Music therapy on parent-infant relationship

Music therapy on parent-infant relationship | Image Credit: © Prostock-studio - © Prostock-studio - stock.adobe.com.

According to a recent study published in JAMA Network Open, parent-led, infant-direct singing is safe and well-accepted, but does not significantly impact mother-infant bonding.

The relationship between parents and infants, along with infant health, is impacted by parent-infant bonding. Preterm birth can negatively affect parent-infant bonding, and factors that contribute to bonding such as maternal emotional state, parent-infant proximity, and infant communicative capacity may worsen in a neonatal intensive care unit (NICU).

Adverse outcomes from preterm birth may lead to poor quality of life, cognitive health, and mental health, along with increased depression and stress risks. Parents are also at an increased risk of posttraumatic stress disorder. This highlights a need for methods of parent-infant bonding to reduce adverse outcome risk.

Music therapy was developed to improve parent-infant communication by having parents sing to their infants. With the help of a musical therapist, parents work to improve infant development, along with their own health. Data has indicated positive short-term results, though data on long-term outcomes is lacking.

To determine the effects of parental singing on preterm infants, investigators conducted a multinational, pragmatic randomized clinical trial known as Longitudinal Study of Music Therapy’s Effectiveness for Premature Infants and Their Caregivers. The trial evaluated music therapy (MT) in the NICU.

Participants were recruited from 8 NICUs, 7 of which were level 3 and 1 level 4. Inclusion criteria for infants included being born at under 35 weeks of gestation, being at significant risk of hospitalization at least 2 weeks after inclusion, and being eligible for MT according to NICU staff.

Participants were randomized 1:1 to receive standard care only or MT with standard care. In cases of multiple pregnancies, only the first infant was included. Randomization also occurred to determine if participants would receive standard care only or MT with standard care after discharge.

Intervention was performed through 3 MT sessions weekly during hospitalizations. Sessions were 30 minutes on average, with no more than 27 sessions given to a single participant. MT included parent-led, infant-directed singing, where parent singing is influenced by infant responses.

After discharge, MT included 7 sessions, lasting an average 45 minutes and all occurring within 6 months of discharge. Singing was expanded based on infant maturity, and experts recommended parents use intervention principles outside of sessions as well.

Mother infant-bonding was the primary outcome of the study, measured using the Postpartum Bonding Questionnaire (PBQ) total score. Maternal depressive symptoms, parental anxiety, parental stress, infant development, infant socioemotional development, and rehospitalization within 1 year of birth were measured as secondary outcomes.

There were 213 infants randomized in NICU, 206 of which were also randomized at discharge. Assessments were completed by 196 mother-infant pairs at 6 months and 181 at 12 months. 

On average, PBQ scores were 0.55 for the MT group in the NICU, compared to 1.02 for the MT group after discharge. Scores of 26 points or more indicated impaired bonding, while those of 40 points or more indicated severe bonding disorder.

Differences were observed in secondary outcomes among patients who received MT, but these differences were not clinically significant. Rehospitalization rates at 6 months and 12 months also did not differ between subgroups.

Overall, improvements in bonding scores were not observed among participants receiving MT. However, bonding scores were not reduced in these patients either. Investigators recommended studies focused on other aspects of parent-infant relationships.

Reference

Ghetti CM, Gaden TS, Bieleninik Ł, et al. Effect of music therapy on parent-infant bonding among infants born preterm: arandomized clinical trial. JAMA Netw Open. 2023;6(5):e2315750. doi:10.1001/jamanetworkopen.2023.15750