A family tune: music therapy with preterm infants and their parents in the neonatal intensive care unit. A mixed methods study
By Dana Yakobson
This PhD project set out to examine the effects and experiences of music therapy (MT) with preterm infants and their parents during their admission period to the neonatal intensive care unit (NICU). Current research has demonstrated varied beneficial effects of MT on improved physiological parameters and feeding abilities in preterm infants and their mothers' anxiety reduction. In the last decade, there has been a blossoming of MT studies that promotes the family-centered care approach and highlights the importance of supporting parents as leaders of the intervention, using live and attuned music interventions. However, the need to present rigorous randomized controlled trials of neonatal MT studies, including fathers, longer-term examinations, and applying sensitive physiological outcomes is still called for. In parallel, qualitative explorations of parents' experiences of MT with their infants are relatively new and scarce.
The current quantitative driven mixed methods study aimed to answer the need to present an objectivist study measuring the effects of MT for preterm infants and their parents to further support the dissemination of MT as part of the standard developmental care of preterm infants and their parents. Another aim was to provide first-hand knowledge of parents' experiences and to describe the mechanisms of the specific MT intervention.
The quantitative examination included a cluster-randomized control trial (c-RCT) with 68 infants and their parents. The families participated in two sessions in the NICU and a three-month follow-up session at home. The primary outcome focused on preterm infants' autonomic nervous system (ANS) stability during combined family-centered MT and skin-to-skin care (SSC), compared to SSC alone. The ANS activity in preterm infants was indicated by spectral analysis of their heart rate variability (HRV) power, and specifically focused on the change in the high frequency (HF) power of the HRV. HRV analysis is a useful non-invasive procedure that provides information on the activity of the parasympathetic and sympathetic branches of the ANS, thus indicating stress and rest states. Secondary outcomes included other HRV indices of low frequency (LF) and the LF/HF ratio during sessions, physiological vital signs, and behavioral state evaluation. Parental outcomes included state-anxiety and attachment-to-infant evaluations. The qualitative inquiry focused on parents' experiences of the MT intervention, and their perceptions of the c-RCT methodology.
Results from the statistical analysis of infants' measurements during sessions demonstrated a significant beneficial effect of MT as compared to SSC alone in the improvement of preterm infants' ANS stability. Parental outcomes did not yield significant group differences.
The qualitative study contained a thematic analysis of nine interviews with parents. The findings suggested that parents experienced MT as an activity that provided a special connection between parents and infants during the NICU period. MT sessions promoted relaxation in both parents and their infant facilitated states of intimacy and focus in the here-and-now, which further assisted them to connect with their babies. A flexible approach to the MT intervention allowed for transition between active and receptive participation and assisted in supporting parents' musical engagement and continuous participation in the intervention and the study.
Overall, this PhD may contribute to the evidence-based literature and clinical practice of MT in neonatal care by the provision of a detailed c-RCT protocol which yielded significant statistical results, in combination with a qualitative study that provided a deep understanding of parents' experiences of MT with their preterm infant.