Discussion
depression, anxiety
PREMATURE BIRTH
We used a multinational, pragmatic RCT to examine longer-term effects of parent-led, infant-directed singing supported by a music therapist on mother-infant bonding, parental well-being, and infant development from NICU hospitalization to 12 months’ corrected age. Parents had lower than anticipated levels of impaired bonding, anxiety, and depression at baseline. Although this parent-led form of music therapy was safe and well-accepted by parents, we found no clinically important effects on mother-infant bonding, nor on maternal anxiety, maternal depression, parental stress, or infant development.Participants in all 4 groups demonstrated mean baseline PBQ scores well below cutoff points for impaired bonding, contrasting with previous research suggesting potential delay or disturbance following premature birth.On average, the infants in our sample were medically quite stable and more mature than those in similar studies (including mean gestational age at birth, mean postmenstrual age at enrollment, and proportions of infants with worst cranial ultrasound at discharge).Qualitative research from this trial suggests the intervention affects the parent-infant relation in ways not captured by the PBQ, namely by facilitating parental agency, parent-infant communication, and a sense of relationship with the infant in the postdischarge period.Our findings demonstrated neither a beneficial nor detrimental effect on infant development. Notably, although statistically significant for infants in the NICU MT group only, at 12 months’ corrected age ASQ-3 scores were higher in all MT groups, indicating improved development scores. However, our confidence in the NICU MT finding is low due to the wide variance in results and nonsignificant estimated effect for those receiving MT in both phases. A lack of conclusive results regarding infant development may be due to insufficient number of MT sessions, insufficiently sensitive outcome measures, or assessment occurring too early to detect the effect on neurodevelopment. A dose-dependent effect of creative MT on preterm infant brain development has been noted in previous research, when infants received nearly double the median MT sessions in the NICU than our study.