By BETSY TAYLOR
Melanie Fain, nurse manager for PeaceHealth Southwest Medical Center's neonatal intensive care unit, estimates it was about a decade ago when many of the nation's neonatal intensive care units, including PeaceHealth Southwest, converted from open wards to private patient rooms in part to "create a haven from noxious noises," the beeps and clatter that go along with providing high-tech care to the sickest babies. Noise can overstimulate and stress a newborn.
Music therapist Susan Palmieri sings a "song of kin" to Paul Marshack in the neonatal intensive care unit at PeaceHealth Southwest Medical Center in Vancouver, Wash. The "song of kin" is selected by parents, who will use it repeatedly to soothe their baby.
The quiet of a private room can reduce a baby's stress, and the privacy is usually appreciated by their families. Staff at the medical center also know, however, that certain sounds help with a child's language and brain development.
And some sounds, such as a mother's voice or a strummed lullaby, are also soothing, and can be therapeutic to a baby in discomfort. To make the most of this salutary effect, PeaceHealth Southwest started a music therapy program in December for its NICU babies. The medical center hired music therapist Susan Palmieri, who is certified in NICU music therapy training, for the program.
She uses specific instruments and techniques to assist babies and their care providers to facilitate a baby's feeding or promote attachment and bonding, and neurological and language development. She'll play a rhythm instrument to calm a baby before an invasive procedure, which can help with pain management. And she uses a percussion instrument called a gato box, to prompt a baby having difficulty eating to suck to the rhythm she's tapping out. She can slow down or speed up the timing to help set the baby's eating pace.
The Vancouver, Wash., NICU has a multidisciplinary team that conducts rounds daily. A team member, or the baby's physician or primary nurse, often ask Palmieri to stop by a baby's room when that clinician thinks a neonate and the baby's parents would benefit from music therapy, Fain said. Palmieri explains how music therapy works to the baby's parents; and, with their permission, she conducts an assessment to determine what type of music therapy may be beneficial for the baby.
The medical center has a 26-bed NICU, with an average daily census of about a dozen patients, Fain said. She said she believes every family approached in the NICU has agreed to music therapy. Sessions can last just a few minutes to a half hour.
An area high school fundraiser, which made about $140,000, is funding the first year of the music therapy program; in addition to program costs, those funds helped to train several staff members about music therapy. PeaceHealth Southwest is exploring ways to fund the program in future years. The music therapy is provided free to the families.
'A song of kin'
Palmieri asks families to identify a "song of kin," either a favorite lullaby, a song with special meaning to the family, or even a new song that she can help them compose. Palmieri is able to modify popular songs to a lullaby cadence; the song will be used to soothe the baby. Often while a parent cradles the baby, Palmieri strums a guitar and sings the song, encouraging mom or dad to relax and sing along. The serenade should signal to the baby that all is well, and the infant can come to associate the song with a loving care environment. As a plus, "Singing has been shown to be extra beneficial with language development," Palmieri said, because it stimulates and promotes several brain processes.
A study in the May 2013 issue of Pediatrics, "The Effects of Music Therapy on Vital Signs, Feeding and Sleep in Premature Infants," found certified music therapists using specific sound, music and rhythm interventions were able to enhance babies' feeding behaviors such as their sucking patterns and prolonged the length of babies' quiet-alert states. It also found the lullabies preferred by parents and sung live in the NICU enhanced bonding between parent and child and decreased the stress parents associate with caring for premature infants.
The study said previous research in NICUs supports the use of music in critical areas such as weight gain, sleep and recovery from painful procedures.
Music as therapy
Dr. John Evered, a neonatologist and the NICU's medical director, explained how music therapy is used to reduce stress and discomfort during an eye exam for retinopathy, a disorder that can lead to vision impairment or blindness in premature babies. To conduct a retinopathy exam, a nurse dilates an infant's eyes, which are already extremely light sensitive. Evered uses a retractor to keep each of the baby's eyelids open, and he uses a camera with a bright light shined into the baby's eyes to conduct the exam. It is not uncommon for babies to fuss and squall.
Now, about 15 minutes prior to a retinopathy exam, Palmieri plays the baby a rhythm on an ocean disk, an instrument with small beads inside of it that sounds like waves on a beach when she shifts it from side to side, or she may quietly hum to a baby during the exam. Evered and Palmieri said without the music therapy sometimes a baby's heart rate can spike or drop during the exam, necessitating a pause or stop in the exam. With the music therapy, infants have been able to remain calmer and maintain a steadier heart rate during the exam, they said.
Palmieri said she'll also use music therapy to calm a baby before a clinician starts a needlestick or an intravenous therapy. "We've started calling it my 'magic trick,'" she said.
Sometimes new parents experience trauma when a baby is born prematurely and admitted to a NICU, Fain said. Having teams of clinicians around can make parents "feel disempowered, or that they're not taking care of the baby the way they want to." She said the music therapy teaches parents ways to comfort their babies. Methods can include a parent humming just a few notes to a baby, while perhaps offering a finger for the baby to grasp. The music therapy sessions help to connect the parents to the baby's clinical care providers. It reinforces for parents that "they're part of the team in the hospital, and then they are the care team when they go home."
Joan Sablan and Nicholas Marshack's son, Paul Marshack, was born at 24 weeks gestation, weighing 1 pound, 5 ounces. While Paul was in the hospital Sablan said he was doing well, but she felt caught up in what the nurses call the "NICU two-step," where for every sign of progress Paul showed, it felt like his health took a step back, before progressing again. Sablan picked "Kiss the Girl" from The Little Mermaid as the family's song of kin.
Paul was discharged from the hospital on April 16, and in late April he weighed 8 pounds, 9 ounces. Sablan said she continued singing the song of kin and others to Paul at home. "We miss Susan," she said. But the lullabies from the hospital work like a charm at home. "Anytime we sing when he fusses, he calms down," she said.
A PeaceHealth Southwest video showing the music therapy program in action is at: http://bit.ly/1r2j0iM.
Copyright © 2016 by the Catholic Health Association of the United States
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