Music Therapy Research in the NICU: An Updated Meta-Analysis

N E O N A T A L N E T W O R KV O L . 3 1 , N O . 5 , S E P T E M B E R / O C T O B E R 2 0 1 2 © 2 0 1 2 S p r i n g e r P u b l i s h i n g C o m p a n y 3 1 1 h t t p : / / d x . d o i . o r g / 1 0 . 1 8 9 1 / 0 7 3 0 - 0 8 3 2 . 3 1 . 5 . 3 1 1

Accepted for publication February 2012.

NeoNAtAl iNteNsive cAr e uNit music ther Apy

(Nicu-mt) is the use of music to enhance devel-opmental care and promote maturation of preterm infants. music has been used to pacify, to increase tolerance for stimula-tion, to enhance nipple feeding ability, to promote sleep follow-ing painful nursing procedures, to provide multimodal stimu-lation that is developmentally appropriate according to post-menstrual age, and to promote attachment with the infants’ mothers. the purpose of this meta-analysis on mt research with preterm infants treated in the Nicu over the last 20 years was to compare standard Nicu care with music versus stan-dard Nicu care without music. Analyses included calculation of effects by research demo-graphics: study design, published versus nonpublished status, early versus later time of the research, and dependent variable (heart rate, behavior state, respira-tory rate, oxygen saturation, length of stay, sucking/feeding ability, weight gain, and blood pressure). Additionally, analy-ses of effects by population demographics included post-menstrual age at study, weight at birth, and infant gender. Finally, analyses on effects by music characteristics included live versus recorded music and reported decibel levels.

BACKGROUNDthe mt research with preterm infants has been ongoing for

more than 20 years. early in its development, medical experts were cautious and cited a lack of research to justify the use of music in Nicu care.2 however, recent surveys of Nicu

medical personnel showed that 72 percent supported music listening with 86 percent supporting Nicu-mt to reduce

stress of preterm infants.3,4

the research base in this area encompasses physiologic and developmental benefits and includes studies by professional board-certified music therapists (mt-Bc) and those by medical personnel. it also includes various music techniques using either live or recorded music. Gooding’s comprehensive literature review of the research in Nicu-mt identified four basic uses of music: developmentally appropriate music listening for pacification; music as a base for pacification during layered, progressive mul-timodal stimulation; music as reinforcement for nonnutritive sucking with transfer to improved feeding skill; and mothers singing during kangaroo care to promote attachment.5

the mt procedures con-ducted by carefully trained parents have also shown benefit. Whipple ascertained that parents trained in music-based mul-timodal stimulation visited more often and spent less time overstimulating their infants.6

currently, music is used in many Nicus, and evidence-based Nicu-mt protocols are receiving reimbursement from third-party payers for health services.7 A meta-analysis of this body of research was conducted to determine overall

AbstrAct

Purpose: to provide an overview of developmental and medical benefits of music therapy for preterm infants.Design: meta-analysis.Sample: empirical music studies with preterm infants in the neonatal intensive care unit (Nicu).Main Outcome: evidence-based Nicu music therapy (Nicu-mt) was highly beneficial with an overall large significant effect size (cohen’s d 5 0.82). effects because of music were consistently in a positive direction.Results: results of the current analysis replicated findings of a prior meta-analysis and included extended use of music.1 Benefits were greatest for live music therapy (mt) and for use early in the infant’s Nicu stay (birth weight ,1,000 g, birth postmenstrual age ,28 weeks). results justify strong consideration for the inclusion of the following evidence-based Nicu-mt protocols in best practice standards for Nicu treatment of preterm infants: music listening for pacification, music reinforcement of sucking, and music pacification as the basis for multilayered, multimodal stimulation.

Music Therapy Research in the NICU: An Updated Meta-Analysis

Jayne Standley, PhD

DisclosureThe author has no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article. No commercial support or sponsorship was provided for this educational activity.

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effects of music for preterm infants and to develop best prac-tice guidelines for NICU-MT.

LITERATURE REVIEWSeverity of prematurity at birth is highly correlated with

lowered cognition at school age and future need for special edu-cation.8 Preterm birth increases risks for infant development, and MT has been proposed as an effective early intervention. Music is an intentional, preferred auditory stimulus with poten-tial for soothing, learning, and neurologic development that is perceived early in fetal development.9 It can mask ambient, envi-ronmental sound that occurs without control of volume, dura-tion, or location and can alleviate the unfortunate consequences of noise such as fatigue, stress, hyperalerting, or startle respons-es.10 Fetal learning research shows that higher order auditory perception begins before birth with early development of dis-crimination of music versus environmental noise and awareness of music variations such as familiarity, tempo, and volume.11 Because many cognitive elements of music are processed simul-taneously or in sequence by both cerebral hemispheres, repeated listening and music training stimulate neurologic development, particularly in the corpus callosum.12–14 Music listening is a highly pleasurable activity of which the preterm infant is capable and research has shown benefits from exposure to it.

Early in the development of NICU-MT, Standley conducted a meta-analysis to ascertain benefits of music for preterm infants.1 At that time, ten studies were found that had been completed by both MT-BC and by medical professionals. Results of that initial meta-analysis showed an overall large significant effect size (Cohen’s d 5 0.83) across various dependent variables. The MT effects in these few early studies were not differentiated; neither by infants’ postmenstrual age at the time of study, birth weight, or type of music delivery, nor by physiologic, behav-ioral, or developmental measures of benefit. The small sample sizes, small number of studies, and inconsistent reporting of patient demographics contributed to this lack of finding.

This initial meta-analysis showed multiple benefits from short periods of continuously playing music in the incuba-tor with infants remaining calmer and demonstrating weight gains, more stable physiologic measures, and higher oxygen saturation levels.15–19 Infants listening to music also reached discharge criteria significantly sooner.21 In a six-month post-discharge follow-up, infants receiving music listening were rated by their mothers as calmer and less irritable than those not receiving music.22 Other music procedures tested included live singing with progressive, layered, multimodal stimula-tion for increasing tolerance to stimulation, contingent music to increase nonnutritive sucking, and contingent music for sucking to improve subsequent feeding ability.23–25

In the second decade of the development of NICU-MT research, almost all of the initial dependent measures of the effects of music have been replicated. Most of these newer studies have used the audiology precautions f irst identi-fied by Cassidy and Ditty.26 The MT assessment and prac-tices have been described for integration with Newborn

Individualized Developmental Care Assessment Program (NIDCAP)—a highly regarded set of guidelines for develop-mental medical treatment of preterm infants.27

In 2009, Hartling and colleagues conducted a systematic review of music benefits for infants in the neonatal period, which included some studies with preterm infants.28 Only studies with randomized controlled trials were included and they identified a total of nine. Only five of these studies were with preterm infants: three that evaluated pain responses during heel sticks and two that dealt with behavioral or physi-ologic changes. The studies with term infants included the use of music as an analgesic during circumcision and the use of MT protocols to attempt to soothe withdrawal symptoms of addicted infants. This partial review of very diverse uses of music with term and preterm infants concluded that there was preliminary evidence to support MT with medical treatment but criticized the small sample sizes of the included studies.

METHODStudy Inclusion

Criteria for inclusion in this meta-analysis were (a) experimen-tal studies using group or individual subject designs; (b) subjects who were preterm and low birth weight infants receiving treat-ment in a NICU; (c) music included as a separate independent variable contrasted with standard NICU care without music; (d) reports in the English language; and (e) reported design, pro-cedures, and results amenable to replicated data analysis. Meta-analysis guidelines stipulate that all research should be included, whether published or not, to eliminate referee bias. Therefore, all studies meeting the aforementioned criteria were included.

The procedures followed the four basic steps of a meta-analysis: (a) a complete literature search was conducted to find all possible members of the defined population of studies; (b) the characteristics and findings of the collected studies were identified, described, and coded; (c) these codes were reviewed for reliability and agreement; then (d) each study’s results were statistically analyzed and converted to computed effect sizes using meta-analysis software.29 The identification process was conducted by trained researchers and included exhaus-tive searches of the Journal of Music Therapy (1964–2010), Dissertation Abstracts (1950–1999), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE (1983–2010), and Google Scholar. Keywords for searches of electronic indexes included neonates, preterm infants, low birth weight, NICU, music, MT, and auditory stimulation. The reference lists of all relevant articles located in the elec-tronic search were also reviewed. All unpublished studies were obtained by interlibrary loan or commercial sources.

Thirty studies met criteria for inclusion in the meta-analysis. These studies are marked with an asterisk in the reference list.

RESULTSThe value of each dependent variable reported in the selected

studies was converted to the estimated effect size—Cohen’s d.30 Table 1 shows design, independent variable, dependent

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TABLE 1 n Design and Results by Study

Authors Design (N) Independent Variable Dependent Variable Cohen’s d p

Arnon et al.31 W (31) ML: live voice, frame drum, & harp Heart rate 4.48 .00

Respiration rate 1.07 .00

Oxygen saturation 0.43 .10

Behavior state 3.89 .00

Bailey32 B (86) ML: recorded Length of stay 4.57 .00


Blumenfeld & Eisenfeld33 W (11) ML: live – mother singing Feeding behavior 0.27 .40

Britt & Kisilevsky34 B (28) ML: recorded Behavior state 0.77 .05

Burke et al.35 W (4) ML: recorded Behavior state 0.99 .12

Caine21 B (52) ML: recorded Length of stay 0.50 .07

Weight gain 0.84 .00


Cassidy36 B (63) ML: recorded Head circumference 0.00 1.00

Cassidy & Standley18 B (20) ML: recorded Oxygen saturation 1.19 .01

Cevasco37 B (20) ML: recorded – mother singing Weight gain 0.09 .84

Length of stay 0.23 .63

Cevasco & Grant38 W (62) PAL: recorded Weight gain 0.16 .39

Chapman15 B (100) ML: recorded Limb motor activity 0.16 .44

Chou, Wang, Chen & Pai39 W (30) ML: recorded Oxygen saturation 0.69 .01

Coleman et al.40 B (66) ML: recorded Heart rate 0.92 .00



Length of stay 0.49 .05

Collins & Kuck19 B (17) ML: recorded music & heart beat Oxygen saturation 0.70 .05


Heart rate 0.46 .19

Flowers, McCain & Hilker41 W (9) ML: recorded music & heart beat Oxygen saturation 1.05 .03


Keith, Russell & Weaver42 W (22) ML: recorded Inconsolable crying 1.36 .00

Lai et al.43 B (30) Recorded music with kangaroo care Sleep behavior 1.70 .00

Lorch et al.17 W (10) ML: recorded Systolic blood pressure 0.13 .78

Lubetsky et al.44 W (18) ML: recorded Resting energy expenditure 0.55 .11

MacDowell45 W (12) ML: recorded-Mother singing Heart rate 0.72 .10

Moore, Gladstone, & Standley46 W (22) ML: recorded Oxygen saturation 1.29 .01

Standley23 B (40) MMS: live voice Length of stay 0.55 .09

Weight gain 0.81 .01

Standley25 B (36) ML: recorded or MMS live Head circumference 0.58 .10

Standley24 W (12) PAL: recorded Nonnutritive sucking rate 0.73 .07

Standley47 B (32) PAL: recorded Feeding rate 0.87 .02

Standley et al.48 B (14) PAL: recorded Days of gavage feeding 4.40 .00

Standley & Moore20 B (20) ML: recorded Oxygen saturation 1.03 .03

Standley & Swedberg49 B (208) MMS: live or PAL recorded Length of stay 0.32 .46

Walworth et al.50 B (108) MMS: live voice and/or guitar Length of stay 0.31 .11

Whipple51 B (60) PAL: recorded Behavior state 1.50 .00

Note: B 5 between groups design; W 5 within groups design; ML 5 music listening; PAL 5 pacifier activated lullaby device; MMS 5 multimodal stimulation with music.


variables, and results by study. The overall meta-analysis resulted in a very large effect size (Cohen’s d 5 0.82) for MT with standard NICU care versus standard NICU care alone. Because the 95 percent confidence interval (CI) did not include zero, this effect size is considered statistically sig-nificant and indicates that music consistently has a positive and significant impact in the NICU. The total number of subjects in this analysis was 1,725—an average of 38.3/study which was comparable to that of the previous study.1

Homogeneity analysis of the effect sizes showed that results were not differentiated by between/within design (29 variables using group comparisons vs. 16 using subjects as their own control), by published (35 variables) versus nonpublished (10 variables) status, or by early (pre-2000, 23 variables) versus later (post-2000, 22 variables) time of completion. Many diverse dependent variables encompassing physiologic, behavioral, and length of stay parameters were included in the sample, so data were analyzed with all variables and also with only the primary variable of each study. Some meta-analyses limit inclusion to one variable/study to avoid weighting results with multiple dependent variables from the same study. There was no difference between these two anal-yses in the overall effect size for music, so it was determined that all 45 dependent measures should be included in this analysis to increase the amount of information about effects of music across diverse dependent variables.

Table 2 shows effect sizes for each dependent variable in hierarchical order. Positive benefits of MT were found across physiologic, length of stay, and behavioral measures. Significant effects for music were found for heart rate, behav-ior state, oxygen saturation, sucking or feeding ability, and length of stay in the NICU. Results for weight gain, mea-sures of head circumference, and systolic blood pressure were not significant. This table also demonstrates replication accumulating within the literature base with multiple studies measuring each dependent variable, except respiration rate and blood pressure.

Studies were coded by reported decibel levels of the music: those greater than 75 dB and those equal to or less than 75 dB. Only the studies reported at 75 dB or less had significant effects for music (d 5 0.77, r 5 0.36, CI 5 10.66/10.88, p , .00).

Results of this meta-analysis showed differentiated effects by population demographics (Table 3). Music benefits for infants aged 28–35 postmenstrual weeks at the time of the NICU-MT intervention were significant but were not signifi-cant for infants ,28 weeks or 35 weeks. The NICU-MT effect sizes consistently decreased as birth weight rose. Females were more responsive than males to MT, a gender difference reported in various studies.

Finally, this meta-analysis showed that effects were differ-entiated by live versus recorded music and by whether infants remained in the incubator untouched or were touched during the NICU-MT intervention (infant held during music with kangaroo care, infant held during music with massage as part of multimodal stimulation, infant not held but touched when given pacifier activated lullaby [PAL] device for music reinforce-ment of sucking; Table 4). Live music was more beneficial when

TABLE 2 n Neonatal Intensive Care Unit Music Therapy Effects by Dependent Variable

Dependent Variable N of studies Cohen’s d p

Heart rate 4 1.19 .00

Behavior state 11 1.09 .00

Respiration rate 1 1.07 1.00*

Oxygen saturation 9 0.97 .04

Sucking/feeding ability 4 0.85 .00

Length of stay 7 0.71 .00

Weight/REE 6 0.43 .38*

Head circumference 2 0.24 .43*

Blood pressure 1 0.13 1.00*

Note: *Not significant. REE 5 resting energy expenditure.

TABLE 3 n Neonatal Intensive Care Unit Music Therapy Effects by Population Demographics

Demographics N of Studies Cohen’s d p

Postmenstrual age at study

,28 weeks 3 1.04 .97*

28–31 weeks 12 0.87 .01

32–35 weeks 17 0.82 .00

35 weeks 4 0.68 .84*

Birth weight

,1,000 g 4 2.15 .00

1,000–1,500 g 16 0.97 .00

1,500 g 8 0.73 .36*

Gender

,50% female 10 0.59 .10*

50% female 30 0.93 .00

Note: *Not significant.

TABLE 4 n Neonatal Intensive Care Unit Music Therapy Effects Sizes by Music Condition

Music Type & Condition Cohen’s d p

Recorded music listening, no physical contact except placement of speakers in the incubator

0.89 .00

Live music, either MT or mother singing, no physical contact

1.4 .00

Recorded music listening with touch 0.49 .00

Live music with touch 0.44 .73*

Note: *Not significant.

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no touch was used, but recorded music was more effective when paired with some type of touch to the infant. The studies using live music interactions were all conducted by qualified music therapists. The recorded music studies were a combination of those by MTs and those conducted by medical personnel.

DISCUSSIONThe effect size of this study is virtually the same as that

found in the prior analysis of the first ten studies in this area.1 Although the number of studies has tripled in the last ten years and new dependent variables have been mea-sured, effects remained consistently positive for the benefits of music, that is, powerful documentation and replication of the positive benefits of MT in the NICU.

In this study, we analyzed results by the decibel level of the music and found better benefits for music below 75 dB Scale C. These data are suspect, however, because many studies did not report which audiometer scale was used. We have found through testing of sound within the incubator that there is an approximate difference of 10 dB between Scale A used to measure the range of the speaking voice and Scale C used to measure the more widespread frequencies of music. Care should be taken in future reports of music use in the NICU to clarify scale of the decibel measurement.

The homogeneity analysis of effects for recorded versus live music with or without touch present showed live music with greater benefit when touch was not included. However, it should be noted that this analysis is confounded by use of music, delivery of music, and medical procedures in combination with music. It should be noted that there is also probably confound-ing between type of MT intervention and the measured depen-dent variable. The studies using the multimodal stimulation protocol and the PAL protocol that have both shown consis-tent and highly significant positive results measured length of stay—a very important and beneficial dependent variable that ranked only sixth in strength of effect size. These highly posi-tive benefits were averaged with that of the measure of head cir-cumference that was the only dependent variable showing no difference because of music. Therefore, the clinical importance of this particular finding is highly suspect. Further research to isolate and refine the most effective NICU-MT protocols com-bining music and touch of infants is warranted.

The NICU-MT can alleviate some of the problems of NICU treatment by reducing lengths of stay, raising oxygen saturation levels, and improving sleep and feeding skills. Since positive MT effect sizes decreased as birth weight increased, it is evident that NICU-MT is more effective early in the infant’s stay. Results also showed greater music benefits for female infants. Music volume is an important consideration, and care should be taken to maintain music volume below 65–75 dB Scale C.

Music stimulation can be processed early in development and has unique auditory input and neurologic consequences for preterm infants. Results of this meta-analysis show evi-dence of increased maturation and development that may be

contributing more to long-term outcomes that has currently been measured. Perhaps one of the most important outcomes of NICU-MT is not yet fully documented in the research literature: lullaby selections for preterm infants convey the human voice and may provide much needed language stim-ulation with important long-term consequences for future learning. Music alone or combined with the human voice would seem to be a valuable resource for enhancing devel-opmental goals in the NICU while functioning to reduce stress; to provide developmental stimulation during a criti-cal period of growth; to promote attachment with parents; and/or to facilitate neurologic, communication, and social development. Research investigating long-term developmen-tal outcomes for infants receiving NICU-MT is warranted.

CONCLUSIONThis comprehensive, updated meta-analysis on music

research with infants treated in the NICU replicated find-ings of a prior meta-analysis of the first ten studies in this field.1 Significant benefits of MT were found on measures of heart rate, behavior state, oxygen saturation, sucking/feeding ability, and length of stay. Benefits were greatest for live MT and for use early in the infant’s NICU stay (birth weight , 1,000 g, birth postmenstrual age ,28 weeks). Results justify strong consideration for the inclusion of these evidence-based NICU-MT protocols in best practice stan-dards for NICU treatment of preterm infants: music listen-ing for pacification, music reinforcement of sucking/feeding ability, and music as a basis for pacification during multilay-ered, multimodal stimulation.

REFERENCES 1. Standley J. A meta-analysis of the efficacy of music therapy for premature

infants. J Pediatr Nurs. 2002;17(2):107–113. 2. Graven S. Sound and the developing infant in the NICU: conclusions

and recommendations for care. J Perinatol. 2000;20(8):88–93. 3. Field T, Hernandez-Reif M, Feijo L, Freedman J. Prenatal, perinatal,

and neonatal stimulation: a survey of neonatal nurses. Infant Behav Dev. 2006;29(1):24–31.

4. Kemper K, Martin K, Block S, Shoaf R, Woods C. Attitudes and expectations about music therapy for premature infants among staff in a neonatal intensive care unit. Altern Ther Health Med. 2004;10(2):50–54.

5. Gooding L. Using music therapy protocols in the treatment of premature infants: an introduction to current practices. Arts Psychother. 2010;37(3):211–214.

6. Whipple J. The effect of parent training in music and multimodal stimulation on parent-neonate interactions in the neonatal intensive care unit. J Music Ther. 2000;37(4):250–268.

7. Standley J, Walworth D. Music Therapy with Premature Infants. 2nd ed. Silver Spring, MD: American Music Therapy Association; 2010.

8. Bhutta A, Cleves M, Casey P, Cradock M, Anand K. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002;288(6):728–737.

9. Cheour-Luhtanen M, Alho K, Sainio K, et al. The ontogenetically earliest discriminative response of the human brain. Psychophysiology. 1996;33:478–481.


10. Maschke C, Rupp T, Hecht K. The influence of stressors on biochemical reactions—a review of present scientific findings with noise. Int J Hyg Environ Health. 2000;203:45–53.

11. Kisilevsky B, Hains S, Jacquet Y, Granier-Deferre C, Lecanuet J. Maturation of fetal responses to music. Dev Sci. 2004;7(5):550–559. http://dx.doi.org/10,1111/j.1467-7687.2004.00979.x.

12. Brust J. Music and the neurologist: a historical perspective. Ann N Y Acad Sci. 2001;930:143–152.

13. Janata P, Birk J, Van Horn J, Leman M, Tillmann B, Bharucha J. The cortical topography of tonal structures underlying western music. Science. 2002;298:2167–2170.

14. Schlaug G, Jäncke L, Huang Y, Staiger J, Steinmetz H. Increased corpus callosum size in musicians. Neuropsychologia. 1995;33:1047–1055.

15. *Chapman JS. The Relation Between Auditory Stimulation of Short Gestation Infants and Their Gross Motor Limb Activity. New York, NY: New York University; 1975. Unpublished doctoral dissertation.

16. Malloy G. The relationship between maternal and musical auditory stimulation and the developmental behavior of premature infants. Birth Defects Orig Artic Ser. 1979;15(7):81–98.

17. *Lorch CA, Lorch V, Diefendorf AO, Earl PW. Effect of stimulative and sedative music on systolic blood pressure, heart rate, and respiratory rate in premature infants. J Music Ther. 1994;31(2):105–118.

18. *Cassidy JW, Standley JM. The effect of music listening on physiological responses of premature infants in the NICU. J Music Ther. 1995;32(4):208–227.

19. *Collins S, Kuck K. Music therapy in the neonatal intensive care unit. Neonatal Network. 1991;9(6):23–26.

20. *Standley JM, Moore RS. Therapeutic effects of music and mother’s voice on premature infants. Pediatr Nurs. 1995;21(6):509–512, 574.

21. *Caine J. The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates in a newborn intensive care unit. J Music Ther. 1991;28(4):180–192.

22. Standley JM. Long-term benefits of music intervention in the newborn intensive care unit: a pilot study. J Int Assoc Music Handicapped. 1991;6(1):12–23.

23. *Standley JM. The effect of music and multimodal stimulation on physiological and developmental responses of premature infants in neonatal intensive care. Pediatr Nurs. 1998;24(6):532–539.

24. *Standley JM. The effect of contingent music to increase non-nutritive sucking of premature infants. Pediatr Nurs. 2000;26(5):493–499.

25. *Standley J. The effect of music intervention on head circumference of premature infants: a post hoc analysis of music research in neonatal intensive care unit. Paper presented at: 13th International Symposium for Research in Music Behavior; April 1999; Montreal, Canada.

26. Cassidy JW, Ditty K. Presentation of aural stimuli to newborns and premature infants: an audiological perspective. J Music Ther. 1998;35(2):70–87.

27. Hanson-Abromeit D. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as a model for clinical music therapy interventions with premature infants. Music Ther Perspect. 2003;21(2):60–68.

28. Hartling L, Shaik MS, Tjosvold L, Leicht R, Liang Y, Kumar M. Music for medical indications in the neonatal period: a systematic review of randomized controlled trials. Arch Dis Child Fetal Neonatal Ed. 2009;94(5):349–354.

29. Johnson BT. DSTAT: Software for the Meta-Analytic Review of Research Literature. Hillsdale, NJ: Lawrence Erlbaum Associates; 1989.

30. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.

31. *Arnon S, Shapsa A, Forman L, et al. Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth. 2006;33(2):131–136.

32. *Bailey K. Music therapy and sound reduction in the neonatal intensive care unit. Paper presented at: Symposium on Research and Applications of Music Therapy in the Neonatal Intensive Care Unit. Symposium conducted by Cleveland Music School Settlement; September 2005; Cleveland, Ohio.

33. *Blumenfeld H, Eisenfeld L. Does a mother singing to her premature baby affect feeding in the neonatal intensive care unit? Clinl Pediatr. 2006;45(1):65–70.

34. *Britt M, Kisilevsky B. Music modulates behavior of premature infants following heel lance. Can J Nurs Res, 2000;31:17–39.

35. *Burke M, Walsh J, Oehler J, Gingras J. Music therapy following suctioning: four case studies. Neonatal Netw, 1995;14(7):41–49.

36. *Cassidy J. The effect of decibel level of music stimuli and gender on head circumference and physiological responses of premature infants in the NICU. J Music Ther. 2009;46(3):180–190.

37. *Cevasco A. The effects of mothers’ singing on full term and preterm infants and maternal emotional responses. J Music Ther. 2008;46(3):273–306.

38. *Cevasco A, Grant R. The effect of the Pacifier Activated Lullaby on weight gain of premature infants. J Music Ther. 2005;42(3):123–139.

39. *Chou L, Wang H, Chen S, Pai L. Effects of music therapy on oxygen saturation in premature infants receiving endotracheal suctioning. J Nurs Res. 2003;11(3):209–215.

40. *Coleman JM, Pratt RR, Stoddard RA, Gertsmann DR, Abel HH. The effects of the male and female singing and speaking voices on selected physiological and behavioral measures of premature infants in the intensive care unit. Int J Arts Med. 1997;5(2):4–11.

41. *Flowers AL, McCain AP, Hilker KA. The effects of music listening on premature infants. Paper presented at: Meeting of Society for Research in Child Development; April 1999; Albuquerque, New Mexico.

42. *Keith D, Russell K, Weaver B. The effects of music listening on inconsolable crying in premature infants. J Music Ther. 2009;46(3):191–203.

43. *Lai H, Chen C, Peng T, et al. Randomized controlled trial of music during kangaroo care of maternal state anxiety and preterm infants’ responses. Int J Nurs Stud. 2006;43:139–146.

44. *Lubetsky R, Mimouni F, Dolberg S, Reifen R, Ashbel G, Mandel D. Effect of music by Mozart on energy expenditure in growing preterm infants. Pediatrics. 2010;125(1):24–28.

45. *MacDowell J. The Effects of Recorded Maternal Singing on the Heart Rate, Respiratory Rate, and Blood Pressure of Premature and Low Birth Weight Infants in Intensive Care [master’s thesis]. Philadelphia, PA: Medical College of Pennsylvania & Hahnemann University; 1995.

46. *Moore R, Gladstone I, Standley J. Effects of music, maternal voice, intrauterine sounds and white noise on the oxygen saturation levels of premature infants. Paper presented at: Meeting of the National Association for Music Therapy, Inc; November 1994; Orlando, FL.

47. *Standley JM. The effect of music-reinforced non-nutritive sucking on feeding rate of premature infants. J Pediatr Nurs. 2003;18(3):169–173.

48. *Standley J, Cassidy J, Grant R, et al. The effect of music reinforcement for non-nutritive sucking on nipple feeding of premature infants. Pediatr Nurs. 2010;36(3):138–145.

49. *Standley J, Swedberg O. NICU music therapy: post hoc analysis of an early intervention clinical program. Arts Psychother. 2010;38(1):36–40.

50. *Walworth D, Standley J, Robertson A, Smith A, Swedberg A, Peyton J. Effects of neurodevelopmental music therapy on premature infants in neonatal intensive care. Poster presented at: Meeting of the American Music Therapy Association; November 2010; Cleveland, Ohio.

51. *Whipple J. The effect of music-reinforced nonnutritive sucking on state of preterm, low birth weight infants experiencing heel stick. J Music Ther. 2008;46(3):227–272.

For further information, please contact: Jayne Standley, PhD Music Therapy College of Music Kuersteiner Music Building 042 The Florida State University Tallahassee, FL 32306-1180 E-mail: [email protected]

Music Therapy Research in the NICU: An Updated Meta-Analysis

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