The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants Effects of standardized acoustic stimulation in premature infants: a randomized controlled trial Combining kangaroo care and live harp music therapy in the neonatal intensive care unit setting. Effect of Music by Mozart on Energy Expenditure in Growing Preterm Infants Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Evaluation of pain management interventions for neonatal circumcision pain. Soothing Pain-Elicited Distress in Chinese Neonates A Pacifier-Activated Music Player With Mother’s Voice Improves Oral Feeding in Preterm Infants The Effect of Recorded Mum's Lullaby and Brahm’s Lullaby on Oxygen Saturation in Preterm Infants: a Randomized Double-Blind Clinical Trial Music and 25% glucose pain relief for the premature infant: a randomized clinical trial 1 Effects of music on physiological and behavioral responses of premature infants: a randomized controlled trial. Effect of lullaby and classical music on physiologic stability of hospitalized preterm infants: a randomized trial. The effect of music-reinforced nonnutritive sucking on feeding rate of premature infants. The effect of music-reinforced nonnutritive sucking on state of preterm, low birthweight infants experiencing heelstick. The effectiveness of music on pain among preterm infants in the neonatal intensive care unit: a systematic review The effect of music reinforcement for non-nutritive sucking on nipple feeding of premature infants. Influence of acoustic stimulation on the circadian and ultradian rhythm of premature infants Pain reduction interventions during neonatal circumcision. Pain reduction during neonatal circumcision.
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 , O2 saturation levels , and activity levels ) and developmental function ( eg , sleep , feeding behavior , and weight gain ) in premature infants . METHODS : A r and omized 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 intervention ( 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 Objective : The objective of this study was to investigate the effects of recorded lullabies and taped maternal voice in premature infants . Study design : Sixty-two preterm infants in a stable condition with 30<37 weeks of gestation and < 10 days of postnatal age were r and omly assigned to hear ( A ) recorded lullabies or ( B ) taped maternal voice for 30 min each evening during 14 consecutive days or ( C ) receive no st and ardized acoustic stimulation ( control group ) . Heart rate and respiratory rate were recorded daily before , during and after the intervention ( A and B ) or a comparable period with no intervention ( C ) , whereas activity was measured on days 1 , 7 and 14 of the intervention using accelerometers . Results : Both interventions led to a significant decrease in heart rate and respiratory rate during and after the stimulation when compared with the control group . The changes were more pronounced in infants with higher gestational ages ( P=0.001 ) . Lower activity was measured during the intervention when compared with the control group ( P<0.01 ) . Conclusions : St and ardized acoustic stimulation with recorded lullabies and taped maternal voice led to a decrease in heart rate and respiratory rate , and was associated with lower activity . Whether this indicates a reduced stress reaction needs to be investigated in further studies BACKGROUND Music therapy has been recommended as an adjuvant therapy for both preterm infants and mothers during their stay in the neonatal intensive care unit ( NICU ) , and has been shown to have beneficial effects . OBJECTIVES To study the usefulness of combining live harp music therapy and kangaroo care ( KC ) on short-term physiological and behavioral parameters of preterm infants and their mothers in the NICU setting . METHODS Included in this study were stable infants born between 32 and 37 weeks of gestation , with normal hearing . Mother-infant dyads were r and omly assigned to KC and live harp music therapy or to KC alone . Using repeated measures , neonatal and maternal heart rate , oxygen saturation and respiratory rate were recorded along with neonatal behavioral state and maternal anxiety state . Maternal age , ethnicity , education , and love of music were documented . RESULTS Fifty-two mother-infant dyads were tested . Compared with KC alone , KC and live harp music therapy had a significantly beneficial effect on maternal anxiety score ( 46.8 + /- 10 vs. 27.7 + /- 7.1 , respectively , P < 0.01 ) . Infants ' physiological responses and behavior did not differ significantly . No correlation was found between mothers ' age , ethnicity , years of education and affinity for music , and anxiety scores ( P = 0.2 to 0.5 for all four variables ) . CONCLUSIONS KC combined with live harp music therapy is more beneficial in reducing maternal anxiety than KC alone . This combined therapy had no apparent effect on the tested infants ' physiological responses or behavioral state OBJECTIVE : The rate of weight gain in preterm infants who are exposed to music seems to improve . A potential mechanism could be increased metabolic efficiency ; therefore , we conducted this study to test the hypothesis that music by Mozart reduces resting energy expenditure ( REE ) in growing healthy preterm infants . DESIGN . A prospect i ve , r and omized clinical trial with crossover was conducted in 20 healthy , appropriate-weight-for-gestational-age , gavage-fed preterm infants . Infants were r and omly assigned to be exposed to a 30-minute period of Mozart music or no music on 2 consecutive days . Metabolic measurements were performed by indirect calorimetry . RESULTS : REE was similar during the first 10-minute period of both r and omization groups . During the next 10-minute period , infants who were exposed to music had a significantly lower REE than when not exposed to music ( P = .028 ) . This was also true during the third 10-minute period ( P = .03 ) . Thus , on average , the effect size of music on REE is a reduction of ∼10 % to 13 % from baseline , an effect obtained within 10 to 30 minutes . CONCLUSIONS : Exposure to Mozart music significantly lowers REE in healthy preterm infants . We speculate that this effect of music on REE might explain , in part , the improved weight gain that results from this “ Mozart effect . BACKGROUND Music stimulation has been shown to provide significant benefits to preterm infants . We hypothesized that live music therapy was more beneficial than recorded music and might improve physiological and behavioral parameters of stable preterm infants in the neonatal intensive care unit . METHODS Thirty-one stable infants r and omly received  live music , recorded music , and no music therapy over 3 consecutive days . A control of the environment noise level was imposed . Each therapy was delivered for 30 minutes . Inclusion criteria were postconceptional age > or = 32 weeks , weight > or = 1,500 g , hearing confirmed by distortion product otoacoustic emissions ( DPOAEs ) , and no active illness or documentation of hyperresponsiveness to the music .  Heart rate , respiratory rate , oxygen saturation , and a behavioral assessment were recorded , every 5 minutes , before , during , and after therapy , allowing 30 minutes for each interval . The infant 's state was given a numerical score as follows : 1 , deep sleep ; 2 , light sleep ; 3 , drowsy ; 4 , quiet awake or alert ; 5 , actively awake and aroused ; 6 , highly aroused , upset , or crying ; and 7 , prolonged respiratory pause > 8 seconds . The volume range of both music therapies was from 55 to 70 dB. Parents and medical personnel completed a brief question naire indicating the effect of the three therapies . RESULTS Live music therapy had no significant effect on physiological and behavioral parameters during the 30-minute therapy ; however , at the 30-minute interval after the therapy ended , it significantly reduced heart rate ( 150 + /- 3.3 beats/min before therapy vs 127 + /- 6.5 beats/min after therapy ) and improved the behavioral score ( 3.1 + /- 0.8 before therapy vs 1.3 + /- 0.6 after therapy , p < 0.001 ) . Recorded music and no music therapies had no significant effect on any of the tested parameters during all intervals . Both medical personnel and parents preferred live music therapy to recorded music and no music therapies ; however , parents considered live music therapy significantly more effective than the other therapies . CONCLUSIONS Compared with recorded music or no music therapy , live music therapy is associated with a reduced heart rate and a deeper sleep at 30 minutes after therapy in stable preterm infants . Both recorded and no music therapies had no significant effect on the tested physiological and behavioral parameters INTRODUCTION The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics ( EMLA ) on pain responses of neonates undergoing circumcision . METHOD A r and omized , double-blind experimental design was used with 23 neonates .  Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate , respiratory rate , oxygen saturation levels , salivary cortisol levels , and length of cry . Each infant 's state was examined for a potential contribution to the pain response . FINDINGS Infant state , salivary cortisol levels , and respiratory rates were not significant . Pain ratings had considerable variability for all treatment conditions , but both single treatment groups had less pain by the end of the procedure . The heart rate was significantly lower for the EMLA group and remained stable for the music group . Oxygen saturation differences were statistically significant for the music group ( P = .02 ) and approached significance for the EMLA group . DISCUSSION Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision . Further study is warranted . Neonates deserve interventions that will provide them with a less painful start in life Objective . To test the effect of nonnutritive sucking ( NNS ) , music therapy ( MT ) , and combined NNS and MT ( NNS + MT ) , versus no intervention , on heart rate , transcutaneous oxygen ( TcPao 2 ) levels , and pain behavior of neonates in intensive care units having blood taken by a heel-stick procedure . Methodology . A within-subjects , counter-balancing , repeated- measures design conducted in a government-funded hospital in Hong Kong , comparing TcPao 2 levels , heart rate , and pain behavior outcomes in 27 neonates . Results . Repeated- measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions ( Wilk 's λ = .142 ; F[3,27 ] = 31.82 ; η2 = .47 ) . One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonates ' heart rate ( Wilk 's λ = .647 ; F[2,27 ] = 18.93 ; η2 = .35 ) , improved their TcPao 2 levels ( Wilk 's λ = .481;F [ 2,27 ] = 37.42 ; η2 = .51 ) , and reduced their pain behavior ( Wilk 's λ = .312 ; F [ 2,27 ] = 76.42 ; η2 = .68 ) . Posthoc scheffe tests revealed that NNS + MT had the strongest effect on neonates ' TcPao 2 levels and pain behavior ; MT alone had the strongest effect on neonates ' heart rate . Conclusions . Health professionals using NNS + MT when doing heel-sticks can improve the TcPao 2 levels of neonates and reduce their pain . Using MT alone can improve the heart rate of neonates OBJECTIVES : We conducted a r and omized trial to test the hypothesis that mother ’s voice played through a pacifier-activated music player ( PAM ) during nonnutritive sucking would improve the development of sucking ability and promote more effective oral feeding in preterm infants . METHODS : Preterm infants between 34 0/7 and 35 6/7 weeks ’ postmenstrual age , including those with brain injury , who were taking at least half their feedings enterally and less than half orally , were r and omly assigned to receive 5 daily 15-minute sessions of either PAM with mother ’s recorded voice or no PAM , along with routine nonnutritive sucking and maternal care in both groups . Assignment was masked to the clinical team . RESULTS : Ninety-four infants ( 46 and 48 in the PAM intervention and control groups , respectively ) completed the study . The intervention group had significantly increased oral feeding rate ( 2.0 vs 0.9 mL/min , P < .001 ) , oral volume intake ( 91.1 vs 48.1 mL/kg/d , P = .001 ) , oral feeds/day ( 6.5 vs 4.0 , P < .001 ) , and faster time-to-full oral feedings ( 31 vs 38 d , P = .04 ) compared with controls . Weight gain and cortisol levels during the 5-day protocol were not different between groups . Average hospital stays were 20 % shorter in the PAM group , but the difference was not significant ( P = .07 ) . CONCLUSIONS : A PAM using mother ’s voice improves oral feeding skills in preterm infants without adverse effects on hormonal stress or growth Introduction : Music stimulation has been shown to provide significant benefits to preterm infants . Thus the aim of this study was determine the effect of recorded mum 's lullaby and Brahm ’s lullaby on oxygen saturation in preterm infants . Methods : This double-blind r and omized controlled trial was carried out on 66 premature newborns with the postnatal age of ≥3 days and weight ≤ 2800 grams at Taleghani Hospital . Infants were r and omly divided into three groups : control , Brahm ’s lullaby and Mum 's lullaby groups . Infants were continuously monitored for primary outcome of percutaneous oxygen saturation , for three consecutive sessions . Results : There were significant difference in neonate oxygen saturation between the Brahm ’s lullaby and Mum 's lullaby as compared with control groups in the 15 minutes after intervention . Conclusion : This study showed beneficial effects of Brahm ’s lullaby and Mum 's lullaby sound . Therefore ; it may be used for improving short term outcomes in premature infants OBJECTIVE : to analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture  during music and 25 % glucose interventions , and to assess their association with neonatal and therapeutic variables . METHOD : a r and omized clinical trial with 80 premature infants ; 24 in the Experimental Group 1 ( music ) , 33 in the Experimental Group 2 ( music and 25 % glucose ) , 23 in the Positive Control Group ( 25 % glucose ) . All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2 ; 25 % glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture . RESULTS : 60.0 % of premature infants had moderate or maximum pain ; pain scores and intervention groups were not statistically significant . Statistically significant variables : Experimental Group 1 : head and chest circumference , Apgar scores , corrected gestational age ; Experimental Group 2 : chest circumference , Apgar scores , oxygen therapy ;  Positive Control group : birth weight , head circumference . CONCLUSION : neonatal variables are associated with pain in premature infants . Brazilian Registry of Clinical Trials : UTN : U1111 - 1123 - 4821 INTRODUCTION Despite persuasive theories about the beneficial effects of music and singing in developmental care for premature infants , few small studies are available in this regard . We conducted this study to investigate the physiological and behavioral responses of premature infants to recorded lullaby music and silence . METHODS In a r and omized controlled trial , 90 premature infants in the neonatal care unit of a hospital in Qom ( Iran ) were r and omly allocated to intervention ( lullaby and silence ) or control groups . Lullaby music was played via headphones at a volume of 50 - 60 dB. In the silence group , headphones were placed on the infants ' ears while no music was played . The three groups were surveyed for physiological responses including oxygen saturation , respiratory and heart rates , and behavioral states every five minutes before , during , and after the intervention . RESULTS The three groups were not significantly different in terms of mean values of respiratory and heart rates , oxygen saturation , and behavioral states of infants . Similarly , no significant within group differences in respiratory and heart rates , oxygen saturation , and behavioral states were observed at different times . CONCLUSION Our findings did not support the beneficial effects of music for premature infants . However , music is a noninvasive , non-pharmaceutical , and relatively low-cost intervention that can be implemented at infants ' bedside . Thus further research is warranted to determine whether the effects noted in previous studies can be consistently replicated in diverse setting s and with diverse groups of preterm infants BACKGROUND Music is considered a subset of developmental supportive care . It may act as a suitable auditory stimulant in preterm infants . Also , it may reduce stress responses in autonomic , motor and state systems . OBJECTIVE To assess and compare the influence of lullaby and classical music on physiologic parameters . METHOD This is a r and omized clinical trial with cross-over design . A total of 25 stable preterm infants with birth weight of 1000 - 2500 grams were studied for six consecutive days . Each infant was exposed to three phases : lullaby music , classical music , and no music ( control ) for two days each . The sequence of these phases was assigned r and omly to each subject . Babies were continuously monitored for heart rate , respiratory rate , and oxygen saturation and changes between phases were analyzed . RESULT Lullaby reduced heart rate ( p < 0.001 ) and respiratory rate ( p = 0.004 ) . These effects extended in the period after the exposure ( p < .001 and p = 0.001 , respectively ) . Classical music reduced heart rate ( p = 0.018 ) . The effects of classical music disappeared once the music stopped . Oxygen saturation did not change during intervention . CONCLUSION Music can affect vital signs of preterm infants ; this effect can possibly be related to the reduction of stress during hospitalization . The implication s of these findings on clinical and developmental outcomes need further study Premature infants are fed by gavage tube before 34 weeks adjusted gestational age and when nipple feeding results in detrimental changes in respiration and heart rate . Nipple feeding skill must be developed and correlates with length of hospitalization and neurobehavioral development . This study provided music reinforcement for nonnutritive sucking and assessed nipple feeding rates pre- and posttreatment for 32 infants referred as poor feeders . A pacifier fitted with a pressure transducer activated 10 seconds of recorded music in a one-trial , 15-minute intervention given to experimental infants ( n = 16 ) 30 to 60 minutes before the late afternoon bottle feeding . Feeding rates were collected for bottle feedings pre- and postintervention and for a similar interval for a no-contact control group ( n = 16 ) . Results showed that the intervention significantly increased feeding rates . Music functioned as reinforcement and the sucking behavior transferred from a nonnutritive to a nutritive event This study examined the physiologic and behavioral effects of music-reinforced nonnutritive sucking ( NNS ) for preterm , low birthweight ( LBW ) infants experiencing heelstick . Subjects were 60 infants , age 32 to 37 weeks post conceptional age in a neonatal intensive care unit . Infants were r and omly assigned to one of three treatment groups : pacifier-activated lullaby ( PAL ) , pacifier-only , and no-contact . Experimental infants were provided the Sondrex PAL System , which plays music contingent on infant sucking . Pacifier-only infants did not receive music reinforcement for sucking , and no-contact infants were not provided a pacifier or music at any point during the procedure . Stress level and behavior state were assessed continuously and heart , respiratory , and oxygen saturation rates were recorded at 15-second intervals for all infants . Most physiologic data results were inconclusive . However , analysis of behavior state and stress level revealed the following significant differences for the PAL and pacifier-only groups compared to the no-contact group , all of which were greatest between the PAL and no-contact groups : lower during-heelstick behavior state means , less time in undesirable behavior states , lower during- and post-heelstick stress level means , and smaller behavior state and stress level differences between intervals . In addition , the PAL group had a significantly lower pre-heelstick stress level mean than the no-contact group . Behavior state and stress level were also more stable across time for the PAL group than the other groups , and patterns of changes in oxygen saturation , behavior state , and stress level indicate that music-reinforced NNS may facilitate return to homeostasis Review question / objective The objective of this review is to synthesize the best available evidence related to the effectiveness of music as pain relieving method among preterm infants during painful procedures in the neonatal intensive care unit . Review questions are : Among preterm infants in the neonatal intensive care unit , is music effective in reducing pain scores ? physiological pain indicators ? behavioural pain indicators ? hormonal pain indicators ? Background Patients and context Preterm infants ( i.e. babies born at or before 37 gestational weeks ) compose a patient group of the most vulnerable to pain . Infants treated in a neonatal intensive care unit ( NICU ) are exposed to a variety of painful procedures ( e.g. heel prick , iv cannula insertion , endotracheal suctioning ) and to environmental stress ( e.g. noise , light ) . Simons et al.1 , for example , described an average 14 + /‐ 4 painful procedures during the first 2 weeks of life within a period of 24 hours among 151 neonates . Many studies have shown that repeated and sustained pain can have direct and long‐term consequences on the neurological and behavior‐oriented development of the neonates during the rapid development phase of the central nervous system . Pain can cause detectable physiological , behavioral and hormonal changes2,3,4 and contribute to the altered development of the pain system during later childhood and adolescence3,4,50 . Instead , live music such as singing is excellent type of music when it is steady , constant , quiet , soothing and directed to the infants6 . Graven7 emphasizes that recorded sound should not replace human voice exposure in the NICU ; therefore , health care providers should provide ample opportunity for the infant to hear parent 's voices live , such as singing or humming , in interactions between the parent and the infant at the bedside . The AmericanAcademy of Pediatrics Committee on Environmental Health has recommended safe levels of sound8 , and these recommendations have been up date d by an expert team of practitioners . Recommendations specify that continuous sound should not exceed an hourly equivalent sound level of 50 A‐weighted decibels (dBA)7,8,9 , and music as an auditory stimulus not exceed 75 dB in NICU6,8,10 . If earphones or other devices are used , sound sources should be kept at reasonable distances from the infant 's ear , played for brief periods and at levels below 55 dB7 . Music listening can be initiated with or without the involvement of a music therapist . In this review , music can be implemented for premature infants by a music therapist or any health care providers and it will include both recorded and live music . Outcomes Regardless of the type of music , several studies have investigated the short term effects of music on preterm infants , including the improvement in physiological outcomes ( e.g. oxygen saturation , heart rate , respiratory rate , and blood pressure ) , as well as in behavioural state ( e.g. crying , facial expression , body movements ) and pain scores6,11,12,13 . For example , Chou et al. 6 showed that premature infants receiving recorded music , that was the combination of womb sounds and the mother singing , with endotracheal suctioning had significantly higher oxygen saturation than when they did not receive music . Butt & Kisilewsky12 compared recorded music involving both the vocal and instrumental version of Brahms lullaby versus no music , and found that infants older than 31 weeks demonstrated significant reduction in heart rate , behavioral state and pain . In the study of Arnon et al.11 the infants receiving live music , compared with infants receiving recorded music or no music , had significantly reduced heart rate and behavioral scores during the post‐intervention period . Live music comprised of a lullaby sang by the female voice with frame drum and an accompanying harp . The same music was played by a tape recorder . Live music showed significant benefits , whereas no statistically significant changes were found for the recorded music and control groups . Teckenberg‐Jansson et al.13 indicated that music therapy combined with kangaroo care  decreased the pulse , slowed down the respiration and increased the transcutaneous oxygen saturation in preterm infants . The musical instruments used were a lyre and a female human voice , which hummed or sang . There is evidence that music has also positive consequences on long‐term outcomes , including length of hospitalization , weight gain , and non‐nutritive sucking10,13,14,15 . For example , in the study of Caine16 the preterm infants received music stimulation which consisted of recorded vocal music ( including lullabies and children 's music ) and routine auditory stimulation . Exposure to the music stimulation had many positive effects on preterm infants , such as it increased daily average weight , formula and caloric intake , and significantly reduced total hospital stays and stress behaviors for the experimental group . In addition , according to Lubetzky et al.10 exposure to music by Mozart significantly lowered energy expenditure among healthy preterm infants . Hartling et al.17 have published a systematic review on the efficacy of music for medical indicators in term and preterm neonates . Nine r and omized trials ( 1989‐2006 ) were included . According to the results of this review music may have positive effects on physiological parameters and behavioral states , and may reduce pain and improve oral feeding rates among the premature infants . The effects of music were evaluated during medical procedures ( circumcision , heel prick ) and for other indicators . In addition , Cignacco et al.18 conducted a systematic literature review on the efficacy of non‐pharmacological interventions in the management of procedural pain in preterm and term neonates during the period from 1984 to 2004 . According to this review there was no clear evidence that the method of music could have a pain‐alleviating effect on neonates . In the Cochrane Library , one systematic review is also available up to year of 2011 concerning  non‐pharmacological  management of infants and young children ( preterm , neonate , older up to three years ) during procedural pain19 , but this review did not consider music as an intervention . To date , there is also one meta‐ analysis published by St and ley20 concerning the efficacy of music therapy  for premature infants during the period from 1950 to 1999 . It concluded that music was beneficial for many outcomes among the preterm infants in the NICU . However , the results of this review were limited by the poor method ological quality of the included studies , and unclear reporting on the phases of review . In our systematic review , studies published in 2000 and after will be considered for inclusion in the review . The number of the RCT 's concerning the effectiveness of music  among the preterm infants in NICU is especially increased during the last few years , and these studies have not included in the previous systematic review s and meta‐ analysis In this r and omized , controlled multi-site study , the pacifier-activated-lullaby system ( PAL ) was used with 68 premature infants . Dependent variables were ( a ) total number of days prior to nipple feeding , ( b ) days of nipple feeding , ( c ) discharge weight , and ( d ) overall weight gain . Independent variables included contingent music reinforcement for non-nutritive sucking for PAL intervention at 32 vs. 34 vs. 36 weeks adjusted gestational age ( AGA ) , with each age group subdivided into three trial conditions : control consisting of no PAL used vs. one 15-minute PAL trial vs. three 15-minute PAL trials . At 34 weeks , PAL trials significantly shortened gavage feeding length , and three trials were significantly better than one trial . At 32 weeks , PAL trials lengthened gavage feeding . Female infants learned to nipple feed significantly faster than male infants . It was noted that PAL babies went home sooner after beginning to nipple feed , a trend that was not statistically significant The aim of the present study was to evaluate the development of the circadian rhythm of the salivary cortisol in premature infants and its correlation with the onset of the sleep – activity behavior pattern during the first 3 weeks of life under controlled light : dark conditions . Furthermore , we investigated the influence of acoustic stimulation by audiotaped lullabies or the maternal voice on the cortisol values and long-term sleep – activity patterns . The study was a block-r and omized , prospect i ve clinical trial with a study population of 62 preterm neonates ( 30 < 37 gestational age ) . We compared two study groups who listened either to music or to the maternal voice ( music : N = 20 ; maternal voice : N = 20 ) with a matched control group ( N = 22 ) . The acoustic stimulation took place every evening between 20:00 and 21:00 h for 30 min over a period of 2 weeks . The cortisol values and activity – rest behavior of the neonates were determined during the first 3 weeks of life on the 1st , 7th and 14th day . Actigraphic monitoring was used to record the activity pattern continuously over 24 h and a vali date d algorithm for neonates was used to estimate sleep and wakefulness . The saliva sample s were obtained 10 min before and 10 min after the acoustic interventions for the study groups . Additionally , saliva sample s were obtained from the control group seven times over a 24-h period ( 20:00 , 21:00 , 01:00 , 05:00 , 08:00 , 13:00 and 17:00 h ) . The cortisol data were analyzed by fast Fourier transformation to assess periodic characteristics and frequencies . Hierarchical linear modeling was further performed for the statistical analysis . Results : The cortisol rhythm analysis indicated a circadian rhythm pattern for only one premature infant , all others of the neonates showed no circadian or ultradian rhythm in cortisol . Cortisol level of the premature neonates was significantly higher during the first day of the study period at night-time ( median : 17.1 nmol/L , IQR = 9.7–24.4 nmol/L ) than on days 7 ( median : 9.6 nmol/L , IQR = 4.7–14.6 nmol/L ; Tukey-HSD , z = 4.12 , p < 0.001 ) and 14 ( IQR = 5.8–13.7 nmol/L ; Tukey-HSD , z = 2.89 , p < 0.05 ) . No significant effect of acoustic stimulation was observed on the cortisol concentration and sleep – wake behavior . The activity – sleep rhythm of preterm neonates was dominated by ultradian rhythm patterns with a prominent period length of 4 h ( 30.5 % ) . Activity frequencies of neonates were also significantly higher overnight on the first study day ( mean : 329 ± 185.1 U ) than of night seven ( mean : 260.2 ± 132.4 U ; Tukey-HSD , z = 2.50 , p < 0.05 ) . Quiet-activity patterns increased , whereas high-activity patterns decreased during the observation period . Average sleep time increased significantly during the study time from day 1 to day 7 ( Tukey-HSD , z = 2.51 , p < 0.05 ) . In conclusion , premature infants showed higher cortisol levels – without a circadian rhythmicity – and higher activity frequencies in the first days after birth which may reflect an adaptation process of neonates after birth . Cortisol concentrations and the activity patterns were not influenced by music interventions The purpose of this study was to determine the effect of some noninvasive pain reduction interventions on pain in 121 neonates undergoing unanesthetized circumcision . Subjects were r and omly assigned to one of six groups : classical music , intrauterine sounds , pacifier , music and pacifier , intrauterine sounds and pacifier , or control ( no nurses present and no pain reduction interventions used ) . Physiological variables that were monitored were heart rate , rhythm , dysrhythmias , blood pressure , transcutaneous oxygen ( tcpO2 ) , rate pressure product , and behavioral state , measured during 14 circumcision steps . Over the 14 steps , 42 % of the heart rates , 78 % of the systolic blood pressures ( SBP ) , 30 % of the diastolic blood pressures ( DBP ) , and 81 % of the tcpO2 pressures were abnormal . Few significant differences were found among any of the steps . SBP and DBP differed significantly between groups during two of the noninvasive steps ; and tcpO2 differed significantly during six steps PURPOSE To determine the effect of two comfort interventions during unanesthesized circumcision on  neonatal pain .  METHODOLOGY Fifty-eight neonates were r and omly assigned to one of three intervention groups . Eighteen control infants received routine care , 15 infants had music played , and 15 infants had a tape of intrauterine sounds played . During circumcision , monitors measured cardiac rate , rhythm , blood pressure , and transcutaneous oxygen . Pain was measured by analysis of videotaped facial expressions using Izard 's Maximally Discriminative Facial Movement Coding System ( 1983 ) . RESULTS Mean heart rate was above normal limits during all steps of the circumcision for the control group and during some of the steps for the other two groups . Facial expressions analyzed showed all three groups had pain much more than any other emotion during the procedure . CONCLUSIONS The two interventions were unable to offset the effects of circumcision pain
OBJECTIVE Neonatal intensive care units ( NICU ) around the world increasingly use music interventions .
The most recent systematic review of r and omized controlled trials ( RCT ) date s from 2009 .
Since then , 15 new RCTs have been published .
We provide an up date d systematic review on the possible benefits of music interventions on premature infants ' well-being .