In a recent study published in the JAMA Network Open, researchers assessed the impact of parent-led, infant-directed singing on language development at 24 months corrected age (CA) in preterm children during and after their neonatal intensive care unit (NICU) stay.
Study: Music Therapy in Infancy and Neurodevelopmental Outcomes in Preterm Children. Image Credit: Prostock-studio/Shutterstock.com
Background
Preterm birth affects 15 million neonates annually, increasing mortality, morbidity, and long-term neurodevelopmental issues. Although 90% of preterm newborns survive without impairments, their brains remain vulnerable, leading to cognitive and behavioral challenges.
The NICU's auditory environment can negatively impact brain development, but early exposure to adult speech and parent-led, infant-directed singing can improve language and cognitive outcomes.
Music therapy (MT) has shown short-term benefits for stress and physiological stability. Further research is needed to determine effective MT approaches, implementation timing, and duration for improving neurodevelopmental outcomes in preterm children.
About the study
The Longitudinal Study of Music Therapy's Effectiveness for Premature Infants and Their Caregivers (LongSTEP) study involved a 2×2 factorial, multicenter, assessor-blind randomized clinical trial (RCT) with children and their parents across eight NICUs in Argentina, Norway, Colombia, Israel, and Poland from August 2018 to April 2022.
Ethics approval was obtained, and informed consent was provided by parents. Recruitment targeted preterm infants born before 35 week gestation who were medically stable and likely to stay in the NICU for over two weeks. Parents needed to consent, participate in MT sessions, live within commuting distance, and understand the local language.
Participants were randomized to MT plus standard care (SC) or SC alone, with a second randomization before discharge to post-discharge MT or SC.
The MT intervention involved parent-led, infant-directed singing, customized to each family's needs, with sessions three times weekly during NICU hospitalization and seven times over six months post-discharge. Eleven trained music therapists conducted the interventions, adhering to the study protocol.
SC included medical, nursing, and social services without MT, and families were advised not to engage in MT outside the study. Neurodevelopmental outcomes were assessed at 24 months’ CA using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), focusing on language, cognitive, and motor composite scores.
Independent, blinded assessors conducted the evaluations with standardized training in controlled environments to ensure reliable assessments.
Statistical analysis employed linear mixed-effects models to evaluate treatment effects, with sample sizes calculated to detect medium effect sizes. Descriptive statistics and intention-to-treat analyses were performed using R software.
Study results
In the present study, 206 families agreed to participate. They were randomized into four intervention groups at enrollment: 51 families to MT with SC and 53 families to SC alone at the NICU, with 52 families randomized to MT and 50 families to SC at discharge.
The original sample comprised 103 female and 103 male infants, with a mean gestational age of 30.5 weeks and a mean birth weight of 1400.5 grams. By the 24-month CA follow-up, 112 families (54%) remained, with the mean CA at assessment being 25.54 months.
Baseline characteristics between intervention groups were well balanced, and there were no significant differences between those followed up and those lost to follow-up. Retention rates varied across countries but were consistent across intervention groups, demonstrating that long-term contact with families is feasible.
The observed BSID-III composite and subscale scores were similar across the four intervention groups. The mean language composite score across groups was 94.7, ranging from 53 to 135.
The cognitive composite score averaged 100.8, ranging from 55 to 145, and the motor composite score averaged 95.0, ranging from 46 to 154. Most participants (70% to 83%) had BSID-III scores within the normal range (≥85).
In the total sample, 33 infants (30%) had language composite scores below the normal range, while 19 infants (17%) and 29 infants (26%) had cognitive and motor scores below the normal range, respectively.
The mean differences in language composite scores were -2.36 for the MT at NICU with postdischarge SC group, 2.65 for the SC at NICU with postdischarge MT group, and -3.77 for the MT group at both NICU and postdischarge, compared with the SC group.
None of these differences were statistically significant; similarly, mean differences for secondary outcomes were insignificant.
Risk factors for lower language composite scores included male sex and the need for oxygen supplementation. However, these factors were not associated with intervention effects. Sensitivity analyses using multiple imputations confirmed the lack of significant effects.
Conclusions
To summarize, results show that children who received MT at the NICU with post-discharge SC had similar developmental scores to those who received SC only. This study found no beneficial or detrimental effects of MT on neurodevelopment in preterm children.
The findings align with recent studies showing no meaningful effects of MT on the BSID-III in preterm children, and all studies reported mean BSID-III scores within the normal range.
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