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Updated: Jul 29, 2025
Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit
Published on: January 7, 2020
Effect of Music Therapy on Parent-Infant Bonding Among Infants Born Preterm: A Randomized Clinical Trial
Claire M Ghetti1,2, Tora Söderström Gaden2,3, Lucja Bieleninik2,4
1GAMUT-The Grieg Academy Music Therapy Research Centre, The Grieg Academy-Department of Music, University of Bergen, Norway.
Insights
Parent-led singing in the neonatal intensive care unit (NICU) did not significantly improve parent-infant bonding. This music therapy intervention was found to be safe and well-accepted by families with preterm infants.
Area of Science:
- Neonatal care
- Developmental psychology
- Music therapy
Background:
- Parent-infant bonding is crucial for infant development and long-term health.
- Preterm birth can disrupt the formation of secure parent-infant attachments.
- Early interventions are needed to support bonding in high-risk populations.
Purpose of the Study:
- To evaluate the effectiveness of parent-led, infant-directed singing, supported by music therapy, in enhancing parent-infant bonding.
- To assess bonding at 6 and 12 months corrected age in infants born preterm.
- To determine if music therapy initiated in the NICU or post-discharge impacts bonding.
Main Methods:
- A randomized clinical trial involving preterm infants (gestation < 35 weeks) and their parents across 5 countries.
- Intervention groups received music therapy (MT) plus standard care or standard care alone, either during NICU stay or post-discharge.
- Mother-infant bonding was measured using the Postpartum Bonding Questionnaire (PBQ) at 6 and 12 months corrected age.
Main Results:
- No clinically significant differences in mother-infant bonding scores were observed between the music therapy groups and the standard care groups at 6 or 12 months corrected age.
- Estimated group effects for the primary outcome (PBQ at 6 months) showed no significant improvements with MT in the NICU (0.55) or post-discharge (1.02).
- Secondary outcomes also did not reveal clinically important between-group differences.
Conclusions:
- Parent-led, infant-directed singing, whether initiated in the NICU or post-discharge, did not demonstrate a clinically significant effect on mother-infant bonding in this trial.
- The music therapy intervention was found to be safe and well-accepted by participants.
- Further research may explore alternative or modified music-based interventions to support parent-infant bonding in preterm populations.
Importance:
Parent-infant bonding contributes to long-term infant health but may be disrupted by preterm birth.
Objective:
To determine if parent-led, infant-directed singing, supported by a music therapist and initiated in the neonatal intensive care unit (NICU), improves parent-infant bonding at 6 and 12 months.
Design, Setting, And Participants:
This randomized clinical trial was conducted in level III and IV NICUs in 5 countries between 2018 and 2022. Eligible participants were preterm infants (under 35 weeks' gestation) and their parents. Follow-up was conducted across 12 months (as part of the LongSTEP study) at home or in clinics. Final follow-up was conducted at 12 months' infant-corrected age. Data were analyzed from August 2022 to November 2022.
Intervention:
Participants randomized to music therapy (MT) plus standard care or standard care alone during NICU admission, or to MT plus standard care or standard care alone postdischarge, using computer-generated randomization (ratio 1:1, block sizes of 2 or 4 varying randomly), stratified by site (51 allocated to MT NICU, 53 to MT postdischarge, 52 to both, and 50 to neither). MT consisted of parent-led, infant-directed singing tailored to infant responses and supported by a music therapist 3 times per week throughout hospitalization or 7 sessions across 6 months' postdischarge.
Main Outcome And Measure:
Primary outcome was mother-infant bonding at 6 months' corrected age, measured by the Postpartum Bonding Questionnaire (PBQ), with follow-up at 12 months' corrected age, and analyzed intention-to-treat as group differences.
Results:
Of 206 enrolled infants with 206 mothers (mean [SD] age, 33 [6] years) and 194 fathers (mean [SD] age, 36 [6] years) randomized at discharge, 196 (95.1%) completed assessments at 6 months and were analyzed. Estimated group effects for PBQ at 6 months' corrected age were 0.55 (95% CI, -2.20 to 3.30; P = .70) for MT in the NICU, 1.02 (95% CI, -1.72 to 3.76; P = .47) for MT postdischarge, and -0.20 (95% CI, -4.03 to 3.63; P = .92) for the interaction (12 months: MT in NICU, 0.17; 95% CI, -2.71 to 3.05; P = .91; MT postdischarge, 1.78; 95% CI, -1.13 to 4.70; P = .24; interaction, -1.68; 95% CI, -5.77 to 2.41; P = .42). There were no clinically important between-group differences for secondary variables.
Conclusions And Relevance:
In this randomized clinical trial, parent-led, infant-directed singing did not have clinically important effects on mother-infant bonding, but was safe and well-accepted.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03564184.
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