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NICU nurses part of 11-hospital study to examine benefits of music for preemies

Monday September 16, 2013
Joanne Loewy, director of Beth Israel’s Louis Armstrong Center for Music and Medicine, plays guitar for baby Tiana Jackson and her parents. Looking on in the background are, from left, study co-authors Ann-Marie Dassler, NP, and Aimee Telsey, neonatologist.
Joanne Loewy, director of Beth Israel’s Louis Armstrong Center for Music and Medicine, plays guitar for baby Tiana Jackson and her parents. Looking on in the background are, from left, study co-authors Ann-Marie Dassler, NP, and Aimee Telsey, neonatologist.
(Photo courtesy of Beth Israel Medical Center)
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Photo courtesy of Beth Israel Medical Center At bottom right, Ann-Marie Dassler, NP, uses a gato box — which mimics a heartbeat — to soothe a baby while Joanne Loewy, standing at left, and the child’s mother, watch the music therapy session.
Family nurse practitioner Ann-Marie Dassler’s belief in music therapy started with a very fragile premature girl she met on her shift as a student nurse at a New York hospital in 1968.

Back then, such infants were alone in their isolettes. Not even the parents were allowed in, Dassler said. So, as the child’s primary caregiver, Dassler did what came naturally to calm the baby girl: she sang.

Dassler couldn’t hold the baby, and nothing would soothe her except a John Denver lullaby called "For Baby (For Bobbie)."

Five years later, Dassler treated the girl again before a surgical procedure. She sang her to sleep with the same song, and the girl’s mother started to cry. Dassler said the mother told her the first time her daughter heard that song on the radio in their home, she was inconsolable until she let her hold the radio in her arms.

"It was powerful to me to understand how therapeutic that interaction, that entrainment, had been for her," said Dassler, RN, MSN, FNP, who now assesses and treats babies in the neonatal ICU at Beth Israel Medical Center in Manhattan.

That’s why she jumped at the chance to work with Joanne Loewy, DA, LCAT, MT-BC, director of Beth Israel’s Louis Armstrong Center for Music and Medicine, when she proposed a multisite study of how music therapy helps preemies. Dassler helped design and implement the study and later helped analyze the results.

How music helps
Loewy wanted to build on existing music therapy literature. There was a large amount of documentation showing music therapy helps patients of all ages, but Loewy wanted to know: What kind of music helps preemies, and what part of a song? Is it the melody or the rhythm? Sung by whom? With what instruments?

Determining what kind of music worked was critical with premature infants, Loewy said, because of the danger of overstimulating their tiny systems.

The study, published in the journal of Pediatrics in April, tested three interventions: a drumlike gato box (to replicate heartbeat), a disc full of beads that made a "wooshing" womb-like sound when tipped, and sung lullabies that were part of the family’s community or culture. All of the interventions were calibrated for volume, pitch and rhythm to match each baby’s vital signs.

Results showed overall improved feeding and sleeping behaviors and sucking patterns, all things that can lead to shorter hospital stays and improved outcomes, Loewy said.

"The old school was put the babies in the incubators and let them sleep and build their cells," Loewy said. "I guess now we’re seeing that neurobiology is at work and learning can occur through quiet-alert states."

Nurses and physicians observed the training of the music therapists and that helped with buy-in, Loewy said. That was important so nurses could coordinate with therapists and give them access during feeding times and feel more confident their charges were getting the help they needed.

"Nurses are with the babies 24/7, and if you have understanding and respect from nurses then your research is golden … particularly in a NICU," Loewy said.


Ann-Marie Dassler, RN
Music soothes all in NICU

Music therapy has benefits not just for the babies, but also for families and nurses, said Leonora Yaun, RN, MA, CLC, NICU nurse manager at St. Luke’s-Roosevelt Hospital Center in Manhattan.

St. Luke’s-Roosevelt and Beth Israel were among the study’s 11 test sites, which also included Montefiore Medical Center, Bronx; Good Samaritan Hospital Medical Center, West Islip, N.Y.; North Shore University Hospital, Manhasset, N.Y.; Stony Brook (N.Y.) University Hospital; Maria Fareri Children’s Hospital at Westchester Medical Center, Valhalla, N.Y.; Vassar Brothers Medical Center, Poughkeepsie, N.Y.; HackensackUMC, Hackensack, N.J.; Children’s Hospital of Pittsburgh; and Hahnemann University Hospital, Philadelphia.

Parents, often commuting from home to the hospital, perhaps also caring for other children and worrying about a fragile child, are calmed by the music and more focused and relaxed in feeding. This takes pressure off of the infants to eat and helps them burn fewer calories.

Even the nurses move at a different pace when the environmental music is playing, Yaun said.

"They don’t know, but I observe them," she said. "As a critical nurse, the tendency is to respond immediately, and they run," she said.

When the music is playing the nurses move in a more deliberate, less-frenzied way, Yaun said, which also is less stressful for the entire NICU.

Marcia Frellick is a freelance writer.


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Soothing sounds

Each intervention in the 11-hospital study benefited premature infants in different ways and to various degrees, said lead author Joanne Loewy, DA, LCAT, MT-BC. The interventions, and some of the benefits, included the following:

Lullabies: Parents identified a song familiar to the family or representative of the culture of the family’s community. It could be a single-line melody from a church or synagogue or a nursery rhyme that a family member sang. The effect was slowed heart rate and improved sleep; improved caloric intake and sucking behavior.

Ocean disc: The Remo ocean disc is a round instrument filled with tiny metal balls. When the disc is rotated, the balls create a quiet “whooshing” to simulate fluid sounds of the womb. It is meant to match the infant’s inhalation and exhalation cycles. The benefit is prolonged sleep and help with breathing.

Gato box: This small rectangular box is played with the fingers and provides a soft timbre rhythm to simulate a mother’s heartbeat. The effect is improved feeding and sucking patterns.