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Background Neonatal intensive care unit (NICU) music therapy is an emerging discipline. There is a growing evidence base supporting its use, with an emphasis on the immediate and short-term positive effects on infants' physiological responses and parents' experiences. Aim To explore the implementation of music therapy aligned with standards of neonatal care and as an integral part of the care routinely provided in a Norwegian NICU. Method Parents of infants hospitalised in the NICU were offered music therapy sessions based on the First Sounds: Rhythm, Breath and Lullaby model. Before discharge from the NICU, parents were asked to complete an electronic survey about their experiences of music therapy. Nurses' feedback and observations were also elicited and collected. Findings A total of 16 parents completed the survey. Overall, their experiences of music therapy were positive, and they noted several benefits for themselves and their infant. In addition, nurses observed that parents' interactions with their infant increased after participation in music therapy. However, nurses reported it was challenging to invite parents to participate in music therapy at a time of uncertainty, anxiety and grief. Nurses also found it challenging to disseminate information about music therapy to parents from other cultures. Furthermore, it was identified that most parents learned about the music therapy sessions from the music therapist, rather than from NICU medical or nursing staff, which indicates that music therapy was not fully integrated among the unit's multidisciplinary team. Conclusion Music therapy can reinforce family-centred care and promote parent-infant bonding, but additional efforts are required to integrate it into the care routinely provided by the NICU multidisciplinary team.

ImportanceParent-infant bonding contributes to long-term infant health but may be disrupted by preterm birth.ObjectiveTo determine if parent-led, infant-directed singing, supported by a music therapist and initiated in the neonatal intensive care unit (NICU), improves parent-infant bonding at 6 and 12 months.Design, Setting, and ParticipantsThis randomized clinical trial was conducted in level III and IV NICUs in 5 countries between 2018 and 2022. Eligible participants were preterm infants (under 35 weeks’ gestation) and their parents. Follow-up was conducted across 12 months (as part of the LongSTEP study) at home or in clinics. Final follow-up was conducted at 12 months’ infant-corrected age. Data were analyzed from August 2022 to November 2022.InterventionParticipants randomized to music therapy (MT) plus standard care or standard care alone during NICU admission, or to MT plus standard care or standard care alone postdischarge, using computer-generated randomization (ratio 1:1, block sizes of 2 or 4 varying randomly), stratified by site (51 allocated to MT NICU, 53 to MT postdischarge, 52 to both, and 50 to neither). MT consisted of parent-led, infant-directed singing tailored to infant responses and supported by a music therapist 3 times per week throughout hospitalization or 7 sessions across 6 months’ postdischarge.Main Outcome and MeasurePrimary outcome was mother-infant bonding at 6 months’ corrected age, measured by the Postpartum Bonding Questionnaire (PBQ), with follow-up at 12 months’ corrected age, and analyzed intention-to-treat as group differences.ResultsOf 206 enrolled infants with 206 mothers (mean [SD] age, 33 [6] years) and 194 fathers (mean [SD] age, 36 [6] years) randomized at discharge, 196 (95.1%) completed assessments at 6 months and were analyzed. Estimated group effects for PBQ at 6 months’ corrected age were 0.55 (95% CI, −2.20 to 3.30; P = .70) for MT in the NICU, 1.02 (95% CI, −1.72 to 3.76; P = .47) for MT postdischarge, and −0.20 (95% CI, −4.03 to 3.63; P = .92) for the interaction (12 months: MT in NICU, 0.17; 95% CI, −2.71 to 3.05; P = .91; MT postdischarge, 1.78; 95% CI, −1.13 to 4.70; P = .24; interaction, −1.68; 95% CI, −5.77 to 2.41; P = .42). There were no clinically important between-group differences for secondary variables.Conclusions and RelevanceIn this randomized clinical trial, parent-led, infant-directed singing did not have clinically important effects on mother-infant bonding, but was safe and well-accepted.Trial RegistrationClinicalTrials.gov Identifier: NCT03564184

OBJECTIVES To evaluate short-term effects of music therapy (MT) for premature infants and their caregivers on mother-infant bonding, parental anxiety, and maternal depression. METHODS Parallel, pragmatic, randomized controlled-trial conducted in 7 level III NICUs and 1 level IV NICU in 5 countries enrolling premature infants ( RESULTS From August 2018 to April 2020, 213 families were enrolled in the study, of whom 108 were randomly assigned to standard care and 105 to MT. Of the participants, 208 of 213 (98%) completed treatment and assessments. Participants in the MT group received a mean (SD) of 10 sessions (5.95), and 87 of 105 participants (83%) received the minimum of 6 sessions. The estimated group effect (95% confidence interval) for PBQ was −0.61 (−1.82 to 0.59). No significant differences between groups were found (P = .32). No significant effects for secondary outcomes or subgroups were found. CONCLUSIONS Parent-led, infant-directed singing supported by a music therapist resulted in no significant differences between groups in mother-infant bonding, parental anxiety, or maternal depression at discharge.

Introduction: Despite medical advances, preterm birth and neonatal intensive care (NICU) hospitalization are demanding and pose risks for infants and parents. Various music therapy (MT) models have suggested parental singing to promote healthy bonding and development in premature infants, but evidence on long-term effects is lacking. Method: We present the theoretical framework and intervention protocol of a resource-oriented MT approach for premature infants and their caregivers used in the international LongSTEP trial (ClinicalTrials.gov NCT03564184). We illustrate how guiding principles manifest in MT sessions, describe frames for phases of intervention, discuss prerequisites and present hypothesized mechanisms of change. Results: The LongSTEP MT approach is resource-oriented, emphasizes parental voice and parent-infant mutual regulation, builds on family-centered care principles, and is relevant in the NICU and beyond. Essential elements include: observation and dialogue on infant and parent needs; voice as the main musical source, with parental voice as the most prominent; active parental participation; modification of music in response to infant states and cues; and integration of the family’s culture and music preferences. The music therapist facilitates and supports interaction between parents and infant. Parents learn how to adapt principles in relation to infant development across NICU hospitalization and post-discharge phases. Discussion: The LongSTEP approach is feasible in culturally diverse countries where consistent parental presence is available, but requires tailoring to local circumstances and culture, particularly in the post-discharge phase. The emphasis on parent-led infant-directed singing places a higher demand on parents than other MT approaches, and requires sufficient psychosocial and musical support for parents. publishedVersion

IntroductionPreterm birth has major medical, psychological and socioeconomic consequences worldwide. Music therapy (MT) has positive effects on physiological measures of preterm infants and maternal anxiety, but rigorous studies including long-term follow-up are missing. Drawing on caregivers’ inherent resources, this study emphasises caregiver involvement in MT to promote attuned, developmentally appropriate musical interactions that may be of mutual benefit to infant and parent. This study will determine whether MT, as delivered by a qualified music therapist during neonatal intensive care unit (NICU) hospitalisation and/or in home/municipal settings following discharge, is superior to standard care in improving bonding between primary caregivers and preterm infants, parent well-being and infant development.Methods and analysisDesign:international multicentre, assessor-blind, 2×2 factorial, pragmatic randomised controlled trial; informed by a completed feasibility study.Participants:250 preterm infants and their parents.Intervention:MT focusing on parental singing specifically tailored to infant responses, will be delivered during NICU and/or during a postdischarge 6-month period.Primary outcome:changes in mother–infant bonding at 6-month corrected age (CA), as measured by the Postpartum Bonding Questionnaire.Secondary outcomes: mother–infant bonding at discharge and at 12-month CA; child development over 24 months; and parental depression, anxiety and stress, and infant rehospitalisation, all over 12 months.Ethics and disseminationThe Regional Committees for Medical and Health Research Ethics approved the study (2018/994/REK Nord, 03 July 2018). Service users were involved in development of the study and will be involved in implementation and dissemination. Dissemination of findings will apply to local, national and international levels.Trial registration numberNCT03564184

This research study explores ways in which music therapy can contribute to supporting new parents and their children during the first year of life. In addition, it examines the health promotion of a carefully designed music therapy program. We undertook the study at a public health clinic that was part of the Norwegian primary child services and asked nine first-time mothers and their infants to attend a weekly music therapy program for 2 months. The group of participants was non-clinical. The study was inspired by new, developmentally informed theory, as well as context-sensitive theory related to the development of a motherhood constellation in a contextual setting. Its research method was qualitative and explorative, and its data included semi-structured interviews undertaken after the program was concluded. We analyzed the interviews in accordance with interpretative phenomenological analysis and focused on each participant’s description of her experiences. The results indicated that the mothers experienced positive development at a personal level, within their relationships with their children, and in relation to their everyday lives. The results also indicated that the music therapy group at the public health clinic had the potential to increase mother-infant interaction and bonding and to support and empower first-time mothers in their new role. Participants also drew attention to the emergence of a social network as a result of their shared participation in the program. Based on our findings, we found that participation in the music therapy group promoted the health of both mother and child. Supporting and strengthening parents during their child’s first years of life should be an important part of public health work, and music therapy has shown potential to be a contribution in this work.