Maternal Singing During Kangaroo Care in Preterm Infants
Condition: Prematurity; Maternal Anxiety
MeSH terms: Premature Birth
Study type: Interventional

Summary: 
      Study objective is to evaluate the additive effect of maternal singing during skin to skin
      contact (Kangaroo Care) on anxiety reduction both to infants and their mothers.
    

Detailed description: 
      Maternal singing to preterm infants during Kangaroo Care intervention, is it beneficial?

      Protocol

      Maternal voice is a predominant source of multimodal stimulation for the developing fetus
      that is largely lost for the preterm infant amidst the unfiltered levels of auditory stimuli
      in the neonatal intensive care unit (NICU). These elevated levels of auditory stimulation in
      the NICU can interfere with an infant's sleep and have a negative effect on vital signs and
      oxygen saturation. Common sources of sound for the preterm infant are derived from routine
      incubator noise, monitoring alarms, and the speech sounds of healthcare team, all of which
      they would not typically encounter if life in the uterus had continued to term. In the midst
      of these additional sounds, preterm infants lose significant contact with an auditory
      stimulus they would typically be exposed to until full-term birth (their mothers' voice).

      Skin to skin contact care (Kangaroo care) was found to produce cardiorespiratory stability,
      decrease apneic and periodic breathing, and improve sleep patterns and weight gain in preterm
      infants. This technique has also been shown to help mothers of preterm infants to develop and
      strengthen self-confidence and attachment behaviors, leading to reduced stress response. Live
      music was shown to have a beneficial effect on psychophysiological responses in both mothers
      and preterm infants during their stay in the NICU.

      Aim: To evaluate the combined influence of live maternal singing during kangaroo care (KC) on
      maternal anxiety and stable preterm infants' responses.

      Participants

      Inclusion criteria clinically stable infants

      postmenstrual age <37 weeks

      normal hearing confirmed by measurement of distortion product otoacoustic emission (DPOAE).

      Exclusion criteria

      observed hyperresponsiveness to live music

      congenital anomaly that mainly affects hearing

      medication intake (phenobarbital, furosemide, gentamycin) that might interfere with the
      reaction to musical stimuli

      brain anomalies associated with neurological disorders (grade 3-4 intraventricular
      hemorrhage, periventricular leukomalacia).

      Maternal inclusion criteria

      ability to hear

      literary ability to read and answer an anxiety questionnaire

      Maternal exclusion criteria

      signs or medical history of postpartum depression.

      Procedure A within-subject, crossover, repeated design will be used with participants acting
      as their own controls. Before starting the research, mothers will get a professional guidance
      of singing lullabies to their offspring, by a music therapist (E.G). The mothers will be
      sitting at the infants' bedside and the child will be placed in the kangaroo position with
      skin-to-skin contact with the mother. Each therapy session will start 30 minutes after
      feeding to get a relaxed infant and to test the intervention with no disturbances such as
      hunger. As recommended the infants will receive either KC alone for 30 minutes or KC combined
      with maternal singing for 30 minutes. According to the randomization schedule, both therapies
      will be performed in the afternoon after finishing the medical and nursing rounds, in
      alternating order 3 to 5 days apart to allow for a washout period, and included the same
      music. Monitor alarms will be silence and the door closed.

      Objective Sound Measurements Music and background sound levels will be checked 10 cm from the
      infant's ear with a sound analyzer and a decibel scale filter (407790 Octave Band Sound
      Analyzer, type 2 Integrating Sound Level Meter and Decibel-A Scale Filter, respectively;
      Extech Instruments, Melrose, MA, USA).

      Infant and Maternal Measures For accuracy, neonatal and maternal heart rates, oxygen
      saturation levels, and respiratory rates will be recorded continuously and documented every 2
      minutes during all sessions. A 7-point scale to assess infants' behavioral state (deep sleep,
      light sleep, drowsy, quiet awake or alert, actively awake and aroused highly aroused, upset,
      or crying, and prolonged respiratory pause > 8 seconds) and a self-report questionnaire
      comprising 20 descriptive statements for measuring maternal anxiety symptoms (state-trait
      anxiety inventory [STAI] scale will be used at the beginning and the end of each
      intervention. Higher scores indicate greater anxiety, with a possible score of 20 to 80
      points. Additional maternal measures will be age, ethnicity (Arab/Jews), education (8 years,
      elementary school; 8-12 years, high school; and >13 years, college/university degree), and
      affinity for music (a 5-point scale: 1, 2, 3, 4, and 5 hours, measuring the length of time
      spent a day listening to music).

      Data will be recorded by a single physician who will remain at the bedside throughout each
      session. Data will be analyzed in a blinded fashion another researcher who will be unaware of
      treatment allocations.

      Power Analysis:

      To achieve a power of 0.8 at α = 0.05 and one-tailed with a medium effect size of 0.610 and a
      medium correlation (r = 0.50) among two repeated measures using the F-test, a sample size of
      30 mother-infant dyads will be needed.
    

Intervention name(s): Maternal singing with Kangaroo Care
Intervention type(s): Other
Intervention description(s): Maternal singing with Kangaroo Care
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Investigator)
Primary purpose: Supportive Care
Keywords: Prematurity; Music; Kangaroo Care; Bonding Mother infant