Classical Music Therapy Influences Physiological Parameters in Preterm Neonates

Safeena Beevi S.S.^1*, Dr. Premaletha T.², Sona P.S³

¹Sister Tutor, College of Nursing, JIPMER, Puduchery-6

²Professor, College of Nursing, Trivandrum-11

³Associate Professor, College of Nursing, Trivandrum-11

*Corresponding Author Email: safeenasamadu@gmail.com

ABSTRACT:

Introduction: Neonates are unique and distinctive from the rest of pediatric population due to particular problems related to extrauterine adaptations, anatomical and physiological immaturity. The primary purpose of this study is to assess the effect of classical music therapy on physiological parameters among preterm neonates.

Methods: The research approach of the study was Quasi experimental with time series design. Classical music (Instrumental Flute) was played for 50 preterm babies of 30-36 weeks of gestation with MP3 player, using head phone for a total duration of 30 minutes at 20 to 30dB-SPL. Heart rate and oxygen saturation by pulse oximeter were monitored along with respiratory rate and recorded at 5-minute intervals during the therapy period and for the pre-music and after music therapy period, the time intervals were 2.5 minutes. The study duration was 60 minutes, 15 minutes before music therapy (BMT), 30 minutes of music therapy (DMT) and 15 minutes after music therapy (AMT). 50 preterm neonates admitted in newborn nursery were selected by convenient sampling and studied for four consecutive days. Day 1 and 3 for music therapy (experimental group) and day 2 and four as the control group when no music was played through the head phone. Here the subjects act as the control group on alternate days. Results: Mean HR value on day 1 and 3 (with music were significantly lower during the music (DMT) and after music (AMT) phases compared to BMT (139.1± 10.9(BMT), 128.9± 10.3 (DMT) and 128.9 ± 10.3 (AMT); BMT Vs DMT (F= 584.25, P<0.001, BMT Vs AMT (F= 295.76, P<0.001). In contrast, day 2 and 4 (control-no music), there were no differences in mean HR during the three phases of observation (139.4± 11.4 (BMT), 139.9±11.4 (DMT) and 140.4±11.2 (AMT); BMT Vs DMT and BMT Vs AMT- NS). The mean respiratory rate on experimental groups (Day 1 and Day 3) with music were significantly lower during the music (DMT) and after music (AMT) phases compared to BMT (53.5 ± 6.2 (BMT), 44.8± 5.3 (DMT), 46.5± 5.6 (AMT); BMT Vs DMT (F=374.12, P= <0.001), BMT Vs AMT (F= 206.12, P= <0.001). In contrast, there were no differences in the respiratory rate in the three phases on day 2 and 4 when no music was played (50.6 ± 4 (BMT), 51±3.9 (DMT), 50.8± 3.8 (AMT); BMT Vs DMT, BMT Vs AMT, NS). No apnoeic bradycardia events were noted during music therapy. Likewise mean SpO2 values on day 1 and 3 with music were significantly higher during music and after music phases than the baseline values (BMT) (96.4 ± 1.3(BMT), 99.5 ± 0.9(DMT), 98.6 ± 0.8(AMT); BMT Vs DMT (F=579.42, P<0.001), BMT Vs AMT (F=283.42, P<0.001). In contrast, there were no differences in the oxygen saturation values in the three phases on day 2 and 4 when no music was played (97.1± 1.4 (BMT), 96.9± 1.4(DMT), 96.9± 1.4 (AMT); BMT Vs DMT, NS BMT Vs AMT, NS). Conclusion: Listening to classical music as used in this study, was associated with a significant (P<0.001) lowering of resting Heart Rate and Respiratory rate and a consistent improvement of oxygen saturation was noted. These effects appear to persist beyond the music therapy for a short period and may play a useful role to achieve relaxation for babies in NICU.

KEYWORDS: dB-Decibel, SPL- Sound Pressure Level, NS- Not significant, NICU- Neonatal Intensive Care Unit.

INTRODUCTION:

In the present era of science and technology, where quality is the supreme priority, Quality Of Life can only be accredited by decreased morbidity and mortality rate of the newborn. The UNICEF’s Flagship Publication, The State of World’s Children, reported that a million neonatal death occurs in India every year.¹ Almost 2/3^rd of infant deaths in India occur in the first month of life with 1/3^rd of all neonatal deaths associated with prematurity and low birth weight.² Preterm babies, associated with higher neonatal mortality and morbidity, impaired growth and cognitive development and chronic diseases later in life. The problems of preterm infants are hypothermia, hypoxia, infection, hypoglycemia, apnea, poor weight gain, prolonged Neonatal Intensive Care Unit (NICU) stay and decreased bonding between the mother and infant.³Music therapy is an important intervention that is soothing for the infants. Music therapy can also encourage parental involvement, support infant development and optimize preterm infant’s neurodevelopmental outcomes.^4,5The music therapy has an effect on the state of pediatric patients, potentially improving the physiological well-being of long-term hospitalized children when exposed to live music.⁶

MATERIALS AND METHODS:

The research approach of the study was Quasi experimental with time series design. Classical music (Instrumental Flute) was played for 50 preterm babies of 30-36 weeks of gestation with MP3 player, using head phone for a total duration of 30 minutes at 20 to 30dB-SPL. Heart rate and oxygen saturation by pulse oximeter were monitored along with respiratory rate and recorded at 5-minute intervals during the therapy period and for the pre-music and after music therapy period, the time intervals were 2.5 minutes. The study duration was 60 minutes, 15 minutes before music therapy (BMT), 30 minutes of music therapy (DMT) and 15 minutes after music therapy (AMT). 50 preterm neonates admitted in newborn nursery were selected by convenient sampling and studied for four consecutive days. Day 1 and 3 for music therapy (experimental group) and day 2 and four as the control group when no music was played through the headphone. Here the subjects act as the control group on alternate days. Data were collected after getting human ethical committee approval and all ethical principles were followed during the entire study.

Inclusion criteria:

· Preterm neonates between the gestational age of 30 to 36 weeks.

· Preterm neonates with a birth weight of 1.5 kg and above.

· Preterm neonates with mild to moderate respiratory distress.

Exclusion criteria:

· Preterm neonates with congenital anomalies.

· Parents or caregivers not willing to provide the consent.

RESULTS:

Table: 1 Heart rate and level of significance in relation to before and during Classical music therapy on Experimental and Control group.

Classical Music Therapy	Mean		F	p
Classical Music Therapy	Experimental	Control	F	p
Before Therapy	139.0	139.3	0.04	0.849
During Therapy	127.1	140.3	74.18**	0.000
Adjusted During Therapy	127.2	140.1	584.25**	0.000

** Significant at 0.01 level (ANCOVA)

It is evident from the above table that the method of classical music therapy significantly reduced the heart rate.

Table:2 Heart rate and level of significance of Experimental and Control groups in relation to before and after Classical music therapy

Classical Music Therapy	Mean		F	p
Classical Music Therapy	Experimental	Control	F	p
Before Therapy	139.0	139.3	0.04	0.849
After Therapy	129.5	140.5	51.72**	0.000
Adjusted After Therapy	129.7	140.3	295.76**	0.000

**Significant at 0.01 level (ANCOVA)

From the table:2, it is clear that the effect of classical music therapy to reduce the heart rate is ongoing even after the therapy for a short period of 15 minutes.

Table: 3 SpO₂and level of significance in relation to before and during Classical music therapy on Experimental and Control groups

Classical Music Therapy	Mean		F	p
Classical Music Therapy	Experimental	Control	F	p
Before Therapy	96.4	97.1	13.67**	0.000
During Therapy	99.5	96.9	239.71**	0.000
Adjusted During Therapy	99.8	96.7	579.42**	0.000

** Significant at 0.01 level (ANCOVA)

Table: 3, shows that Classical music therapy significantly increases the SpO₂ level.

Table: 4 SpO₂and level of significance in relation to before and after Classical music therapy on Experimental and Control groups

Classical Music Therapy	Mean		F	p
Classical Music Therapy	Experimental	Control	F	p
Before Therapy	96.4	97.1	13.67**	0.000
After Therapy	98.6	96.9	107.79**	0.000
Adjusted After Therapy	98.8	96.7	283.42**	0.000

** Significant at 0.01 level (ANCOVA)

The above table concludes that the classical music therapy significantly increases the SpO₂level after the music therapy.

Table:5, Respiratory rate and level of significance in relation to before and during Classical music therapy on Experimental and Control groups

Classical Music Therapy	Mean		F	p
Classical Music Therapy	Experimental	Control	F	p
Before Therapy	53.5	50.6	17.36**	0.000
During Therapy	44.8	51.0	94.94**	0.000
Adjusted During Therapy	43.8	52.0	374.12**	0.000

**Significant at 0.01 level (ANCOVA)

Table:5, implies that the classical music therapy significantly reduces the respiratory rate during the therapy period.

Table:6, Respiratory rate and level of significance in relation to before and after Classical music therapy on Experimental and Control groups

Classical Music Therapy	Mean		F	p
Classical Music Therapy	Experimental	Control	F	p
Before Therapy	53.5	50.6	17.36**	0.000
After Therapy	46.5	50.8	50.07**	0.000
Adjusted After Therapy	45.5	51.7	206.12**	0.000

** Significant at 0.01 level (ANCOVA)

From the above table, it is clear that the classical music therapy significantly reduces the respiratory rate and the effect is ongoing after therapy.

DISCUSSION:

The study findings disseminate that classical music therapy has statistically significant effect on the physiological parameters in preterm neonates. A study done by Staneslow in 2006, stated that live music therapy is associated with reduced heart rate and a deeper sleep at 30 min after music therapy.⁷ In 2008, similar study by Desquiotz, suggest that singing for preterm infants music therapy in neonatology found a positive impact on oxygen saturation,heart beat and on the general level of relaxation experienced by premature infants.⁸

REFERENCE:

1. The UNICEF Flagship publication- The state of World’s children(15^th Jan 2009)

2. Sharma RK. Newborn health among tribes of Madhya Pradesh - an overview. (Online) 2007. RMRCT Update 4. Available: http://icmr.nic.in /000519/updatevol4no1. pdf (Accessed 12 November 2007)

3. World Health Organization. The World Health Report: Fighting Diseases and Fostering Development. Geneva: WHO, 1996, 2006

4. Nordoff, Robbins. Newborn Babies and their Mothers. 2004; available at www.web.mac.com.

5. Nordoff P, Robbins C. Creative Music therapy. NewYork: John ay.1977.

6. Elena Longhi, Nick Pickett. Music and well-being in long-term hospitalized children. Psychology of Music. 2008; 36 (2): 247-56.

7. Staneslow S, Spring. Live music lulls newborns and slows heart rates. The Harp Therapy. 2006; 14.

8. Desquiotz-Sunnen N. Singing for preterm born infants. Music therapy in neonatology. Bull Soc Sci Med Grand Duche Luxemb. 2008; Spec No 1: 131-43.

Received on 07.02.2017 Modified on 24.02.2017

Asian J. Nur. Edu. and Research.2017; 7(2): 155-157.

DOI: 10.5958/2349-2996.2017.00031.3

Safeena Beevi S.S.1*, Dr. Premaletha T.2, Sona P.S3

Safeena Beevi S.S.^1*, Dr. Premaletha T.², Sona P.S³