Using music to stabilize NICU babies—as well as their parents

When music therapist Christine Vaskas works with babies in the neonatal intensive-care unit, the effect of her interventions are almost always immediately apparent.

"If I see the heart rate is high or jumping around, and I provide an intervention," Vaskas said, "all of a sudden I see the heart rate stabilize. It's bringing the baby back to the womb in an auditory way."

Vaskas, who has been a music therapist for five years, conducts clinical work and supervises interns and fellows at NICUs at three hospitals in the Mount Sinai Health System in New York City. The NICU program, First Sounds: Rhythm, Breath and Lullaby, is one of several under the umbrella of the Louis Armstrong Center for Music and Medicine, which offers music therapy in medical settings.

In 2013, a study led by Joanne Loewy, the Armstrong Center's director, found that certain live sounds, when provided in a music therapy context, could influence the respiratory and cardiac functions of premature infants. Those interventions could improve feeding behavior, enhance sleep and decrease stress, according to the randomized clinical trial, which spanned two years and 11 facilities in the Northeast.

About 1 in 10 infants in the U.S. is born preterm, or before 37 weeks, according to 2015 data from the Centers for Disease Control and Prevention. These babies are at higher risk of serious disability or death, and in 2013, about a third of infant deaths were caused by preterm issues. Those who survive can have trouble breathing or eating. They also often have developmental delays and other medical problems.

The music therapy Vaskas provides is not your conventional Bach or Mozart drifting passively in the background. These are sounds directed at the baby and the parents, and they draw on three specific techniques developed by Loewy: rhythm, breath and lullaby.

The rhythm technique uses a gato box, a small, two-toned wooden box that, when tapped with a finger, creates a soft rhythm in a timbre meant to mimic the mother's heartbeat. The breath technique uses a round instrument filled with tiny balls of metal, known as a Remo Ocean Disk. Rotating it produces the sound of fluid in the womb.

For the lullaby component of the therapy, parents choose a song to sing regularly to their child. They are encouraged to pick one that has special meaning for them, be it a Beatles song or "Over the Rainbow."

"We don't just work with these babies. The reality is that they go home when they're ready," Loewy said. "And lots of times when you have fragile babies, you have fragile parents, so part of our model is to provide music psychotherapy for the parents."

Babies can recognize their parents' voices over a stranger's, and so both baby and parent benefit when a parent is empowered to sing the lullaby, Vaskas said.

In the NICU, certified music therapists work with babies anywhere from every day to a few times a week, depending on the infants' and parents' needs, with each session lasting 10 to 20 minutes. They don't go longer, in order to avoid overstimulating the babies. Sometimes they work just with the babies, and at other times, they bring in the parents, too. Including parents is key to successful, sustainable therapy.

"Parents can use some music techniques . . . to help feed, to help put the babies to sleep, to ease the attachment process," Loewy said.

Typically, babies receive interventions at least three times a week. Usually the sessions begin when the baby is 32 weeks, but in some special cases, they've started music therapy for a baby as young as 23 weeks old. It's usually neonatologists who refer infants to music therapy, but if parents at Mount Sinai request it, their babies will receive it.

The full medical and cost impact of the therapy remains to be determined, but the potential is considerable, the findings of 2013 study suggest. When an infant is discharged from the NICU, his or her neuro-behavioral status is thought to be related to long-term development, and that status is in turn affected by sleep state organization, physiology and feeding interactions with the mother or father.