Medical Center of Central Georgia Neonatal Intensive Care Unit







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Medical Center of Central Georgia Neonatal Intensive Care Unit

The Effect of Music Therapy as a Nursing Intervention for the

Inconsolable 32-40 Week Critically Ill Infant

Dr. Douglas Keith, PhD, MT-BC Dr. Kendra Russell, RN, PhD Barbara Weaver, RN


Medical Center of Central Georgia

600+ beds (2nd in Georgia)

Level 1 Trauma Center

Serves 28 counties (> 750 k residents) 5000+ employees; 1500 nurses

Regional economic impact > $1 Billion Magnet designated 5/17/2007


Georgia College & State University

Georgia’s Public Liberal Arts University Milledgeville, Georgia



Music Therapy

GCSU School of Health Sciences



Nursing Research Council


Educates Mentors

Reviews and approves Consults



Prematurity: 10-12% of all US births

MCCG average daily census: 50 babies


Stress for Infants

Routine care in the NICU causes stress for infants Painful Non-painful Effects of stress Physiologic Behavioral


Stress for Caregivers

“Difficult to console” babies: challenging for caregivers Parents Helplessness Emotional pain Despair Nurses Environmental stress Frustration Helplessness (Hughes, 2002)


Interventions for stress: Nursing

Neurodevelopmental care Kangaroo care Nonnutritive sucking (NNS) Swaddling Containment


Music Therapy in the NICU

Provided by Board-Certified Music Therapist (MT-BC)

NICU Music Therapy interventions

Recorded music (age-appropriate) Live singing & multimodal stimulation Pacifier-activated lullaby (PAL)


Music Therapy in NICU:

Evidence-based effects

Improve O2 saturation

Increase weight gain Shorten hospital stay Reinforce NNS

Increase tolerance for stimulation



To explore the effectiveness of music therapy to reduce crying among our patients

To promote parental bonding

To reduce workload and environmental stress for our nurses.


Research Questions

1. What is the effect of music therapy on the

“inconsolable” behaviors of critically ill infants?

2. What is the effect of music therapy on the

physiological measures (heart rate,

respiratory rate, mean arterial pressure and oxygen saturation) of critically ill infants

during periods of “inconsolability”?

3. What is the effect of music therapy on




24 Infants in Level III NICU 90 Nurses


Neonatal Nurses approached parents of infants who met inclusion criteria

Nurses who cared for infants enrolled in the study were asked to participate




Nursing researchers designed form to gather data on infants and from nurses


Inclusion/Exclusion criteria (A)

Inclusion/Exclusion Criteria: 32-40 weeks gestation

Admitted to the Level III NNICU Not mechanically ventilated


No pain medications used


Inclusion/Exclusion criteria (B)

Customary nursing interventions unsuccessful

Nonnutritive sucking Swaddling

Changing diaper Repositioning

Quiet and dark environment

Inconsolable crying 5 minutes post-intervention

Intense, loud rhythmic and sustained cry vocalizations,


Research Design:

Repeated measures

Each infant assigned to one of two four-day protocols


Each infant experienced both conditions

Protocols differed in order of presentation


Condition A: “Music day”

Provide nursing interventions If unsuccessful, record nursing interventions and vital signs

Provide music intervention

Record behavioral state, vital signs, and duration of crying


Condition B: “No music day”

Provide nursing interventions

Record behavioral state, vital signs, and duration of crying


Research tools

Informed consent form

Research packets for random

assignment to treatment protocol Red or green selection cards Data collection tools

Quick reference guides


Research Tools

CD player & small speakers

CD of developmentally appropriate music

18 minutes (guideline: < 30 min)

Female voice (GCSU music therapy student)

In English (culturally appropriate) Unaccompanied lullabies

Narrow pitch and dynamic range Nursing staff questionnaire


Nursing Research Tool

Physiological Assessment data Nursing Interventions Music Intervention Infant Response


Nursing questionnaire

Five survey questions with rating scale

Demographic questions


disagree Strongly agree


Nursing Questionnaire

Survey questions

Answer area


Sample Demographics: Infants

n = 24 infants (complete data for 22)

Mean adjusted gestational age: 33.125 weeks (SD = 2.45)

68% Male, 32% Female

Most common diagnosis: Respiratory distress syndrome

98% single births

Mean APGAR scores at 3 and 5 minutes were 5.82 (SD = 1.74) and 8.50 (SD = .86)


Analysis of Infant Data

Paired-sample t-tests ANOVA


Results: Frequency of

“inconsolability” episodes

Mean number of episodes SD Condition A: Music 4.29 1.14 Condition B: No Music 7.21 2.83 t (23) = 6.61; p < .001)


Results: Duration of

“inconsolability” episodes

Mean duration (minutes) SD Condition A: Music 5.53 1.14 Condition B: No Music 23.14 9.99 t (23) = 8.94; p < .001)


Results: Physiological



Condition ConditionNo Music

Pre Post Pre Post

Heart Rate 152.15 144.39* 154.36 154.28 Respiration

Rate 56.25 48.98* 59.60 60.45 O2 Sat 91.16 92.67* 90.56 90.90


Results: Infants

1. What is the effect of music therapy on the “inconsolable” behaviors of critically ill


Music days: 4 inconsolable episodes/day, lasting 5.5 minutes

Non-music days: 7 inconsolable episodes/day, lasting 23 minutes


Results: Infants

2. What is the effect of music therapy on the physiologic measures of critically ill infants during periods of inconsolability?

Positive effects

Heart rate

Respiratory rate Oxygen saturation


Sample Demographics: Nurses

51% (n= 46) Dayshift Nurses


Analysis of Nurse Data


Results: Nurses

Music therapy decreased the stress I

experienced with this inconsolable

baby (M = 4.59)

MT was an effective intervention for


Results: Nurses

MT with this inconsolable baby

helped me make more efficient use of

my time (M = 4.58)

MT made my workload lighter (M =


Music therapy impacted the


Comments from Nursing Form


Loved music therapy, thought it helped, wanted CD, worried about “B” days of research

Mom felt like we were doing what she would have done if she could have with music therapy

Wanted to keep using after four days Parents felt music therapy helped a lot Parents loved music therapy CD



Music intervention was well tolerated Reduction in duration and frequency of inconsolability in premature infants

Improved physiological measures

Nurses expressed agreement that MT was an effective intervention, impacted parental bonding and their work environment


Implications for Practice

NICU staff can consult with

Board-Certified Music Therapists (MT-BC) to provide developmentally appropriate music interventions

Music therapy is an effective,

research-based intervention in the hospital setting



Nurse researchers were not blinded to participant status

Use of a convenience sample No tests of infant hearing

Variability in nursing and infant

behaviors (e.g., order of interventions) Use of recorded music


Recommendations for Future


Using recordings of the mother’s voice in her native language

Use of live vs. recorded music

Music interventions in infants under 32 weeks, looking at other indicators of

stress based on gestational age

Impact of music therapy on the work environment of nurses in NICU



Mitch Rodriguez, MD Nursing researchers Judith Danford, RN

Nursing Research Grant, MCCG




Aucott, S., Donahue, P., Atkins, E. & Allen, M. (2002). Neurodevelopmental care in the NICU. MRDD Research Reviews, 8, 298-308.

Evans, J., Vogelpohl, D., Bourguignon, C. M., Morcott, C. S. (1997). Pain behaviors in LBW infants accompany some "nonpainful" caregiving procedures. Neonatal network, 16 (3), 33-40.

Hughes, M.B. (2002). Infant excessive crying: Temperament, development and parenting stress. Unpublished doctoral dissertation, University of Pennsylvania.

March of Dimes (2007). Premature fact sheet: The growing problem of

prematurity. Retrieved November 10, 2007 from

Standley, J. M. (2000). A meta-analysis of the efficacy of music therapy for premature infants. Journal of Pediatric Nursing, 17 (2), 107-113).





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