being recognized as potential stressors of the preterm infant. Exposure to noise levels above 80 dB has been identified as one cause of hearing loss in young children. Sound levels in a neonatal ICU have been measured as averaging between 70 and 80 dB, with effects intensified rather than diminished by the incubator.

Researchers studied the effects of taped intrauterine sounds on seventeen agitated, intubated premature infants. The sounds were combined with synthesized vocal singing. The studies concluded that oxygen saturation and behavioral state improved significantly during the playing of the taped sounds.

What types of music should be played for the preterm infant? Care must be taken with the neonate to ensure that any music therapy given is indeed therapeutic and not just for the comfort of the ICU staff. Music is made up of several components including rhythm, tone, pitch, dynamics, melody, and harmony. High pitch creates tension; low pitch promotes relaxation. Rhythms of more than ninety beats per minute can also cause tension, while a slower rhythm can cause suspense or fear. A tempo of sixty beats per minute can be soothing. Dynamically, the measured intrauterine noise level is said to be 80 to 95 dB. To achieve the desired decibel level with the neonate, researchers suggest music be played at a volume of 80 dB, at a distance of three inches from the baby’s ear.
Music in the environment of a developing infant has been shown to improve oxygenation and may also enhance brain development.
Compared with recorded music or no music therapy, live music therapy is associated with a reduced heart rate and a deeper sleep at 30 minutes after therapy is stable preterm infants. Both recorded and no music therapies had no significant effect on the tested physiological and behavioral parameters.

The Power of Sound  by Joshua Leeds
Excerpt
The impact of lullaby music on premature babies in intensive care units has been scientifically studied in the Center for Music Research, Florida State University, Tallahassee, USA. The benefits of lullaby singing and multimodal stimulation on premature infants in neonatal intensive care has thus been tested. 40 infants in a Level III Newborn Intermediate Care Unit were divided into two groups of 20, pair matched on the basis of gender, birthweight, gestational age at birth and severity of medical complications. The babies were all (a) corrected gestational age more than 32 weeks; (b) age since birth more than 10 days; and (c) weight more than 1700 g, and all of the babies had been referred for developmental stimulation by the medical staff.

The subjects received reciprocal, multimodal (ATVV) stimulation paired with line singing of Brahms’ Lullaby – provided for 15-30 minutes, one or two times per week from referral to discharge. The results confirmed that playing a music lullaby can have a perceivable therapeutic effect on premature babies in a neo-natal intensive care unit (NICU).

Music and Your Baby (newborn to 1 year) S. Jhoanna Robledo
Reviewed by the
BabyCenter Medical Advisory Board

Can Listening to Music Benefit my Child?

Definitely. Think about how music affects you — how an upbeat tune fends off the blues and soft music helps you fall asleep. Your baby is no different. Lullabies have a proven track record for soothing infants — ask any parent who has resorted to singing them when the baby wakes up at 2 o’clock in the morning. “I remember rocking my son to sleep to the tune of ‘Snuggle Up,’ ” says Rich Ham-Kucharski of Canton, Michigan, father of Alex. “When we didn’t play music, he would fight sleep.”

Music may even help strengthen premature babies. Researchers from Brigham Young University studied the effects of music on 33 premature infants in the neonatal intensive care unit at Utah Valley Regional Medical Center in Provo. Cassette players piped voices of men and women singing lullabies into each baby’s isolette for 40 minutes a day for four days. When doctors examined the babies on the fourth day, they found that babies who were exposed to music gained more weight, and had lower blood pressure and a stronger heartbeat.

Mozart Therapy: A Sonata a Day Keeps the Doctor Away
ScienceDaily (Jan. 8, 2010)

The music they listen to doesn’t have any lyrics that tell them to grow, but new research from Tel Aviv University finds that premature babies who are exposed to music by 18th-century composer Wolfgang Amadeus Mozart gain weight faster — and therefore become stronger — than those who don’t.

A new study carried out by Dr. Dror Mandel and Dr. Ronit Lubetzky of the Tel Aviv Medical Center affiliated with Tel Aviv University’s Sackler School of Medicine has found that pre-term infants exposed to thirty minutes of Mozart’s music in one session, once per day expend less energy — and therefore need fewer calories to grow rapidly — than when they are not “listening” to the music.

“It’s not exactly clear how the music is affecting them, but it makes them calmer and less likely to be agitated,” says Dr. Mendel, a lecturer at Tel Aviv University.

In the study, Dr. Mandel and Dr. Lubetzky and their team measured the physiological effects of music by Mozart played to pre-term newborns for 30 minutes. After the music was played, the researchers measured infants’ energy expenditure again, and compared it to the amount of energy expended when the baby was at rest. After “hearing” the music, the infant expended less energy, a process that can lead to faster weight gain.

A “Musical Environment” for Preemies

When it comes to preemies, one of the main priorities for doctors is to get the baby up to an acceptable body weight so he or she can be sent home. At the hospital, preterm babies may be exposed to infections and other illnesses, and a healthy body weight keeps them immune to other problems in the future.

While the scientists are not sure what occasioned the response, Dr. Mandel offers one hypothesis. “The repetitive melodies in Mozart’s music may be affecting the organizational centers of the brain’s cortex,” he says. “Unlike Beethoven, Bach or Bartok, Mozart’s music is composed with a melody that is highly repetitive. This might be the musical explanation. For the scientific one, more investigation is needed.”

The study came about through an international project led by the U.S.-based consortium NIDCAP, whose goal is to create a set of standard practices to optimize the health and well-being of neonates. A number of environmental effects, such as tactile stimulation and room lighting, are already known to affect the survival and health of these very susceptible babies.

The TAU study is the first to quantify the effect of music, specifically Mozart, on newly born children. “Medical practitioners are aware that by changing the environment, we can create a whole new treatment paradigm for babies in neonatal care,” says Dr. Mandel. “That’s our main goal — to improve their quality of life.

“The point of our research is to quantify these effects so that standards and care-guides can be developed. We still don’t know the long-term effects of the music, or if other kinds of music will work just as well.”

Rockabye Baby: Research Shows Gentle Singing Soothes Sick Infants
ScienceDaily (Feb. 14, 2006)

A project led by a researcher from the University of Western Sydney has found that music therapy can help sick babies in intensive care maintain normal behavioral development, making them less irritable, upset and less likely to cry.

Dr Stephen Malloch, a Research Fellow at the University’s MARCS Auditory Laboratories at Bankstown Campus, says one of the aims of this three-year project, which was carried out in collaboration with the Royal Children’s Hospital in Melbourne, was to see what impact music therapy had on infants in intensive care.

The project studied 40 infants, divided into three groups: those hospitalised and receiving music therapy; those hospitalised and not having music therapy; and healthy babies, cared for at home, without music therapy.

Infant neuropsychologist Dr Carol Newnham performed a behavioural development test twice on each infant, about a month apart.

During that month, the hospitalised infants who received music therapy had up to 12 sessions of the therapist gently singing to them and touching them in a way that directly related to the therapist’s perception of the social needs of the babies.

“We found that music therapy supported the infants’ behaviour – these infants maintained the same levels of irritability and crying that they had at admission,” says Dr Malloch.

“Meanwhile, those babies in the Neonatal Unit who did not have music therapy deteriorated in their irritability and crying behaviour – coping less with their hospitalisation as time went on.

“It’s likely the babies who received music therapy used up less energy when compared with the babies who did not receive the therapy. If a baby is less irritable and cries less, this has implications for rate of healing and weight gain, two significant factors which contribute to the length of a hospital stay.”

These research findings were reported at the World Congress on Music Therapy held in Brisbane last year, and will be published in an international music therapy journal this year.

An Australian Research Council Linkage grant of $163,000 funded the study. Other strands of this research close to being completed include a comparative study of the mental health of the babies, and a study of their physiological measures as they interact with the music therapist.

The researchers hope to replicate and expand this study in the future in order to consolidate their findings.

The researcher who had the task of singing and interacting with the sick infants was Helen Shoemark, a Senior Music Therapist at Melbourne’s Royal Children’s Hospital and an honorary Research Fellow at the Murdoch Children’s Research Institute.

Music for Premature Babies
Thursday, June 9, 2011
Health Psychology

Premature babies seem to experience less pain and more food for music, a new study suggests. Experts led by Dr. Manoj Kumar of the University of Alberta, Canada, analyzed nine trials and found that the music had a beneficial effect in reducing pain in preterm infants undergoing painful procedures such as testing a few drops of blood from the heel . He also appeared on behalf of babies born at term during operations.

The research, published in Archives of Disease in Childhood, trials were published between 1989 and 2006 relates to the rate of the music and the heart, oxygen levels and levels of pain. Most tests used with or without her lullabies added, such as heartbeat sounds and uterus. Using live music, a lullaby sung without words, specially composed by a female voice and accompanied by a harp.

The studies covered a range of populations studied in different ways, making the final conclusions, but found “a lot of prima facie evidence of the therapeutic benefits of music for specific guidance.”

Mr. Kumar said: An investigation shows that the use of a pacifier-activated lullaby of preterm infants have improved their rate of oral feeding.”

The team writes: “In short, there is preliminary evidence that music can have beneficial effects in terms of physiological, behavioral problems and reduce pain in painful medical procedures.

“Most of the studies by the poor methodological quality. In addition, methodologically rigorous, randomized controlled trials are warranted to confirm and further explain the benefits of music in newborns, before any recommendation can be made use of music in infants.”

Neonatal units in several countries are increasingly using music as a method to improve outcomes and health behavior, or to control pain during procedures. Benefits are expected to include quiet babies and parents more likely to reach the steady state, remains the fastest weight gain and shorter in the hospital.

A team of in Bern, Switzerland examined the benefits of playing music to babies in neonatal intensive care units. They explain that these babies are exposed to many painful procedures. “Since the repeated and prolonged pain may affect neurological development and mechanical behavior of the newborn, the more attention should be given to a systematictreatment of pain in neonates,” they write.

The team adds that the non-pharmacological methods of treatment are still studied pain and pain relief. They are looking for research and identified 13 studies of good quality and analysis of two previous music, and other approaches are also bands and touch her mother.

They found that some techniques have “a positive and significant effect on heart rate, respiration and oxygen saturation, reduction of motor activity, and states of arousal by invasive measures.” But “clear evidence of this yet presented,” they conclude.

A variety of music has been used in experiments:, intrauterine sounds (tones uterus), instrumental music or singing a cappella (without instruments). Regardless of the music, a positive effect on pain response has always been recorded, said the Swiss team.

The results include the regulation and reduction of pulse rate, faster physical recovery, increasing oxygen levels and a reduction in the excited state. The music has been especially effective in reducing pain response when combined with the use of pacifiers. But researchers conducting these tests were in agreement that music should not be played for more than 15 minutes per session to avoid sensory overload.

A very recent study from Tel Aviv, Israel, looked at the “Mozart effect”. Based on the finding that weight gain seems to improve preterm infants exposed to music, the study examined whether the effect is caused by a boost in metabolic efficiency.

Mozart played half an hour on two consecutive days and ten preterm infants in good health, and there is music to babies than a dozen others. When you hear the music, the energy expenditure of children significantly reduced from ten to 13 percent. “Exposure to the music of Mozart significantly reduced resting energy expenditure in healthy preterm infants,” write the authors. “We believe that this effect of music on resting energy expenditure might partly explain the improvement of weight gain as a result of the” Mozart effect. “

Diana O. Neal’s comments at the Minnesota Intercollegiate Nursing Consortium said that music has been found to “reduce the extent and severity of problems related to prematurity.” She believes there is considerable evidence to support the use of appropriate music in premature babies. More rigorous research on the subject is still needed, she adds.

Surge in Babies Addicted to Drugs, Donna Leinwand Leger
USA Today  11/14/11

Medical authorities are witnessing explosive growth in the number of newborn babies hooked on prescription painkillers, innocent victims of their mothers‘ addictions.