Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

In recent years, creative music therapy really has emerged as a very promising new therapy to improve neuro development of pre-term infants. And in the protocol we provide here we really describe how we can use music and singing to empower the infants and their parents. Creative music therapy is a relatively low cost, and most likely low risk intervention which has great potential for improvement of outcomes of pre-term infants, and also of outcomes of parents, parent to parent interaction, also child to parent interaction.

But we definitely have to prove that it's really working. Creative music therapy can be provided to other patient groups as well, for example hospitalized infants. It can be extended to at risk pregnant woman, and followup music therapy after discharge.

This method may function as a neuroregenerative and neuroprotective early intervention. We may speculate that the enriched musical social-emotional experience may promote brain development. The individual performing CMT should be a specially trained music therapist who is familiar with the assessment of the needs of the pre-term infants, and the parents, and with all music therapy methods in neonatal care.

It is important to be responsive to the needs of the macro system, up to the micro system level to the intensive care unit environment, up to the individual needs of the infant. Visual and audio features are needed to demonstrate how to tailor the improvised singing and humming to the breathing pattern, facial expression, and gestures of the pre-term infant. Prior to initiating music therapy, conduct an in depth assessment with the medical team members and the parents to identify the needs of both the infant and the family.

Create therapeutic objectives oriented toward the principles of neonatal music therapy, and family integrated care approaches. Introduce musical therapy to the parents and assess their needs, resources, musical heritage, and culture. Note their preference in music along with their natural vocal range.

Find out of they already played music for the infant during pregnancy, and incorporate this music in the therapy as song of kin. Supply the parents with empowering intercultural music material to motivate them to sing for their infants. Identify a reasonable time frame for the therapy, as well as whether the session should take place at the incubator or bedside, with infant alone or together with the parents.

When obtaining approval from the neonatal team, seek the latest meaningful clinical information about the infant and the family. If the monochord will be used in the session, tune it in the key of the most dominant and frequent monitor beeping tone within the unit. Before entering the patient zone to conduct the session, disinfect hands, arms, and the instrument following the hygiene guidelines of the neonatal unit.

Disinfect and prepare a chair at the infant's bedside. If the infant tolerates touch, touch them at the head and feet, then lightly lay one hand on the chest or back. Form a connection by taking note of any muscle tension or movement, and support their breathing pattern by adjusting the pressure and weight of the hand on the infant's chest or back.

After a period of observation, start with humming entrained to the infant's breathing pattern, incorporating the infant's signs of mimicry and movements. Develop the melody slowly, depending on the infant's response. For example, if the infant's eyebrows lift, move the melodic pitch and tempo upwards.

In contrast, if the infant is overly aroused, reduce the melody's span of pitches and pitch range, slow the tempo, and repeat the closing notes. Synchronize and interact with older infants or those who open their eyes and mouth, or move their fingers and arms. Hum and sing in lullaby style, keeping the voice calm, slow, simple, predictable, and repetitive.

Hum with flowing breath and a free, natural voice full of overtones and total ease. Hey little. Incorporate the song of kin in lullaby style and the individualized attuned improvisation.

If necessary, attune to environmental sounds to integrate and mitigate disturbing noises such as beeping monitors. After 15 to 20 minutes, fade the humming or singing slowly by reducing the notes, the tempo, and the rhythms. Conclude by repeating the last note, and hold the infant for a few seconds longer before slowly and cautiously removing the hand.

Assess the preferences of the parents, such as whether they would like to listen and relax, or sing along during the therapy session. Invite them to sit or lie down comfortably, and position the monochord next to the elbow or arm of the parent with the infant in kangaroo care. If appropriate, invite the parents to breath in and out deeply by asking them to close their eyes, focus on their breathing, and focus on feeling the infant.

Alternatively, invite them to observe and interact with their infant as they prefer. After a short period of observation, start with long, calm, sound waves on the monochord entrained to the infant's breathing pattern, fading the sound in smoothly. After a while, hum along with the monochord, or accompany and support the parents humming or singing.

Attune and tailor the humming and singing to the effects, rhythms, and needs of the infant, as well as to the environmental sounds. Hum and sing with the parents vocal range, making sure to incorporate the parents'favorite music in the singing. After 15 to 20 minutes, fade out the humming or singing slowly as previously described, but continue to play the monochord for an additional one to two minutes.

Then, fade out the monochord and hold the moment of reverberation and silence for a few more seconds before removing the instrument. If appropriate, ask the parents about their experience during the session, and about their perception of their infant's reactions. Share your perceptions of the infant's reactions, and give feedback on the parent-infant interaction to encourage attachment.

Upon exiting the patient zone, disinfect following the neonatal hygiene guidelines. Make sure to document the session, and discuss it with the neonatal staff. Video microanalysis of CMT revealed that when the infant was aroused, the therapist would sing as simple and repetitive as possible to calm her down.

The therapist softly hummed only two long holding notes centering around the tonic of the scale to provide a musical holding, stability, and safety. The therapist would continually entrain the singing to the breathing rhythms of the infant. Furthermore, the therapist sings in the key of the monitor alarms to mitigate the disturbing noises.

Consequently, the infant remains calm after the sudden alarm during music therapy. The therapist continuously tailors the singing to the facial expressions and gestures of the infant. For instance, when the infant smiles and raises her fingers, the therapist raises the melody, tempo, and dynamics synchronously.

The therapy helped previously stressed and distant mothers connect with their infants through meaningful vocal interaction. The infant began her sucking pattern precisely at the beginning of the musical phrase of her mother. The key element of CMT is to continually tailor the music to the individual needs of the infant and the family by providing family integrated resource and relationship based music therapy.

Creative music therapy can be standard to post discharge music therapy programs. For example, home visits and music groups. It may improve psycho-social adaption in parents and neuro development in infants.

It is important to remember that creative music therapy plays a subordinated and complementary role in the live-saving setting of medical treatment and intensive care so that CMT should be delivered to clinically stable pre-term infants only.