The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants WHAT’S KNOWN ON THIS SUBJECT: Recorded music, parent voices, and sung lullabies have been shown to increase oxygen saturation, nonnutritive sucking, and weight gain in premature infants. WHAT THIS STUDY ADDS: Parent-preferred melodies and entrained live rhythm and breath sounds can enhance quiet alert and sleep states, suck response, and oxygen saturation in premature infants and significantly reduce fear and anxiety perception in parents. abstract OBJECTIVES: Recorded music risks overstimulation in NICUs. The live elements of music such as rhythm, breath, and parent-preferred lullabies may affect physiologic function (eg, heart and respiratory rates, O 2 saturation levels, and activity levels) and developmental function (eg, sleep, feeding behavior, and weight gain) in premature infants. METHODS: A randomized clinical multisite trial of 272 premature infants aged $32 weeks with respiratory distress syndrome, clinical sepsis, and/or SGA (small for gestational age) served as their own controls in 11 NICUs. Infants received 3 interventions per week within a 2-week period, when data of physiologic and developmental domains were collected before, during, and after the interventions or no interventions and daily during a 2-week period. RESULTS: Three live music interventions showed changes in heart rate interactive with time. Lower heart rates occurred during the lullaby (P , .001) and rhythm intervention (P = .04). Sucking behavior showed differences with rhythm sound interventions (P = .03). Entrained breath sounds rendered lower heart rates after the inter- vention (P = .04) and differences in sleep patterns (P , .001). Caloric intake (P = .01) and sucking behavior (P = .02) were higher with parent-preferred lullabies. Music decreased parental stress perception (P , .001). CONCLUSIONS: The informed, intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function. Entrained with a premature infant ’ s observed vital signs, sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet–alert states. Parent-preferred lullabies, sung live, can enhance bonding, thus decreasing the stress parents associate with premature infant care. Pediatrics 2013;131:902–918 AUTHORS: Joanne Loewy, DA, LCAT, MT-BC, a Kristen Stewart, MA, LCAT, MT-BC, SEP, a Ann-Marie Dassler, RN, MSN, FNP, IBCLC, b Aimee Telsey, MD, b and Peter Homel, PhD c a The Louis Armstrong Center for Music & Medicine; b NICU, and c Department of Biostatistics, Beth Israel Medical Center, New York, New York KEY WORDS music therapy, music medicine, acoustic stimulation, NICU music interventions ABBREVIATIONS CI—95% confidence interval ES—effect size HR—heart rate IRB—institutional review board RR—respiratory rate SGA—small for gestational age Dr Loewy conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted; Ms Stewart designed the data collection materials and trained the multisite researchers, and analyzed the data and reviewed the final manuscript; Ms Dassler assisted in the study design, interpreted the results of the outcomes, and edited the final manuscript; Dr Telsey assisted in the study design, implemented methods of data collection and interpretation, and analyzed the data, writing about the implications of the findings, and she also edited the final manuscript; and Dr Homel provided randomization before data collection, provided statistical analysis of the outcomes, and edited the final manuscript. Dr Homel’ s current affiliation is Maimonides Medical Center, Brooklyn, New York. Ms Stewart’ s current affiliation is VA - Hudson Valley Healthcare System, Castle Point, New York. This trial has been registered at www.clinicaltrials.gov (identifier NCT0151195). www.pediatrics.org/cgi/doi/10.1542/peds.2012-1367 doi:10.1542/peds.2012-1367 Accepted for publication Jan 3, 2013 Address correspondence to Joanne Loewy, The Louis Armstrong Center for Music and Medicine, Beth Israel Medical Center, 6 Silver 21 1st Ave and 16th St, New York, NY 10003. E-mail: jloewy@chpnet.org PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2013 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: All aspects of this study were supported by the Heather on Earth Music Foundation. 902 LOEWY et al