CONTEXT: Given the recent expansion of research in the area of music therapy (MT) for preterm infants, there is a need for an up-to-date meta-analysis of rigorously designed studies that focus exclusively on MT. OBJECTIVE:To systematically review and meta-analyze the effect of MT on preterm infants and their parents during NICU hospitalization and after discharge from the hospital.DATA SOURCES: PubMed/Medline, PsycINFO, Embase, Cochrane Database of Systematic Reviews, CINAHL, ERIC, Web of Science, RILM. STUDY SELECTION:Only parallel or crossover randomized controlled trials of MT versus standard care, comparison therapy, or placebo were included.DATA EXTRACTION: Independent extraction by 2 reviewers, including risk of bias indicators. RESULTS:From 1803 relevant records, 16 met inclusion criteria, of which 14 contained appropriate data for meta-analysis involving 964 infant participants and 266 parent participants. Overall, random-effects meta-analyses suggested significant large effects favoring MT for infant respiratory rate (mean difference, -3.91/min, 95% confidence interval, −7.8 to −0.03) and maternal anxiety (standardized mean difference, -1.82, 95% confidence interval, −2.42 to −1.22). There was not enough evidence to confirm or refute any effects of MT on other physiologic and behavioral outcomes or on short-term infant and service-level outcomes. There was considerable heterogeneity between studies for the majority of outcomes.LIMITATIONS: This review is limited by a lack of studies assessing long-term outcomes. CONCLUSIONS:There is sufficient evidence to confirm a large, favorable effect of MT on infant respiratory rate and maternal anxiety. More rigorous research on short-term and long-term infant and parent outcomes is required.

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

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 (<35 weeks gestational age at birth) and their parents. MT included 3 sessions per week with parent-led, infant-directed singing supported by a music therapist. Primary outcome was mother-infant bonding as measured by the Postpartum Bonding Questionnaire (PBQ) at discharge from NICU. Secondary outcomes were parents’ symptoms of anxiety measured by General Anxiety Disorder-7 (GAD-7) and maternal depression measured by Edinburgh Postpartum Depression Scale (EPDS). Group differences at the assessment timepoint of discharge from hospital were tested by linear mixed effect models (ANCOVA). 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.

In partial response to the demand for evidence-based practice, there is an increasing interest in the use of music therapy as procedural support for both invasive and non-invasive medical procedures. Clinicians and researchers are attempting to define how music therapy functions as procedural support in order to advance clinical practice and research, but concepts remain inadequately specified in the literature. The current philosophical inquiry used qualitative document analysis to critically examine the extant literature in music therapy as procedural support during invasive medical procedures. The aims of the analysis were to identify key concepts, provide definitions of those concepts, and begin to explicate the interrelationships among concepts related to music therapy as procedural support. A total of 19 clinical practice articles, clinical practice book chapters, and research articles met the criteria for inclusion in the analysis. Data analysis and synthesis resulted in a working model of music therapy as procedural support, in which the music therapist engages in a reflexive process of continually assessing the patient's responses in order to refocus the intervention lens (e.g., altering aspects of the music, of focus of attention, and of patient/therapist interaction) to positively influence outcomes. It is hoped that the working model of music therapy as procedural support may stimulate clinical dialogue and serve as an initial systematic step toward theory construction in this area.