Music in the NICU

A friend who is a chaplain in a nearby hospital often sings to the premature infants in the neonatal intensive care unit (NICU).  She does this because it just feels like the right thing to do. Don’t we always sing to babies to soothe and comfort them? And she notices that the babies immediately calm down.  Several years ago, nurses in various hospitals began noticing that, not only did preemies calm down when someone sang to them, but premature infants who routinely heard music developed more quickly than those who did not hear music. Now, several research studies have shown that music, both singing and instrumental, helps the underdeveloped neural networks of preterm infants mature more quickly than those who do not listen to music. 

A full-term pregnancy is considered to be 39 weeks or more.  Infants who are full term have functioning neural networks for breathing, heart rate, movement, and sucking – which allows them to develop normally.  But according to the CDC, one in ten births in the US is preterm, occurring before 37 weeks. Extreme preterm infants may be born in as few as 24 weeks. The neural networks in these infants’ brains are not fully developed and the infants are at risk of developing neurodevelopmental disorders in learning, concentration, and emotional management.  They have difficulty breathing and feeding, have faster heart rates, may have vision and hearing problems, and tend to have decreased quality of sleep.   

Most of these preterm infants spend two to three months in the NICU in an incubator.  They are under a great deal of stress caused by daily medical interventions such as blood sampling and feeding tubes, loud technical equipment, alarms on ventilators and pumps, the hiss of oxygen, and medical personnel coming and going.  This is an environment that is quite different from the quiet, supportive environment of the mother’s womb in which the infant would normally develop to full term.  It is difficult for the brain networks to continue to develop when the infant is under stress.  But recent studies have shown that listening to music can help.

Researchers at Beth Israel Medical Center in New York City conducted a three-year study that found that live music was beneficial for premature babies.  At Beth Israel and 11 other hospitals, parents of premature infants were asked to pick a favorite song that music therapists then turned into a lullaby.  Songs ranged from the Beatles to soul music, but all of the tunes ended up as lullabies sung softly by either the therapist or a parent to the individual infants – either in the incubator or held. Researchers found that the lullabies helped to slow the infants’ heartbeats, calm their breathing, helped them sleep better, and stay quietly alert longer. 

The study also used a Gato box, a two-note slit drum that is often played with a mallet. But in this case, it was played softly with the fingers to replicate the sound of the mother’s heartbeat. As the infant’s heartbeat entrained to the rhythm of the Gato box (synced with), the heart rate slowed down and sucking rates became faster, making it possible for the infant to get more food. The lullabies and the Gato box helped to decrease the stress response of the infants, allowing their brains to devote more energy to neural development.

Researchers at the Neonatal Intensive Care Unit at the University Hospitals of Geneva, Switzerland, took a different approach. For this three-year study, they asked harpist/composer Andreas Vollenweider to compose music specifically for the premature infants. With the help of a nurse specializing in developmental support care, Vollenweider played a variety of instruments for the babies to see which generated the most reaction.  Their favorites were harp, bells, and the punji – the Indian snake charmer’s flute.  When the infants heard the punji, even the most agitated infants calmed down almost instantly. (If anyone has any theories about why a punji had a more calming effect than another kind of flute, I would love to hear them.)

Vollenweider composed three eight-minute soundscapes:  one to be played as the baby is waking up, a second to be played while the infant is awake, and the third when the infant is going to sleep.  This was a double blind study, meaning that there was a group of premature infants who listened to the music, another group who did not, and a control group of full-term infants to which they could compare. 

Sound files for the three preemie compositions can be found on Vollenweider’s website.

Researchers found that the network most affected by listening to the music was the salience network. This is a somewhat recently discovered network in the brain that monitors internal and external information and decides which information should be paid attention to and then links to other brain networks to respond. Lara Lordier, one of the researchers, commented that “this network is essential, both for learning and performing cognitive tasks, as well as in social relationships or emotional management.” They found that the salience network in the premature infants who had heard Vollenweider’s music was very similar to that of full-term babies, although remained underdeveloped in the preterm infants who had not heard music.

Premature infants spend a great deal of time sleeping, but a recent study shows that music played during sleep also has a beneficial effect, lowering respiratory rates, and increasing oxygen saturation.

Premature infants are considered a vulnerable population, a term used to describe groups of people who are disadvantaged in terms of medical conditions, socioeconomic status, being a member of a racial or ethnic minority, victims of trauma, infants or the elderly. Music has been found to be not only helpful, but life-changing for many of these groups, and we will look at some of them in the coming weeks.


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2 responses to “Music in the NICU”

  1. Lyle Sanford Avatar

    1) – A doctor friend worked a neonatal unit back in the 70’s and often touched, and even sometimes carried one around in his arm, saying depriving them of stimulation didn’t help. 2) – Just saw on X a dad calming a crying new born with an long extended “ah” sound that he’d made on the mom’s belly during pregnancy – worked instantly. 3) – Love the book!!!! Bought multiple copies and have already given away two. As much as I’ve thought about it, don’t feel we fully appreciate the ways mirror neurons can be used in music therapy. For one thing, feels like the more people know about them, the better they can tune in when they want to get deeper responses?

  2. Lois Svard Avatar

    Hi Lyle, Great to hear from you! 1). In many of the studies, they also use “kangaroo care” so babies are held skin to skin against the chest. That seems to be standard now so your friend was ahead of his time. 2) Interesting – the newborn seems to have been responding to a familiar sound. 3). Thanks so much – happy to know you liked the book. I agree about mirror neurons. We don’t fully appreciate how powerful they are. And yes, Marco Iacoboni, one of the big researchers in mirror neurons, told me that just by virtue of a student knowing about them, it would have an affect on his performance. Thanks!