Premature birth: is music the answer?!

We know that premature births are happening more frequently. This is of course something none of us would want, however, being forewarned is being forearmed and the great news is that not only has technology advanced significantly to allow earlier and earlier survival, but research is showing there are some very positive things that we as parents can do within the NICU to aid our baby’s development. This article looks at some very promising research recently published showing that music can have a very positive role to play in helping your baby’s development.

Unfortunately, premature birth is on the rise globally. The latest figures show that in the US for example, as many as 1 in 8 are now born prematurely and according to figures published in the highly respected medical journal: The Lancet, last year saw 15 million babies born before 37 weeks with that number growing 0.8% per year over the last three decades. Sadly, it remains the single biggest cause of infant death at one month old and below. (1)

The good news however, is that technology has come on leaps and bounds, particularly since the 1960s and we are able to save babies earlier and earlier. Hooray! That being said, in some cases premature babies can potentially face lasting consequences, particularly related to neurodevelopment as a great deal of brain development occurs in the third trimester. To put this into context; we see a four-to-fivefold increase in the volume of cortical grey and white matter (2) and by 30 weeks of gestation, the brain has achieved only half of its full-term weight.’

Don’t panic however, babies can be incredibly resilient and the good news is that as parents there may be a positive role we can play to help the brain develop in a more typical fashion. This relates to the environment a premature baby finds itself in: the Neonatal Intensive Care Unit or NICU and some factors we can potentially have an influence over….

Once again, there have been tremendous advances when it comes to care that a premature baby gets, starting with the work of Louis Gluck in the 1960s who revolutionised care structure: putting babies all in together vs isolation and working on reducing incidence of infection which has continued to have a benefit in terms of survival and the work of the NICU is often nothing short of miraculous. However, the NICU itself can be a stressful place, for both the baby and the parents, and survival within the NICU may potentially have other consequences.

How so?

Essentially the shielded environment of the womb is abandoned too early and ‘besides other stressful experiences such as the separation from the mother and other painful procedures, preterm infants must cope with the unusual sound environment of an intensive care unit.’ (4)

This however may be an opportunity, that we as parents can positively influence:

Associated stress of the NICU has been shown to have a potential impact on a developing brain: ‘Brain maturation in preterm infants may be affected amongst other things by the overwhelming auditory environment of the NICU. Conversely audio deprivation (eg. the lack of the regular intrauterine rhythms of the maternal heartbeat and the maternal voice) may also have an impact on brain maturation.’ (4)

In fact, in 1997 the American Academy of Pediatrics recommended that sound levels do not exceed 45 dB but studies have found that the reality is sound levels often range between 50-80 dB, sometimes reaching peaks of 120 which has been linked to short term effects on cardiovascular, respiratory systems and increased stress. Preterm babies are also particularly vulnerable because both their auditory system and brain development are in a critical, vulnerable and fast period of growth (4)

Here is the opportunity….

Having a baby born prematurely is often excruciating for a parent who can often (on top of worry and stress) feel powerless to help, particularly as the NICU team take the reigns and do their amazing lifesaving work.

However, there is emerging research showing that environmental changes that can be instigated by parents can potentially have a very positive effect on many aspects of development including the crucial brain development. We have already written about one way that you as a parent can play a positive role (click here for more) but science seems to be suggesting another….

This is where music comes in:

We know that babies can hear very early on in their lives, starting in utero and continuing into early life. You may have heard of studies about the effects of music being played to babies in the womb or babies reacting to loud noises. Well, when it comes to brain development, music may play a particularly interesting role:

‘Musical learning also occurs before birth. Music activates limbic and paralimbic regions in the human brain. This engagement may enhance the psychological and physiological health which is particularly crucial following preterm birth… (where) the plasticity of auditory regions and cortex development are heavily dependent on the quality of auditory experiences.’ (4)

Translation: music has been shown to play a role even before birth in brain development. Research has shown that the foetus responds to sound at least as early as 25-27 weeks of gestational age.

Is this an opportunity?!

Well researchers seem to think so, as in the last few years the number of studies conducted looking at the impact of music and preterm babies, focusing on brain development and various other aspects that have an influence like feeding, weight gain, sleeping, stress levels (cortisol), heart rate etc has increased.

So, what has the research concluded?

Well, until more recently, there were some positive signs for example a study by Angelucci et al demonstrated that exposure to music in mice could facilitate the differentiation of new neurons and production of nerve growth factor in the brain. (4) Multiple other studies demonstrated combinations of several effects on factors ranging from heart rate, behavioural state, oxygen saturation, feeding ability and length of stay. (3) However, other studies showed more mixed and inconsistent results so it was looking hard to equivocally say.

But here’s where it gets really interesting….

Recently there was a study published using what is known as fMRI imaging (functional magnetic resonance imaging - which detects brain activity by detecting changes associated with blood flow) which has had some very noticeable and positive results linked to music therapy and preterm infants adding significant weight to the potential benefits….

What did it show?

This team of researchers highlighted that in some preterm infants there is a lack of development in certain crucial networks or connections within the brain, areas that relate to higher levels of functionality. One of the reasons they appear not to develop as they should in a preterm infant is due to the difference in environment:

‘The development of these brain functional networks occurs either in utero for full term infants or in the NICU for preterm infants, two very different environments in terms of how stimuli are presented which may have long-lasting effects.’ (6)

Music it seems can have a very positive effect of rebuilding this:

Research appears to show that music can play a significant role in brain development in general - regardless of gestational age. In fact the research suggests that musical training in both children and adults increases connectivity in particular core areas of the brain vs non musicians, ‘indicating that music training changes large-scale brain networks...suggesting potential adaptive, neuroplastic effects of music.’ (6).

In fact, their study showed that when music therapy was applied, the preterm babies who had been exposed ended up with ‘significantly higher’ connectivity versus those that had not been exposed, in particular in an area of brain connectivity that has been shown to be affected by premature birth!

Even more impressively they demonstrated that the brains preterm infants exposed to the music intervention were more similar to that of full term babies:

‘We show that this early intervention in preterm newborns leads to functional brain architecture more similar to those of full-term newborns.’

Pretty amazing stuff!

So: how exactly did they do this? Putting theory into practise:

Various different methods have been used by other studies to expose premature babies to music. Ranging from lullabies played, to the sounds of heartbeats to live music (including a harpist). However, this particular study listened to recorded music specifically composed using instruments (i.e., harp, pungi, and bells) that have produced behavioral and brain responses in preterm newborns in a previous study. The music exposure occurred five times per week from a gestational age of 33 weeks until they were discharged.

Conclusions?

Well first off, if you want to look at the study in detail, the link is below - but in short, the research presents (on top of other existing research) a compelling case for music to be integrated into the care of a premature baby to help brain development continue outside of the womb. This is a discussion as a parent you are very entitled to have with the staff at the NICU. Don't be afraid to speak up. Further, what’s interesting about that study is the power of music on the brain of a child who has not been born prematurely. The study also demonstrated ‘increased structural connectivity… observed in children with two years of musical training.’ (6). Now, that's not to say you have to go all ‘Tiger Parent’ on your kids, but it does go to show the potential power of music on brain development and is worth considering. After all, most people like music so surely this is just an added bonus! Spotify at the ready!

Link to full study: https://www.pnas.org/content/pnas/116/24/12103.full.pdf

References:

  1. WILLIAMS CL, TANN CJ: Global perspectives of premature birth across the life course. The Lancet Child & Adolescent Health, April 2019. Vol 3 No. 6 p370-371

  2. GLASS H, COSTARINO A, DAVIS PJ: Outcomes for Extremely Premature Infants: Anaesthesia and A nalgesia. 2015 Jun: 120(6): 1337-1351.

  3. HEIJDEN MJE, ARAGHI SO, DIJK: Do Hospitalized premature infants benefit from music interventions? A systematic review of randomised controlled trials. PLoS One: 2016; 11(9)

  4. HASLBECK FB, BASSLER D: Music from the very beginning - a neuroscience-based framework for music as therapy for Preterm Infants and their parents. Frontiers in Behavioural Neuroscience. 2018: 12: 112

  5. MORELIUS E, HE HG, SHOREY S: Salivary Cortisol Reactivity in Preterm Infants in Neonatal Intensive Care: An Integrative Review: International Journal of Environmental Research and Public Health

  6. LORDIER L, MESKALDJI M, GROUILLER F, HUPPI PS: Music in premature infants enhances high-level cognitive brain networks. Proceedings of the National Academy of Sciences of the United States (PNAS) June 2019: 11:116(24)

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This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.

Sarah Heywood