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NICU Music Therapy

The NICU Music Therapy Program at Mount Sinai Beth Israel

Image: Louis Armstrong

For the past six years, music therapy has been an effective intervention for referred premature infants during their stay in the NICU at Mount Sinai Beth Israel and at a growing number of medical centers in the United States.

The use of live music, and in particular the effects that intrauterine sounds may have when implemented in conjunction with music therapy techniques may have a great impact on the growing premature infant. Pilot study indicates that newborn infants, particularly infants born prematurely, may have a notable response explicitly to the voice and intrauterine sounds especially when these sounds are entrained to the babies' heart rate and respiratory rate. The Louis Armstrong team is investigating the use of music therapy, and three specific interventions on the vital signs and developmental parameters of growing premature infants. Furthermore, this study will include the use of mother's voice, father's voice and the effect of continuity of care through musical parameters (key, timbre, melodic structure), as indicated through assessment. Lullabies and songs of kin (Loewy et al, 2005) will be used as a transitional object as needed and thus will be implemented as a controlled variable.

Working with the emotional concerns of pregnant mothers has demonstrated efficacy in reducing the stress and anxiety that may be transferred to the fetus during pregnancy. Since the fetus responds to the mother's blood flow that is influenced by emotion and affect, music psychotherapy for expectant mothers and parents has been shown to be a useful forum for addressing physiological measures through affective means. When a pregnant mother experiences fear, her physiological system may be shut down which can cause altercations in her eating and sleeping patterns. Clements (1996, in Pratt, 1999) reported that fetuses responded positively to tonal music and became more agitated when presented with atonal music. This has important implications for the music therapist working with pregnant women.

The developing relationship between mother and fetus has important implications for the neonatal music therapist. McKinney (1990) provided a review of music therapy used in obstetrics and cited three studies that incorporated GIM (Linquist, 1985), music therapy using directed imagery and recorded music (Winslow, 1986), and progressive muscle relaxation using recorded music (Liebman, 1989). She provided insight not only about how music therapy may be used but, in addition, provided psychological rationale supporting the recognition that high anxiety and unresolved conflicts during pregnancy may have negative effects on the progress of labor and the incidence of obstetric complications. When an infant is born prematurely, a parent/caretaker might feel hopeless and powerless. As the infant is in need of round-the-clock medical attention, the relationship, in particular the ability to bond, becomes severed.

The positive implications noted in these three music therapy studies provide compelling case material that supports the use of music therapy, particularly to empower and strengthen a pregnant mother's sense of well-being during a time of increased vulnerability. McKinney notes that interventions designed to have a positive impact on psychological variables may also positively affect physical variables. When one considers implementing music therapy in the NICU, the conditions of the environment cannot be overlooked. The sound environment must be nurturing and womb-like.

The role of the parent/s and staff in enhancing growth for premature infants should reduce stress for the neonate and parent/s. Parent/s of premature babies might feel that their role is minimal. This may setup feelings of guilt and inadequacy; parents often feel powerless at a time when they thought they would have full control (pregnancy). Therefore, teaching ways to provide and nurture within the baby's sound environment may be medically advantageous, while at the same time may serve to be critical in the bonding process.

Music Therapy at Beth Israel: A Team-Centered Context
The Neonatal Intensive Care Unit is an environment of great need. The implementation and inclusion of music therapy in a team-centered context is essential to the growth of service in the NICU. Intensive care units maintain procedures that include accountability and documentation of services. It is therefore useful to have a formal structure in the referral process. The Referral form at Mount Sinai Beth Israel which accompanies the Criteria for Referral ensures that the referred infants will be treated, and additionally provides the music therapist with a clear direction regarding the area of greatest need from a medical and psychosocial perspective.

More pages on NICU Music Therapy at Beth Israel:

References

Calabro, L., Wolfe, R. & Shoemark, Helen (2003). The effects of recorded sedative music on the physiology and behaviour of premature infants with a respiratory disorder. Australian Journal of Music Therapy, 14, 3-19.

Clements, A. (1996). New sense out of old sense. In R. Pratt & Groke, D. (eds.) Musicmedicine 3: Expanding Horizons, pp101-119. Melbourne, Australia: University of Melbourne.

Liebman, S. (1989). The effects of music and relaxation on third trimester anxirty in 3rd trimester anxiety in adolescent pregnancy. Unpublished doctoral thesis. Miami.

Linquist, R. (1985). The role of GIM in the birthing process. Unpublished fellows paper. Institute for music and consciousness. Townsend, WA.

Loewy, J. Hallan, C., Friedman, E. & Martinez, C. Sleep/Sedation in Children Undergoing EEG Testing:  A Comparison of Chloral Hydrate and Music Therapy. Journal of Perianesthesia Nursing, 20 (5), 323-31.

McKinney, C. (1990). Music therapy in obstetrics: A review. Music Therapy Perspectives. 8: 57-60.

Pratt, RR. (1999). Music and infant well-being. In R.R. Pratt & D Grocke, (Eds), MusicMedicine 3-Expanding horizons. Melbourne , Australia : University of Melbourne.

Shoemark, Helen (2004). Family-centred music therapy for infants with complex medical and surgical needs. In M. Nocker (Ed). Music therapy for premature and newborn infants. (141-157). Gilsum, NH: Barcelona.

Shoemark, Helen (2000). The use of music therapy in treating infants with complex bowel complaints. In J. Loewy (Ed.). Music Therapy in the Neonatal Intensive Care Unit. (pp.101 - 107). New York: Satchnote Press.

Standley, J.M. (2000). Music therapy in medical treatment. In Smith. D. (Ed.) Effectiveness of Music Therapy Procedures: Documentation of Research and Clinical Practice. American Music Therapy Association: Silver Spring, MD.

Winslow, G. (1986). Music therapy in the treatment of anxiety in hospitalized high-risk mothers. Music Therapy Perspective 3:29-33.

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