Music Therapy and Family-Integrated Care in the NICU: Using Heartbeat-Music Interventions to Promote Mother-Infant Bonding.

BACKGROUND: Family-integrated care in the neonatal intensive care unit (NICU) is the criterion standard. Parent-infant bonding may be an indicator of successful family involvement. Music therapy (MT) is a growing service in the NICU, with interventions to support meaningful family involvement and improve bonding. PURPOSE: To study the effects of heartbeat-music interventions to support mother-infant bonding in the NICU and explore experiences of mothers participating in MT. METHODS: Parallel-group randomized trial (MT vs standard care) to compare Mother-to-Infant Bonding Scale (MIBS) scores from baseline to 1 week postenrollment. MT included 2 heartbeat-music interventions (recorded maternal lullaby and heartbeat for infants, and recorded infant heartbeat and preferred music for mothers). Five mothers were randomly asked to complete a survey regarding their experiences with MT services. RESULTS: One hundred mothers enrolled. In total, 44.3% completed the MIBS follow-up. Covarying out baseline MIBS, one-way analysis of covariance found no statistical difference between groups for MIBS 1-week follow-up (MT: mean = 0.64, SD = 1.6; standard care: mean = 0.57, SD = 1.5; P = .60) but underpowered in post hoc. Comforting, family cohesion, and personal growth and development themes emerged in qualitative analysis of survey responses. IMPLICATIONS FOR PRACTICE: MT remains a viable service for purposefully including parents in the care of their NICU infants. Nurses and music therapists must work closely to successfully implement meaningful interventions such as heartbeat-music. IMPLICATIONS FOR RESEARCH: Heartbeat-music interventions should be further studied for diverse applications, including family integration, family coping, and bereavement.

Assessment of Mesenteric Tissue Saturation, Oxygen Saturation, and Heart Rate Pre- and Post-Blood Transfusion in Very Low-Birth-Weight Infants Using Abdominal Site Near-Infrared Spectroscopy.

BACKGROUND: Preterm infants often receive blood transfusions during hospitalization. Although transfusions are intended to enhance oxygen delivery, previous studies found decreases in tissue and mesenteric oxygen saturation during and after blood transfusions without changes in vital signs and hemoglobin oxygen saturation. PURPOSE: To study the effect of blood transfusions on regional mesenteric tissue oxygen saturation (rSO2), hemoglobin saturation of oxygen (SpO2), and heart rate (HR) in premature infants. METHOD: A prospective, observational, nonrandomized study using a repeated-measures design was done to evaluate changes in physiologic variables (HR, SpO2, rSO2) before, during, and after a blood transfusion in premature infants. RESULTS: A convenience sample of 30 infants with a mean gestational age of 25.5 (2.1) weeks was recruited. Repeated-measures analysis of variance found no significant differences in HR (P = .06) and SpO2 (P = .55) over time. However, significant differences occurred in rSO2 over the 3 time periods (P < .001). The rSO2 increased during the transfusion from 40.3% to 41.5%, but decreased to 34.9% in the posttransfusion period. Pairwise comparisons revealed statistically significant mean rSO2 differences between pretransfusion and posttransfusion (P < .001), and during transfusion to posttransfusion (P < .001) periods. IMPLICATIONS FOR RESEARCH: This study supports previous findings of perfusion changes during blood transfusions in preterm infants. IMPLICATIONS FOR PRACTICE: Measuring mesenteric tissue oxygenation during blood transfusion in very low-birth-weight infants can potentially add another physiologic parameter to guide further clinical assessment and interventions during transfusions.

The effects of an aerobic exercise program on posttraumatic stress disorder symptom severity in adolescents.

The purpose of the study was to investigate the impact of aerobic exercise on the severity of symptoms of Posttraumatic Stress Disorder (PTSD), depression, and anxiety. Twelve institutionalized female adolescents completed a 15-session aerobic exercise program consisting of moderate-intensity walking. All participants completed the Child PTSD Symptom Scale (CPSS), Trauma Symptom Checklist for Children (TSCC), Multidimensional Anxiety Scale for Children (MASC), and Children's Depression Inventory (CDI) twice at pretest. Data were collected twice during an extended baseline period, at postintervention, and again at a 1-month follow-up assessment. Yarnolds (1988) ipsative z-score comparison method for single-case repeated measures design was utilized in data analysis for participants with stable levels of symptomatology during baseline. Strong effects of aerobic exercise were found for PTSD and trauma symptom severity but not for anxiety and depressive symptom severity. Follow-up results were mixed. The results of this study were fairly consistent with previous research findings. Strong effects of aerobic exercise on depression and anxiety were not found; however, relatively low levels of such symptomatology had been noted for many participants during the baseline phase of the study.

A quasi-experimental trial on individualized, developmentally supportive family-centered care.

OBJECTIVE: To evaluate the impact of individualized, developmentally supportive family-centered care on infant physiological variables, growth, behavioral stress cues, return to sleep state, medical and developmental progress, complications, resource utilization, parental perception of the neonatal intensive-care unit experience, and overall parental satisfaction. DESIGN: Quasi-experimental, repeated measures design. SETTING: Developmental and a control nursery in a 78-bed, level II/III neonatal intensive-care unit. PARTICIPANTS: A convenience sample of 114 premature infants and their parents. INTERVENTIONS: Control group infants received the routine neonatal intensive-care unit standard of care. Experimental infants received routine care plus the addition of individualized, developmentally supportive family-centered interventions. MAIN OUTCOME MEASURES: Between groups, there were no statistically significant differences in demographic factors, days to medical or developmental milestones, length of stay, or direct cost/case. Repeated measures analysis of variance determined that at every point of data collection, the average number of baseline, activity, and postactivity stress cues were lower in the developmentally supportive group. Infants in the developmental group had 8% less sedatives/narcotics and 15% less vasopressors costs than the control group. There were no differences in complication rates, parental perceptions of the neonatal intensive-care unit experience, or parental satisfaction between groups. CONCLUSIONS: Preterm infants who received developmentally supportive family-centered care demonstrated fewer behavioral stress cues and comparable short-term outcomes and resource utilization than infants who received routine care.