Developmental Delay (Disorder) Clinical Trial
Official title:
Creative Music Therapy for Premature Infants: Testing a Possible Influence on Brain Structure, Function and Neurobehavioral Outcome
This study investigates whether creative music therapy applied to premature infants will facilitate brain growth and development at term equivalent assessed by magnetic resonance imaging. Secondary objective are improvement of neurobehavioral outcomes of premature infants at 24 months, as well as at 5 years of age.
Premature infants are a highly prevalent and vulnerable group in paediatric care, and face
several short- and long-term challenges. Research on brain development in premature infants
demonstrates a high incidence of white and grey matter abnormalities and neurobehavioral
delay, as well as an increased risk of brain injury. There is growing awareness that
premature infants need individualized nurturing interactions with their caregivers while they
are in a neonatal intensive care unit (NICU) to support healthy development and prevent
future difficulties. One particular intervention that may have considerable potential in the
NICU is creative music therapy (CMT), an individualized, interactive, resource- and
needs-oriented music therapy approach. Results demonstrate that CMT can facilitate relaxation
and stabilization in premature infants; by experiencing inter-subjectivity through music, the
infants can be empowered to engage in meaningful and nurturing interactions (Haslbeck, 2013
a,b) .
Several researchers (Als, 2012; Trevarthen, 2008; Schore, 2003) have described how
interactive and multi-sensory experiences of the fetus particularly facilitate brain
development and learning about socio-emotional figures, respectively, in prematurely born
infants. It is assumed that positive auditory experiences can promote premature infants'
early brain maturation and contribute to their healthy neurodevelopment (Xu et al., 2009).
Studies in music and neuroscience have demonstrated that music promotes neurobiological
processes and modulates synaptic plasticity, neuronal learning and readjustment in the human
brain (Rickard et al., 2005). The individualized approach in active music therapy may
especially activate brain structures involved in emotional, sensorimotor and cognitive
processing (Koelsch, 2009; Fachner et al., 2012).
Since, on one hand, individualized interactive experiences and, on the other hand, music may
alter brain development in the fetus and very young infants, the question arises as to
whether CMT might actually promote a premature infant's brain development by facilitating
nurturing socio-emotional and auditory interactive experiences at the same time. Therefore a
randomized, controlled, clinical trial will be conducted. 30 premature infants receive CMT
during their hospitalization time and 30 premature infants without music therapy serves as
control group. The primary objective is to explore if the experience of CMT in premature
infants improves their brain growth and development at 38-42 weeks of corrected gestational
age. The main secondary objective is to explore if CMT improves the neurobehavioral outcomes
of premature infants at 9 and 24 months, as well as at 5 years of age. Magnetic resonance
imaging is used to evaluate the infants' cerebral cortical development and myelination.
Electroencephalography (EEG) is used to evaluate the infants' brain function and maturation.
Insights into possible long-term and sustainable outcomes will be gained via
neuro-developmental follow-up examinations. It is hypothesized that the experience of CMT in
neonatal care improves both short- and long-term neurological outcomes. We expect that the
experimental group will demonstrate superior brain growth and development at 38-42 weeks of
corrected gestational age as well as improved cognitive, behavioral and motor developmental
outcomes later on. This paper will introduce first insights and preliminary results of the
ongoing study. Strategies and challenges inherent in conducting a controlled clinical trial
within this vulnerable group will be discussed.
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