Combining Kangaroo Care and Live-Performed Music Therapy: Effects on Physiological Stability and Neurological Functioning in Extremely and Very Preterm Infants

Loïs C Span, Nienke H van Dokkum, Anne-Greet Ravensbergen, Arend F Bos, Artur C Jaschke, Loïs C Span, Nienke H van Dokkum, Anne-Greet Ravensbergen, Arend F Bos, Artur C Jaschke

Abstract

Interventions such as kangaroo care (KC) and live-performed music therapy (LPMT), are increasingly used to facilitate stress reduction in neonates. This study aims to investigate the effect of combining the two on physiological responses and neurological functioning in very preterm infants. Infants received six sessions of LPMT. KC was added to one LPMT session. Physiological responses included heart rate, respiratory rate and oxygen saturation. We videotaped infants for 30 min before and after two sessions to assess general movements (GMs). We included 17 infants, gestational age median 26.0 weeks (IQR 25.6-30.6 weeks), of whom six were males. Combined interventions showed a decrease in heart rate from mean 164 bpm before to 157 bpm during therapy, p = 0.001. Oxygen saturation levels increased during combination therapy from median 91.4% to 94.5%, p = 0.044. We found no effects of LPMT or combined interventions on GMs. Infants with a postnatal age (PNA) <7 days generally seem to display less optimal GMs after therapy compared with infants with a PNA >7 days. In conclusion, combining interventions is equally beneficial for physiological stability and neurological functioning as LPMT alone. Future studies should focus on the effects of this combination on parent-infant bonding.

Keywords: general movement optimality score; general movements; kangaroo care; live-performed music therapy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Heart rate before, during and after LPMT compared with combined interventions. The boxes represent the interquartile ranges and the whiskers represent the range of all infants. Grey stars indicate the outliers of this study. PNA, Postnatal age; LPMT, live-performed music therapy; KC, kangaroo care; Bpm, beats per minute; B, before therapy; D, during therapy; A, after therapy; *, p < 0.05; **, p ≤ 0.01; ***, p ≤ 0.001.
Figure 2
Figure 2
Respiratory rate before, during and after LPMT compared with combined interventions. The boxes represent the interquartile ranges and the whiskers represent the range of all infants. Grey points and stars indicate the outliers of this study. PNA, postnatal age; LPMT, live-performed music therapy; KC, kangaroo care; B, before therapy; D, during therapy; A, after therapy; *, p < 0.05.
Figure 3
Figure 3
Oxygen saturation before, during and after LPMT compared with combined interventions. The boxes represent the interquartile ranges and the whiskers represent the range of all ages. Grey points and stars indicate the outliers of this study. LPMT: live-performed music therapy KC: kangaroo care; B, before therapy; D, during therapy; A, after therapy; *, p < 0.05.
Figure 4
Figure 4
Delta General Movement Optimality Score (GMOS) for all infants, infants 7 days PNA. Grey points indicate the outliers of this study. GMOS, General movement optimality score; LPMT, live-performed music therapy; KC, kangaroo care; PNA, postnatal age.

References

    1. WHO Preterm Birth. [(accessed on 14 October 2020)];2018 . Available online: .
    1. Chawanpaiboon S., Vogel J.P., Moller A.-B., Lumbiganon P., Petzold M., Hogan D., Landoulsi S., Jampathong N., Kongwattanakul K., Laopaiboon M., et al. Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis. Lancet Glob. Health. 2019;7:e37–e46. doi: 10.1016/S2214-109X(18)30451-0.
    1. Buitendijk S., Zeitlin J., Cuttini M., Langhoff-Roos J., Bottu J. Indicators of fetal and infant health outcomes. Eur. J. Obstet. Gynecol. Reprod. Biol. 2003;111(Suppl. 1):S66–S77. doi: 10.1016/j.ejogrb.2003.09.007.
    1. Zeitlin J., Szamotulska K., Drewniak N., Mohangoo A., Chalmers J., Sakkeus L., Irgens L., Gatt M., Gissler M., Blondel B., et al. Preterm birth time trends in Europe: A study of 19 countries. BJOG Int. J. Obstet. Gynaecol. 2013;120:1356–1365. doi: 10.1111/1471-0528.12281.
    1. Blencowe H., Cousens S., Chou D., Oestergaard M., Say L., Moller A.-B., Kinney M., Lawn J. The Born Too Soon Preterm Birth Action Group. Born Too Soon: The global epidemiology of 15 million preterm births. Reprod. Health. 2013;10(Suppl. 1):S2. doi: 10.1186/1742-4755-10-S1-S2.
    1. Pickler R.H., McGrath J., Reyna B.A., McCain N.L., Lewis M., Cone S., Wetzel P., Best A.M. A Model of Neurodevelopmental Risk and Protection for Preterm Infants. J. Périnat. Neonatal Nurs. 2010;24:356–365. doi: 10.1097/JPN.0b013e3181fb1e70.
    1. Arhan E., Gücüyener K., Soysal Ş., Şalvarlı Ş., Gürses M.A., Serdaroğlu A., Demir E., Ergenekon E., Türkyılmaz C., Önal E., et al. Regional brain volume reduction and cognitive outcomes in preterm children at low risk at 9 years of age. Child’s Nerv. Syst. 2017;177:695–1326. doi: 10.1007/s00381-017-3421-2.
    1. Foulder-Hughes L., Cooke R.W. Motor, cognitive, and behavioural disorders in children born very preterm. Dev. Med. Child Neurol. 2003;45:97–103. doi: 10.1111/j.1469-8749.2003.tb00912.x.
    1. Saigal S., Doyle L. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet. 2008;371:261–269. doi: 10.1016/S0140-6736(08)60136-1.
    1. Behrman R.E., Butler A.S. Preterm Birth: Causes, Consequences, and Prevention. The National Academies Press; Washington, DC, USA: 2007. pp. 1–772.
    1. Ment L.R., Vohr B.R. Preterm birth and the developing brain. Lancet Neurol. 2008;7:378–379. doi: 10.1016/S1474-4422(08)70073-5.
    1. Head L.M. The Effect of Kangaroo Care on Neurodevelopmental Outcomes in Preterm Infants. J. Périnat. Neonatal Nurs. 2014;28:290–299. doi: 10.1097/JPN.0000000000000062.
    1. Königk E. Quantitative dünnschichtchromatographie von 14C-markierten nukleotiden. J. Chromatogr. A. 1968;37:128–131. doi: 10.1016/S0021-9673(01)99086-7.
    1. Lawn J.E., Mwansa-Kambafwile J., Horta B.L., Barros F.C., Cousens S. ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Int. J. Epidemiol. 2010;39(Suppl. 1):i144–i154. doi: 10.1093/ije/dyq031.
    1. Boundy E.O., Dastjerdi R., Spiegelman D., Fawzi W.W., Missmer S.A., Lieberman E., Kajeepeta S., Wall S., Chan G.J. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. 2015;137:e20152238. doi: 10.1542/peds.2015-2238.
    1. Mooney-Leber S.M., Brummelte S. Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development. Neuroscience. 2017;342:21–36. doi: 10.1016/j.neuroscience.2016.05.001.
    1. Haslbeck F.B., Bassler D. Music From the Very Beginning—A Neuroscience-Based Framework for Music as Therapy for Preterm Infants and Their Parents. Front. Behav. Neurosci. 2018;12:112. doi: 10.3389/fnbeh.2018.00112.
    1. Standley J. Music Therapy Research in the NICU: An Updated Meta-Analysis. Neonatal Netw. 2012;31:311–316. doi: 10.1891/0730-0832.31.5.311.
    1. AMTA . American Music Therapy Association; 2018. [(accessed on 16 May 2021)]. What Is Music Therapy. Available online: .
    1. Bieleninik Ł., Ghetti C., Gold C. Music Therapy for Preterm Infants and Their Parents: A Meta-analysis. Pediatrics. 2016;138:e20160971. doi: 10.1542/peds.2016-0971.
    1. Standley J.M., Gutierrez C. Benefits of a comprehensive evidence-based NICU-MT program: Family-centered, neurodevelop-mental music therapy for premature infants. Pediatr. Nurs. 2020;46:40–46.
    1. Haslbeck F.B. Music therapy for premature infants and their parents: An integrative review. Nord. J. Music Ther. 2012;21:203–226. doi: 10.1080/08098131.2011.648653.
    1. Loewy J., Stewart K., Dassler A.-M., Telsey A., Homel P. The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants. Pediatrics. 2013;131:902–918. doi: 10.1542/peds.2012-1367.
    1. Teckenberg-Jansson P., Huotilainen M., Pölkki T., Lipsanen J., Järvenpää A.-L. Rapid effects of neonatal music therapy combined with kangaroo care on prematurely-born infants. Nord. J. Music Ther. 2011;20:22–42. doi: 10.1080/08098131003768123.
    1. Van Dokkum N.H., Jaschke A.C., Ravensbergen A.-G., Reijneveld S.A., Hakvoort L., De Kroon M.L.A., Bos A.F. Feasibility of Live-Performed Music Therapy for Extremely and Very Preterm Infants in a Tertiary NICU. Front. Pediatr. 2020;8:581372. doi: 10.3389/fped.2020.581372.
    1. Morales-Betancourt C., Acuña-Muga J., López-Maestro M., De La Cruz-Bértolo J., Moral-Pumarega M.T., Pallás-Alonso C.R., Vena M.E. Live music can play a major role in aiding the development of preterm infants in neonatal intensive care units. Acta Paediatr. 2020;109:1895–1896. doi: 10.1111/apa.15191.
    1. Karlsson V., Heinemann A.-B., Sjörs G., Nykvist K.H., Ågren J. Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment. J. Pediatr. 2012;161:422–426. doi: 10.1016/j.jpeds.2012.02.034.
    1. Yusuf N., Hadisaputro S., Runjati R., Suwondo A., Mashoedi I.D., Supriyana S. The effectiveness of combination of kangaroo mother care method and lullaby music therapy on vital sign change in infants with low birth weight. Belitung Nurs. J. 2017;3:352–359. doi: 10.33546/bnj.161.
    1. Ettenberger M., Cárdenas C.R., Parker M., Odell-Miller H. Family-centred music therapy with preterm infants and their parents in the Neonatal Intensive Care Unit (NICU) in Colombia—A mixed-methods study. Nord. J. Music Ther. 2016;26:207–234. doi: 10.1080/08098131.2016.1205650.
    1. Schlez A., Litmanovitz I., Bauer S., Dolfin T., Regev R., Arnon S. Combining kangaroo care and live harp music therapy in the neonatal intensive care unit setting. Isr. Med. Assoc. J. IMAJ. 2011;13:354–358.
    1. Arnon S., Diamant C., Bauer S., Regev R., Sirota G., Litmanovitz I. Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety. Acta Paediatr. 2014;103:1039–1044. doi: 10.1111/apa.12744.
    1. Einspieler C., Bos A.F., Libertus M.E., Marschik P.B. The General Movement Assessment Helps Us to Identify Preterm Infants at Risk for Cognitive Dysfunction. Front. Psychol. 2016;7:406. doi: 10.3389/fpsyg.2016.00406.
    1. Prechtl H.F., Einspieler C., Cioni G., Bos A.F., Ferrari F., Sontheimer D. An early marker for neurological deficits after perinatal brain lesions. Lancet. 1997;349:1361–1363. doi: 10.1016/S0140-6736(96)10182-3.
    1. Einspieler C., Prechtl H.F.R. Prechtl’s assessment of general movements: A diagnostic tool for the functional assessment of the young nervous system. Ment. Retard. Dev. Disabil. Res. Rev. 2005;11:61–67. doi: 10.1002/mrdd.20051.
    1. Einspieler C., Marschik P.B., Pansy J., Scheuchenegger A., Krieber M., Yang H., Kornacka M.K., Rowinska E., Soloveichick M., Bos A.F. The general movement optimality score: A detailed assessment of general movements during preterm and term age. Dev. Med. Child Neurol. 2016;58:361–368. doi: 10.1111/dmcn.12923.
    1. Flacking R., Lehtonen L., Thomson G., Axelin A., Ahlqvist S., Moran V.H., Ewald U., Dykes F., SCENE Group Closeness and separation in neonatal intensive care. Acta Paediatr. 2012;101:1032–1037. doi: 10.1111/j.1651-2227.2012.02787.x.
    1. Feldman R. Parent-infant synchrony and the construction of shared timing; physiological precursors, developmental out-comes, and risk conditions. J. Child. Psychol. Psychiatry Allied Discip. 2007;48:329–354. doi: 10.1111/j.1469-7610.2006.01701.x.
    1. Kostandy R.R., Ludington-Hoe S.M. The evolution of the science of kangaroo (mother) care (skin-to-skin contact) Birth Defects Res. 2019;111:1032–1043. doi: 10.1002/bdr2.1565.
    1. Gathwala G., Singh B., Balhara B. KMC facilitates mother baby attachment in low birth weight infants. Indian J. Pediatr. 2008;75:43–47. doi: 10.1007/s12098-008-0005-x.
    1. Lai H.-L., Chen C.-J., Peng T.-C., Chang F.-M., Hsieh M.-L., Huang H.-Y., Chang S.-C. Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants’ responses. Int. J. Nurs. Stud. 2006;43:139–146. doi: 10.1016/j.ijnurstu.2005.04.008.
    1. Standley J.M. A meta-analysis of the efficacy of music therapy for premature infants. J. Pediatr. Nurs. 2002;17:107–113. doi: 10.1053/jpdn.2002.124128.
    1. Bosanquet M., Copeland L.G., Ware R.S., Boyd R.N. A systematic review of tests to predict cerebral palsy in young children. Dev. Med. Child Neurol. 2013;55:418–426. doi: 10.1111/dmcn.12140.
    1. Nitzan M., Romem A., Koppel R. Pulse oximetry: Fundamentals and technology update. Med. Devices Évid. Res. 2014;7:231–239. doi: 10.2147/MDER.S47319.
    1. Bos M., van Dokkum N.H., Ravensbergen A., Kraft K.E., Bos A.F., Jaschke A.C. Pilot study finds that performing live music therapy in intensive care units may be beneficial for infants’ neurodevelopment. Acta Paediatr. 2021 doi: 10.1111/apa.15867. [epub ahead of print]
    1. Charpak N., Ruiz J.G., Zupan J., Cattaneo A., Figueroa Z., Tessier R., Cristo M., Anderson G., Ludington S., Mendoza S., et al. Kangaroo Mother Care: 25 years after. Acta Paediatr. 2007;94:514–522. doi: 10.1111/j.1651-2227.2005.tb01930.x.
    1. Mori R., Khanna R., Pledge D., Nakayama T. Meta-analysis of physiological effects of skin-to-skin contact for newborns and mothers. Pediatr. Int. 2010;52:161–170. doi: 10.1111/j.1442-200X.2009.02909.x.
    1. Walworth D., Standley J.M., Robertson A., Smith A., Swedberg O., Peyton J.J. Effects of neurodevelopmental stimulation on premature infants in neonatal intensive care: Randomized controlled trial. J. Neonatal Nurs. 2012;18:210–216. doi: 10.1016/j.jnn.2012.01.001.
    1. Arnon S., Shapsa A., Forman L., Regev R., Bauer S., Litmanovitz I., Dolfin T. Live Music Is Beneficial to Preterm Infants in the Neonatal Intensive Care Unit Environment. Birth. 2006;33:131–136. doi: 10.1111/j.0730-7659.2006.00090.x.
    1. Adde L., Rygg M., Lossius K., Øberg G.K., Støen R. General movement assessment: Predicting cerebral palsy in clinical practise. Early Hum. Dev. 2007;83:13–18. doi: 10.1016/j.earlhumdev.2006.03.005.
    1. Barnes F., Graham L., Loganathan P., Nair V. General Movement Assessment Predicts Neuro-Developmental Outcome in Very Low Birth Weight Infants at Two Years—A Five-Year Observational Study. Indian J. Pediatr. 2021;88:28–33. doi: 10.1007/s12098-020-03365-1.
    1. De Vries N., Erwich J., Bos A. General movements in the first fourteen days of life in extremely low birth weight (ELBW) infants. Early Hum. Dev. 2008;84:763–768. doi: 10.1016/j.earlhumdev.2008.05.003.
    1. De Vries N.K.S., Bos A.F. The quality of general movements in the first ten days of life in preterm infants. Early Hum. Dev. 2010;86:225–229. doi: 10.1016/j.earlhumdev.2010.03.004.
    1. Hempenius M.A., Verhagen E.A., Tanis J.C., Einspieler C., Bos A.F. Early neonatal morbidities and neurological functioning of preterm infants 2 weeks after birth. J. Perinatol. 2018;38:1518–1525. doi: 10.1038/s41372-018-0211-y.
    1. Ploegstra W.M., Bos A.F., de Vries N.K. General movements in healthy full term infants during the first week after birth. Early Hum. Dev. 2014;90:55–60. doi: 10.1016/j.earlhumdev.2013.10.004.

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