Music for medical indications in the neonatal period: a systematic review of randomised controlled trials

Lisa Hartling ¹, Mehaboob Shaik ¹, Lisa Tjosvold ¹, Robin Leicht ¹, Yuanyuan Liang ¹ and Manoj Kumar ^1*

¹ University of Alberta, Canada

^* To whom correspondence should be addressed. E-mail: manoj.kumar{at}capitalhealth.ca.

Accepted 26 January 2009

Abstract

Objective: To conduct a systematic review of the efficacy of music for medical indications in term or preterm neonates.

Methods: We searched 17 electronic databases; subject bibliographies; reference lists; and trials registries. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. Meta-analysis was not feasible due to heterogeneity in outcomes; a qualitative analysis is presented.

Results: Nine randomized trials were included. The methodological quality was generally poor (median Jadad score=1). The outcomes most commonly reported were: physiological measures (heart rate [HR], respiratory rate, oxygen saturation [SaO2]); behavioral state; and pain. Six studies evaluated music for painful procedures: circumcision (3 trials) and heel stick (3 trials). For circumcisions, one high quality pilot study (n=23) showed benefits of music for the outcomes of HR, SaO2, and pain, while two low-quality studies showed no difference. For heel prick, three low quality studies provided some evidence that music may be beneficial primarily for measures of behavior and pain. The remaining studies evaluated music in preterm infants: to improve physiological and behavioral parameters (n=31; benefits observed for behavioral parameters); to reinforce nonnutritive sucking via use of pacifier-activated lullaby (n=32; significant increase in feeding rates); and to influence physiological stability and behaviors in infants with chronic lung disease (n=22; no significant differences for outcomes assessed).

Conclusions: The heterogeneity in study populations, interventions, and outcomes precludes definitive conclusions around efficacy. There is preliminary evidence for some therapeutic benefits of music for specific indications, however, these findings need to be confirmed in methodologically rigorous trials.