Music soothes, and the existence of the lullaby is presumptive evidence that mothers have always, or nearly always, believed that it can quieten babies. For over a quarter of a century evidence has accumulated that music might improve the physiological responses and growth of premature infants. Such infants are often subjected to levels of noise which cause concern but the special properties of music may make it beneficial. Meta-analysis supports the view that music is good for premature infants (Standley 2002). Ten studies met predetermined inclusion criteria. Six studies used recorded, free-field music, usually lullabies, three used recorded music through earphones, and one used live singing. Music at 55 to 80 dB was associated with improvements in behavioural state, heart rate, respiratory rate, oxygen saturation, weight gain, feeding rate, non-nutritive sucking rate, and duration of stay in hospital.

This meta-analysis (Standley 2002) shows an overall large, significant, consistent effect size of almost a standard deviation (d =.83) (Cohen, 1998). Effects are not mediated by infants' gestational age at the time of study, birthweight, or type of music delivery nor by physiologic, behavioral, or developmental measures of benefit. The homogeneity of findings suggests that music has statistically significant and clinically important benefits for premature infants in the NICU. The unique acoustic properties that differentiate music from all other sounds are discussed and clinical implications for research-based music therapy procedures cited.

Standley recommends lightly rhythmic music with unaccompanied voice or voice plus one instrument, constant rhythm and volume (low seventies dB), and no more than 1.5 hours per day, alternating 30 minutes on with 30 minutes off. Live singing of lullabies is recommended but music-generating toys or mobiles are counter-productive.

Several studies have shown how music therapy enhances the efficacy of nursing interventions.

Chous’s study investigates how premature infants' oxygen saturation changes in response to music therapy while receiving endotracheal suctioning (Chou, Wang, Chen et al. 2003). Premature infants receiving music therapy with endotracheal suctioning had a significantly higher SPO(2); than that when not receiving music therapy (p <.01), and the level of oxygen saturation returned to the baseline level faster than when they did not receive music therapy (p <.01). Giving appropriate music therapy as developmental care to premature infants when performing any nursing intervention may enhance not only the quality of nursing care but also quality of the infant's life.

Whipple (2000) examined the effects of parent training in music and multimodal stimulation on the quantity and quality of parent-neonate interactions and the weight gain and length of hospitalization of premature and low birthweight  infants in a Neonatal Intensive Care Unit. Parents in the experimental group (n = 10) received approximately one hour of instruction in appropriate uses of music, multimodal stimulation including massage techniques, and signs of infant overstimulation and techniques for its avoidance. Parent-neonate interactions, specifically parent actions and responses and infant stress and nonstress behaviors, were observed for subjects in both groups. Infant stress behaviors were significantly fewer and appropriateness of parent actions and responses were significantly greater for experimental infants and parents than for control subjects. Parents in the experimental group also self-reported spending significantly more time visiting in the NICU than did parents of control infants. In addition, length of hospitalization was shorter and average daily weight gain was greater for infants whose parents received training, although these differences were not significant. A one month, postdischarge follow-up showed little difference between experimental and control group parent-infant interactions in the home.

Music therapy is an important intervention that is soothing for the infant. Perhaps as importantly, music therapy can also encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.

For the staff in such settings, music appears to be an acceptable intervention and its value readily understood both as an anxiolytic and for promoting communication. Music reduces stress in premature infants, but little is known about the attitudes and expectations about music among clinicians caring for these infants. In a study by Kemper (Kemper, Martin, Block et al. 2004) staff were asked if they would like to have music played in Neonatal Intensive Care Unit (NICU) and would they prefer live to recorded music. Of the 37 physicians and 150 nurses and other clinical staff in the NICU, the majority (68%) agreed that they would like to have music played in the NICU. Most agreed that music could reduce stress (86%) and crying (79%) and improve sleep (79%) in premature infants. NICU staff have a  favourable attitudes toward music for premature infants. We also know that the caregivers’ attitudes, mood and behavior contribute to its impact on infants. Music appears to be an acceptable intervention in such settings.

This project will provide a music therapy service for mothers and their babies. During the later stages of pregnancy, mothers will have the opportunity to take active part in making music with a music therapist. In addition, they will have the opportunity to learn a variety of music making activities appropriate for their infants. This will include lullabies and songs for babies.

A parallel structure will offer musical interventions within the intensive care setting for babies and their mothers that will meet their needs as suggested by the intensive care medical and nursing staff. There is an existing, albeit small, literature related to these activities (see below). This activity will continue until mother and baby are discharged home with the possibility of extending music therapy to a home setting.

This project will look at the possibilities of delivering music therapy as an intervention

Haslbeck, F. (2004): Music Therapy with preterm infants - Theoretical approach and first practical experience. Music Therapy Today (online), Vol. V, Issue 4.