E.R. in the NICU

The NICU where I was stationed was a sprawling, surrealistic collage of see-through isolettes, scales, ventilators, monitors, IVs, feeding apparatus, and ‘procedure’ areas. All of them were bathed in an eerie bluish fluorescent light. The hums and bells and alarms of the machines provided a continuous dissonant electronic drone. Las Vegas, this was not. In stark contrast to these “mechs” were the huddled groups of bleary-eyed, sleep-deprived, confused and humbled parents and visitors. They all wore hospital-issued yellow gowns, head coverings, and booties, and they expressed pained emotions through the clear plastic confines of their child’s first out-of-womb home.

What did we, as emergency medicine residents, do in the NICU? For the most part, we simply recorded things. We weighed and measured. We counted drops of IV fluids being pumped into microscopically small, translucent veins. We calculated numbers of calories, vitamins, minerals, and medications based on weight, size, and age. We adjusted numbers of breaths and concentration of oxygen being delivered through breathing tubes and monitored the heartbeat, blood pressure, temperature, and oxygenation. Aside from placing IVs and breathing tubes, that’s all we really could do. The numbers, however, were very important. They were the only objective evidence we had to guide us in the care of these tiny, flaccid human beings.

Music in the NICU; CDs for Preemies?

There are many inherent difficulties in designing research studies to assess the effects of music on the premature infant. There are debates on the fundamental issues of whether the preemie needs additional stimulation to promote weight gain, effective breathing, and brain development, to name a few, or whether a quiet environment would best channel the neonate’s minimal energy resources in the right direction. And what is the right direction, and how can that be measured? In grams, millimeters, or milliliters of breath? In decibel of cry, cubic centimeters of urine output, integers of coordinated limb movements? In amount of months, weeks, and days spent in the NICU before ‘graduating’ to possibly another intensive care unit? These parameters and others have been used by NICU specialists to assess the effectiveness of their care. Mortality and morbidity in the NICU has greatly improved during the past 20 years. Preemies have a much greater chance of surviving and living normal lives than ever before, and they are surviving from earlier ages. It seems only natural that any modality which can be used to further these successes should be explored. This has been the case with the use of music as an adjunct therapy in the care of the neonate.

Are there scientific studies showing that music helps premature infants?

It has been demonstrated that music played for neonates can increase oxygenation, heart rate, and respiratory rate (1). Studies have suggested that music stimulation may reduce initial weight loss, boost daily average weight gain, increase caloric intake, improve oxygen saturation, and reduce the length of the NICU and total hospital stay (2,3). While these findings are positive, the experiments themselves were small, and none of the studies reduced experimental bias by being blinded and randomized. It would be extremely difficult to design a meaningful study with premature infants in the NICU that would eliminate all variables associated with the infant’s environment and physical makeup and prove that music alone caused a positive result.

What's in a number?

I recognize the above as a physician, but the musician in me understands that numbers cannot entirely reflect the benefits of music in the NICU. The real benefit to music is not necessarily in the direct physiologic effects on the infant, which are probably minute compared with medical interventions, but on the beneficial effects it might have on the family and caregivers of that infant (4). As I described initially, the NICU was not designed like Starbucks. It was not designed for families to congregate, socialize and schmooze. Music, the great art that it is, has the ability to replace alien mechanized and electronic cacophony with familiar humanistic warmth. It can sharpen the senses, improve concentration, and decrease irritability. These statements are not necessarily based on hard science, but most who have taken a long car ride without music can attest to these assumptions. Music has been known to inspire and comfort. In fact, some of the greatest music ever written was written by composers facing their own personal health tragedies and may have served as their own medicine (Beethoven, Mozart, Schubert, Mahler, to name a few).

E.R.'s bottom line:

The real and immeasurable value of music in the NICU may lie in its ability to enable stressed parents and caregivers to share the very first positive experiences of life together with the newest member or members of the family.

We at E.R. Music applaud the efforts of those researchers seeking ways to help the premature infant and their families through music and are grateful to readers who inform us about new research being published involving music and the premature infant. We will review the studies and incorporate them into this chapter. Please join our mailing list if you would like to be informed of the latest developments.

References

1) Cassidy, Standley, “ The Effect of Music Listening on Physiological Responses of Premature Infants in the NICU,” Journal of Music Therapy, XXXII (4), 1995, 208-227

2) Caine, “The Effects of Music on the Selected Stress Behaviors, Weight, Caloric and Formula Intake, and Length of Stay of Premature and Low Birth Weight Neonates in a Newborn Intensive Care Unit,” Journal of Music Therapy, XXVIII(4), 180-192

3) Standley JM, Moore RS, “Therapeutic effects of music and mother’s voice on premature infants,” Pediatric Nursing, 1995 Nov-Dec;21(6)509-512, 574

4) Kemper K, Martin K, et al, “Attitudes and expectations about music therapy for premature infants among staff in a neonatal intensive care unit,” Altern Ther Health Med. 2004 Mar-Apr;10(2):50-4

Copyright 2008, E.R. Music, LLC