Unit Practice Committee Evidence Based Review of Music Therapy

background: Our NICU has several developmental care protocols concerning limiting loud noises.in the NICU in compliance with the AAP guidelines.

The American Academy of Pediatrics recommends that noise levels not exceed 40-45 dB in NICU. (Background: you are not supposed to do anything that violates AAP recommendations)

Your unit design included Single-Family Rooms, sound-absorbing-hospital-grade material, HVAC design to reduce background sounds, thick glass windows, silent alarms, quiet close cabinets, quiet sinks, and more

Your protocols emphasize reducing noise which includes staff training on the importance of quiet background so that parental voice is predominant when parents are with their infant. Examples of protocols and training include a ban on recorded music, staff training on voice levels, learning to read infant cues so that you can read infant stress concerning sounds.

Parents are taught infant cues so that they can respond to any stress during interactions. Parents are encouraged to talk to their baby and you have observed parent turn-taking with the preterm infant making sounds, then a parent talking back during skin-to-skin care. Volunteers come in and read softly to infants whose parents need to be away. Infants of different gestational ages and illness states tolerate and enjoy different levels of auditory stimulation. Very sick full-term infants, say those with a CHD pre or post-surgery, might also need quiet to remain stable.

Between these strategies, measures show that you have reduced background noise from 85db in the old open bay unit to 45 db with occasional spikes in the new unit.

Two members of your unit attended a conference on NICU care and have brought articles on music therapy that promote adding music therapy, including recorded music – which would require a change in unit practice.

I am attaching the meta-analysis by Standley that was referenced on the slides. I also included a 2016 analysis of music in the NICU.

I am also attaching some articles about sound and noise that were used when creating unit policy.

As a group, divide the work of examining the evidence in the Standley article. You may also look at new articles about music therapy in the NICU

If you decide to use music therapy, you will need to define how it meets the AAP recommendations on noise and NIDCAP standards for reading stress in the infant to modulate interactions – or make an argument to make an exception…

As a group come to a consensus and turn in an individually written summary of any changes to the current policies and why or why you did not approve a change to policies.

Look for the applicability of reference in supporting documents (is it adult literature applied to preemies – is that justified? is there any bias? how good is the evidence?)

Essay Prompt: Your unit policies state that no recorded music is allowed. Looking at the evidence what is your assessment of the evidence for music therapy? Would you add it? Would you provide limits? Would you keep the current policy? Provide evidence to back up the decision

What my group decided: music therapy can be helpful especially live music. So we want to use live music by putting a decibel rater in the NICU, using single family room for treatment. Regular Therapy with soft noice, and preventing background noise