Us­ing mu­sic to sta­bi­lize NICU ba­bies— as well as their par­ents

Modern Healthcare - - BEST PRACTICES - By El­iz­a­beth Whit­man

When mu­sic ther­a­pist Chris­tine Vaskas works with ba­bies in the neona­tal in­ten­sive-care unit, the ef­fect of her in­ter­ven­tions are al­most al­ways im­me­di­ately ap­par­ent.

“If I see the heart rate is high or jump­ing around, and I pro­vide an intervention,” Vaskas said, “all of a sud­den I see the heart rate sta­bi­lize. It’s bring­ing the baby back to the womb in an au­di­tory way.”

Vaskas, who has been a mu­sic ther­a­pist for five years, con­ducts clin­i­cal work and su­per­vises in­terns and fel­lows at NICUs at three hospi­tals in the Mount Si­nai Health Sys­tem in New York City. The NICU pro­gram, First Sounds: Rhythm, Breath and Lul­laby, is one of sev­eral un­der the um­brella of the Louis Arm­strong Cen­ter for Mu­sic and Medicine, which of­fers mu­sic ther­apy in med­i­cal set­tings.

In 2013, a study led by Joanne Loewy, the Arm­strong Cen­ter’s di­rec­tor, found that cer­tain live sounds, when provided in a mu­sic ther­apy con­text, could in­flu­ence the res­pi­ra­tory and car­diac func­tions of pre­ma­ture in­fants. Those in­ter­ven­tions could im­prove feed­ing behavior, en­hance sleep and de­crease stress, ac­cord­ing to the ran­dom­ized clin­i­cal trial, which spanned two years and 11 fa­cil­i­ties in the North­east.

About 1 in 10 in­fants in the U.S. is born preterm, or be­fore 37 weeks, ac­cord­ing to 2015 data from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion. These ba­bies are at higher risk of se­ri­ous dis­abil­ity or death, and in 2013, about a third of in­fant deaths were caused by preterm is­sues. Those who sur­vive can have trou­ble breath­ing or eat­ing. They also of­ten have de­vel­op­men­tal de­lays and other med­i­cal prob­lems.

The mu­sic ther­apy Vaskas pro­vides is not your con­ven­tional Bach or Mo- zart drift­ing pas­sively in the back­ground. These are sounds di­rected at the baby and the par­ents, and they draw on three spe­cific tech­niques de­vel­oped by Loewy: rhythm, breath and lul­laby.

The rhythm technique uses a gato box, a small, two-toned wooden box that, when tapped with a fin­ger, cre­ates a soft rhythm in a tim­bre meant to mimic the mother’s heart­beat. The breath technique uses a round instrument filled with tiny balls of metal, known as a Remo Ocean Disk. Ro­tat­ing it pro­duces the sound of fluid in the womb.

For the lul­laby com­po­nent of the ther­apy, par­ents choose a song to sing reg­u­larly to their child. They are en­cour­aged to pick one that has spe­cial mean­ing for them, be it a Bea­tles song or “Over the Rain­bow.”

“We don’t just work with these ba­bies. The re­al­ity is that they go home when they’re ready,” Loewy said. “And lots of times when you have frag­ile ba­bies, you have frag­ile par­ents, so part of our model is to pro­vide mu­sic psy­chother­apy for the par­ents.”

Ba­bies can rec­og­nize their par­ents’ voices over a stranger’s, and so both baby and par­ent ben­e­fit when a par­ent is em­pow­ered to sing the lul­laby, Vaskas said.

In the NICU, cer­ti­fied mu­sic ther­a­pists work with ba­bies any­where from every day to a few times a week, de­pend­ing on the in­fants’ and par­ents’ needs, with each ses­sion last­ing 10 to 20 min­utes. They don’t go longer, in or­der to avoid over­stim­u­lat­ing the ba­bies. Some­times they work just with the ba­bies, and at other times, they bring in the par­ents, too. In­clud­ing par­ents is key to suc­cess­ful, sus­tain­able ther­apy.

"Par­ents can use some mu­sic tech­niques ... to help feed, to help put the ba­bies to sleep, to ease the at­tach­ment process,” Loewy said.

Typ­i­cally, ba­bies re­ceive in­ter­ven­tions at least three times a week. Usu­ally the ses­sions be­gin when the baby is 32 weeks, but in some spe­cial cases, they’ve started mu­sic ther­apy for a baby as young as 23 weeks old. It's usu­ally neona­tol­o­gists who re­fer in­fants to mu­sic ther­apy, but if par­ents at Mount Si­nai re­quest it, their ba­bies will re­ceive it.

The full med­i­cal and cost im­pact of the ther­apy re­mains to be de­ter­mined, but the po­ten­tial is con­sid­er­able, the find­ings of 2013 study sug­gest. When an in­fant is dis­charged from the NICU, his or her neuro-be­hav­ioral sta­tus is thought to be re­lated to long-term devel­op­ment, and that sta­tus is in turn af­fected by sleep state or­ga­ni­za­tion, phys­i­ol­ogy and feed­ing in­ter­ac­tions with the mother or fa­ther.

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