Background Prematurity is still the leading cause of mortality and morbidity in neonates. The premature change of the environment causes stress, which leads to hemodynamic instability. Music therapy may have a positive impact on hemodynamic parameters of preterm infants in the NICU. Objective To evaluate preterm infants’ physiological responses to music therapy in NICU setting. Methods A systematic review was performed in 12 electronic databases from March 2000–April 2018. Our review included all English language publications on parallel or crossover RCTs of music therapy versus standard care or placebo in preterm infants. The outcomes were physiological indicators [heart rate (HR), respiratory rate (RR), and oxygen saturation (SaO2)]. Risk of bias was assessed using the Revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Results The search yielded 20 articles on 1,148 preterm infants of gestational age 28 and 37 weeks, who received recorded music, recorded maternal/male voice or lullaby, or live music interventions in the NICU with intensity of 30–76 dB. Recorded music improved all outcomes in 6, 6, and 4 of 16 studies for HR, RR, and SaO2, respectively. Seven studies used classical music as melodic elements. However, eight studies showed no significant results on all outcomes. Conclusion Despite the finding that music interventions demonstrate promising results in some studies, the variation in quality of the studies, age groups, outcome measures, as well as type and timing of the interventions across the studies make it difficult to draw overall conclusions about the effects of music in preterm infants.
Background Establishing a diagnosis of neonatal sepsis is difficult. As such, appropriate timing of antibiotic therapy remains the biggest challenge. As a consequence of non-definitive diagnoses, inappropriate antibiotic administration is common. Recently, a sepsis calculator to estimate risk of early-onset sepsis (EOS) based on both maternal risk factors and infants’ clinical presentation was established. Objective To determine the impact of the sepsis calculator in daily clinical settings, especially with regards to antibiotic usage. Methods A literature search of Pubmed, EBSCO, Embase, and Scopus database from January 2011 (after sepsis calculator was established) to June 2018 was performed. We included observational studies that compared the sepsis calculator to recent neonatal sepsis guidelines in terms of antibiotic administration, blood culture, and admission to the neonatal intensive care unit (NICU). The literature search, validation study, and assessment risk of bias were done independently by our four authors, while the first author did the statistical analysis. Results Of the 35 studies identified, 5 cohort studies met the criteria, with a total sample size of 18,352 infants from various countries. We developed a fixed-effect meta analysis of the data. The use of the sepsis calculator significantly reduced inappropriate use of antibiotics [RR 0.46; 95%CI 0.41 to 0.51; z=13.57; P<0.001], blood culture sampling [RR 0.46; 95%CI 0.40 to 0.52; z=12.11; P<0.001), and higher neonatal care level admissions [RR 0.68; 95%CI 0.59 to 0.78); z=5.47; P<0.001). No safety issues were reported from studies using the sepsis calculator. Conclusion The new EOS risk estimation using a neonatal sepsis calculator is an easy, effective, and safe tool to improve appropriate antibiotic use and outcomes. This calculator is ready to be implemented in all levels of neonatal care units.
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