In a recent study published in JAMA Network Open, Researchers assessed the impact of parent- and infant-directed singing on language development at 24 months corrected age (CA) in preterm infants during and after their neonatal intensive care unit (NICU) stay.
Study: Music therapy in infancy and neurodevelopmental outcomes in preterm children. Image credit: Prostock-studio/Shutterstock.com
Record
Preterm birth affects 15 million newborns annually, increasing mortality, morbidity and long-term neurodevelopmental problems. Although 90% of premature babies survive unharmed, their brains remain vulnerable, leading to cognitive and behavioral challenges.
The acoustic environment of the NICU can negatively affect brain development, but early exposure to adult speech and parent-directed, infant-directed singing can improve language and cognitive outcomes.
Music therapy (MT) has shown short-term benefits for stress and physiological stability. Further research is needed to determine effective MT approaches, timing of implementation, and duration to improve neurodevelopmental outcomes in preterm children.
About the study
The Longitudinal Study of Music Therapy’s Effectiveness for Premature Infants and their Caregiers (LongSTEP) was a factorial, multicenter, blinded, 2×2 randomized clinical trial with children and their parents in eight NICUs in Argentina, Norway, Colombia. Israel and Poland from August 2018 to April 2022.
Ethics approval was obtained and informed consent was given from the parents. Recruitment targeted preterm infants born before 35 weeks’ gestation who were medically stable and likely to remain in the NICU for more than two weeks. Parents must consent, attend MT sessions, live within commuting distance, and understand the local language.
Participants were randomized to MT plus standard care (SC) or SC alone, with a second randomization before discharge to MT or SC after discharge.
The MT intervention involved parent-directed, infant-directed singing, tailored to the needs of each family, with sessions three times per week during the ICU stay and seven times over a six-month period after discharge. Eleven trained music therapists performed the interventions, following the study protocol.
SC included non-MT medical, nursing and social services, and families were advised not to engage in MT outside the study. Neurodevelopmental outcomes were assessed at 24 months CA using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), focusing on language, cognitive, and motor composite scores.
Independent, blinded assessors conducted the assessments with standardized training in controlled settings to ensure reliable assessments.
Statistical analysis used linear mixed-effects models to assess treatment effects, with sample sizes calculated to detect medium effect sizes. Descriptive statistics and intention-to-treat analyzes were performed using R software.
Study results
206 families agreed to participate in the present study. They were randomized to four intervention groups at enrollment: 51 families to MT with SC and 53 families to SC in the ICU alone, with 52 families randomized to MT and 50 families to SC at discharge.
The original sample included 103 female and 103 male infants, with a mean gestational age of 30.5 weeks and a mean birth weight of 1400.5 grams. By the 24-month PA follow-up, 112 families (54%) remained, with a mean PA at assessment of 25.54 months.
Baseline characteristics between the intervention groups were well balanced and there were no significant differences between those followed up and those lost to follow-up. Retention rates varied from country to country but were consistent across intervention groups, demonstrating that long-term contact with families is feasible.
Observed BSID-III composite and subscale scores were similar across the four intervention groups. The mean composite language score across groups was 94.7, ranging from 53 to 135.
The cognitive composite score averaged 100.8, ranging from 55 to 145, and the motor composite score averaged 95.0, ranging from 46 to 154. Most participants (70% to 83%) had BSID scores -III within normal range (≥85).
In the total sample, 33 infants (30%) had composite language scores below the normal range, while 19 infants (17%) and 29 infants (26%) had cognitive and motor scores below the normal range, respectively.
Mean differences in language composite scores were -2.36 for the MT in the NICU with the post-discharge SC group, 2.65 for the SC in the NICU with the post-discharge MT group, and -3.77 for the MT group at both ICU as well as in the post-discharge group, compared to the SC group.
None of these differences were statistically significant. Similarly, mean differences for secondary outcomes were insignificant.
Risk factors for lower composite language scores included male gender and need for supplemental oxygen. However, these factors were not associated with intervention outcomes. Sensitivity analyzes using multiple imputations confirmed the lack of significant effects.
conclusions
In summary, the results show that children who received MT in the ICU with SC after discharge had similar developmental scores to those who received SC alone. This study found no beneficial or harmful effects of MT on neurodevelopment in preterm children.
The findings are in line with recent studies showing no significant effects of MT on BSID-III in preterm children, and all studies reported mean BSID-III scores within the normal range.
