Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Neonatal group has produced several hundred systematic reviews of interventions that might help to improve the care and treatment of preterm infants and their families. In this podcast, one of the group’s researchers, Dirk Bassler, talks with lead author Friederike Haslbeck, a clinical music therapist and senior researcher at the University Hospital Zurich, Department of Neonatology in Switzerland, about the September 2023 review looking at music and vocal interventions to improve neurodevelopmental outcomes for preterm infants.

Dirk: Hello Friederike, first of all, could you tell us a little about music and vocal interventions for preterm infants?

Friederike: Hello Dirk. Various approaches of music therapy and music medicine are increasingly common in neonatal intensive care units, with the aim of improving health outcomes, well-being and quality of life for both preterm infants and their parents. Music or vocal stimulation are provided live, for example by a music therapist in a therapeutic relationship or through a recording, and address either the infant alone or also the parents.

Dirk: Thanks, moving on to the effects of the interventions, what are these and why is it important to assess the potential benefits for preterm infants and their parents?

Friederike: Preterm infants are at risk for various health issues and preterm birth is a traumatic event for the parents as well. Therefore, complementary approaches such as music and vocal interventions are being used in neonatal care to improve physical and mental health for both the babies and their parents. However, various studies and reviews show ambiguous results for the efficacy of a variety of music and vocal interventions, and a more comprehensive and rigorous systematic review was needed to address the conflicting data and reviews.

Dirk: So, did you find the evidence you needed?

Friederike: On exploring the available evidence, we found 25 studies from around the world that involved approximately 1500 preterm infants and 700 parents. The reported music and vocal interventions varied widely in type, delivery, frequency, and duration. They were mainly characterized by calm, soft, musical parameters in lullaby style, often integrating the mother's voice live or recorded. Mainly, the immediate effects of music and voice were examined during the intervention and in the minutes after it. They were defined as music therapy when provided by a music therapist within a therapeutic relationship or music medicine when delivered as "medicine" by medical and healthcare professionals.

Dirk: And, what do the trials tell us about music and vocal interventions for preterm infants and their parents?

Friederike: Music and voice may lead to a beneficial reduction in infants' heart rates during the intervention and this benefit was even more substantial and certain after the intervention, leading to a medium-to-large beneficial reduction in the heart rate. On the other hand, music and voice make no difference to oxygen saturation during the intervention and may make no difference afterwards, and probably make no difference to the respiratory rate during and after the intervention.
We were less sure about any other possible effects such as the baby’s development by two years of age or the effects of music therapy on parental anxiety and postnatal depression. And there was no information in any of the studies about possible harmful effects of music or voice.

Dirk: Overall, what’s your take-home message about the use of music and vocal interventions in neonatal care?

Friederike: Despite the limitations with the current evidence, we suggest that music and vocal interventions may be used to reduce heart rates in preterm infants and because the beneficial effect was even more substantial after the intervention, this suggests a long-lasting relaxing and stabilizing effect. We found no evidence of any other clear benefits or harms on the babies, their parents, or parent-infant bonding, and more good-quality evidence is needed to draw further clear conclusions.

Dirk: Thanks, Friederike. If listeners would like to read the review, how can they get hold of it?

Friederike: Thanks, Dirk. It’s available online. People should go to Cochrane Library dot com and type 'musical and vocal interventions' in the search box to see our review near the top of the list.