Effects of Music Therapy on the Occupational Performance of Premature Infants in the Neonatal Intensive Care Unit

Abstract

Background: Premature infants in neonatal intensive care units (NICUs) face significant challenges in sensory development and growth. Music, an integral component of occupational therapy (OT), has been shown to alleviate stress, promote sleep, and reduce hospitalization duration, underscoring its importance in neonatal care. Despite increasing global evidence, the systematic application of music therapy within Iranian NICUs remains largely uninvestigated. Cultural and environmental differences between Western and Iranian neonatal care settings necessitate exploration of the effectiveness of music-based interventions in this specific context. Objectives: This study aimed to examine the effects of music therapy on the occupational performance of premature infants in an Iranian NICU, focusing on both behavioral regulation and motor development. Methods: This clinical trial, registered with the Iranian Registry of Clinical Trials, included 40 premature infants admitted to the NICU at Akbar Abadi Hospital. Participants were randomly assigned to intervention and control groups using convenience sampling stratified by birth weight. The intervention consisted of 10 music therapy sessions over 6 days, each lasting 10 minutes, featuring two custom-composed pieces and two adapted selections delivered via headphones at approximately 55 - 60 dB SPL. The control group received standard neonatal care without music therapy. Outcome measures included the test of infant motor performance (TIMP) and the Neonatal Behavioral Assessment Scale (NBAS), assessed by a blinded occupational therapist before and after the intervention. Data analysis utilized the Wilcoxon Signed Rank test and Mann-Whitney test to evaluate within- and between-group changes. Results: Significant between-group differences were observed in several NBAS domains, including state regulation (Z = -3.47, P = 0.001), supplementary items (Z = -3.20, P = 0.001), social interactions (Z = -3.32, P = 0.001), habituation (Z = -2.30, P = 0.021), and autonomic functioning (Z = -2.79, P = 0.005). No significant differences were found in motor performance (Z = -0.79, P = 0.429), state organization (P = 0.945), or smile (P = 0.382). Test of infant motor performance scores showed no significant between-group differences (intervention pre/post: 8.3/8.3; control pre/post: 7.9/8.1; P = 0.52) and no significant within-group changes. These results indicate selective behavioral benefits without measurable short-term motor improvement. Conclusions: The study concluded that music, as a cost-effective tool in neonatal care, significantly enhanced various aspects of premature infants' development, including state regulation and social interactions. These findings underscore music's potential as a comprehensive intervention for diverse aspects of infant development.