Special Issue "Sound in the Neonatal Intensive Care Unit (NICU)"

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (15 November 2021).

Special Issue Editors

Dr. Fabia Franco
E-Mail Website
Guest Editor
Department of Psychology, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK
Interests: developmental science (infancy); lifespan music psychology
Prof. Dr. Mirco Fasolo
E-Mail Website
Guest Editor
Department of Neuroscience Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
Interests: developmental science; vocal communication; typical and atypical development
Dr. Manuela Filippa
E-Mail Website
Guest Editor
NEAD, University of Geneva, Geneva, Switzerland
Interests: bio-behavioral mechanisms of early vocal interactions; musicality; prematurity
Prof. Dr. Pierre Kuhn
E-Mail Website
Guest Editor
Strasbourg University Hospital, Strasbourg, France
Interests: pediatrics; neonatal and perinatology; neuroscience; prematurity; clinical research

Special Issue Information

The particular soundscape of the Neonatal Intensive Care Unit (NICU) has been at the centre of both scrutiny, due to potential aversive effects on both infants and parents, and interest as a potential focus for early interventions ameliorating the challenges of pre-term birth. We aim to collect novel empirical evidence and state-of-the art papers from a multidisciplinary perspective (paediatric/neonatology, biomedical/neuroscience, developmental science, music psychology/music therapy, communication and affective sciences, bio-engineering and design), investigating the NICU soundscape and its impact on infants, parents, and staff. With a focus on sound, a hypothetical core structure would cover the following themes: (a) auditory development and adaptation in premature infants, (b) stress and trauma in parents at the NICU, (c) parent–infant interaction, communication and bonding at the NICU, (d) vocal and musical interaction, and music therapy in the NICU, and (e) bio-engineering and technological innovation to enhance the NICU soundscape. For each theme, we invite mostly empirical papers with original research and follow-up studies reporting the developmental outcomes of early intervention in sound-related aspects of the NICU experience. A limited number of systematic reviews, meta-analyses, case studies, and technological innovation papers relevant for the topic (no technical notes) will be welcomed. All papers will be peer-reviewed.

Dr. Fabia Franco
Prof. Dr. Mirco Fasolo
Dr. Manuela Filippa
Prof. Dr. Pierre Kuhn
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • NICU
  • Soundscape
  • Vocalisation
  • Infant-directed speech
  • Music and music therapy
  • Voice
  • Parent–infant interaction

Published Papers (9 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

Article
Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants
Children 2021, 8(12), 1081; https://doi.org/10.3390/children8121081 - 24 Nov 2021
Viewed by 326
Abstract
Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks [...] Read more.
Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks (SPs) and light levels variations (LLVs) in the NICU. We measured spontaneously occurring SPs and LLVs in the incubators of 26 VPIs over 10 h. Their behavioural responses were analysed through video recordings using the “Douleur Aigue du Nouveau-né” (DAN) scale. We compared the maximum DAN scores before and after environmental stimuli and the percentage of VPIs with a score ≥ 3 according to the type of stimuli. A total of 591 SPs and 278 LLVs were analysed. SPs of 5 to 15 dBA and LLVs significantly increased the maximum DAN scores compared to baseline. The occurrence of DAN scores ≥ 3 increased with both stressors, with a total of 16% of SPs and 8% of LLVs leading to quantifiable pain behaviour. Altogether, this study shows that VPIs are sensitive to SPs and LLVs, with a slighter higher sensitivity to SPs. The mechanisms leading to pain behaviours induced by noise and light changes should be evaluated further in the context of VPIs brain development. Our results provide further arguments to optimize the NICU sensory environment of neonatal units and to adapt it to the expectations and sensory abilities of VPIs. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Figure 1

Article
Effects of Live Music Therapy on Autonomic Stability in Preterm Infants: A Cluster-Randomized Controlled Trial
Children 2021, 8(11), 1077; https://doi.org/10.3390/children8111077 - 22 Nov 2021
Viewed by 589
Abstract
Unbuffered stress levels may negatively influence preterm-infants’ autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm [...] Read more.
Unbuffered stress levels may negatively influence preterm-infants’ autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm infants and their parents and enhance family-centered care. Accordingly, we aimed to compare the effects of combined MT and SSC and SSC alone on ANS stabilization in preterm infants. In a single-center, cluster-randomized trial design, ten two-month time-clusters were randomized to either combined MT and SSC or SSC alone. Families of preterm infants were offered two sessions of the allocated condition in the NICU, and a three-month follow up session at home. The primary outcome variable was stabilization of the ANS, defined by change in the high frequency (HF) power of heart rate variability (HRV) during the second session. Secondary outcomes included other HRV measures, parent–infant attachment, and parental anxiety at each session. Sixty-eight families were included. MT combined with SSC improved infants’ ANS stability, as indicated by a greater increase in HF power during MT compared to SSC alone (mean difference 5.19 m2/Hz, SE = 1.27, p < 0.001) (95% confidence interval 0.87 to 2.05). Most secondary outcomes were not significantly different between the study groups. MT contributes to preterm-infants’ autonomic stability, thus laying an important foundation for neuro-behavioral and psycho-emotional development. Studies evaluating longer-term effects of MT on preterm infants’ development are warranted. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Graphical abstract

Article
Multimodal Interaction between a Mother and Her Twin Preterm Infants (Male and Female) in Maternal Speech and Humming during Kangaroo Care: A Microanalytical Case Study
Children 2021, 8(9), 754; https://doi.org/10.3390/children8090754 - 30 Aug 2021
Viewed by 501
Abstract
The literature reports the benefits of multimodal interaction with the maternal voice for preterm dyads in kangaroo care. Little is known about multimodal interaction and vocal modulation between preterm mother–twin dyads. This study aims to deepen the knowledge about multimodal interaction (maternal touch, [...] Read more.
The literature reports the benefits of multimodal interaction with the maternal voice for preterm dyads in kangaroo care. Little is known about multimodal interaction and vocal modulation between preterm mother–twin dyads. This study aims to deepen the knowledge about multimodal interaction (maternal touch, mother’s and infants’ vocalizations and infants’ gaze) between a mother and her twin preterm infants (twin 1 [female] and twin 2 [male]) during speech and humming in kangaroo care. A microanalytical case study was carried out using ELAN, PRAAT, and MAXQDA software (Version R20.4.0). Descriptive and comparative analysis was performed using SPSS software (Version V27). We observed: (1) significantly longer humming phrases to twin 2 than to twin 1 (p = 0.002), (2) significantly longer instances of maternal touch in humming than in speech to twin 1 (p = 0.000), (3) a significant increase in the pitch of maternal speech after twin 2 gazed (p = 0.002), and (4) a significant increase of pitch in humming after twin 1 vocalized (p = 0.026). This exploratory study contributes to questioning the role of maternal touch during humming in kangaroo care, as well as the mediating role of the infant’s gender and visual and vocal behavior in the tonal change of humming or speech. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Graphical abstract

Article
Newborn Incubators Do Not Protect from High Noise Levels in the Neonatal Intensive Care Unit and Are Relevant Noise Sources by Themselves
Children 2021, 8(8), 704; https://doi.org/10.3390/children8080704 - 16 Aug 2021
Viewed by 1383
Abstract
Background: While meaningful sound exposure has been shown to be important for newborn development, an excess of noise can delay the proper development of the auditory cortex. Aim: The aim of this study was to assess the acoustic environment of a preterm baby [...] Read more.
Background: While meaningful sound exposure has been shown to be important for newborn development, an excess of noise can delay the proper development of the auditory cortex. Aim: The aim of this study was to assess the acoustic environment of a preterm baby in an incubator on a newborn intensive care unit (NICU). Methods: An empty but running incubator (Giraffe Omnibed, GE Healthcare) was used to evaluate the incubator frequency response with 60 measurements. In addition, a full day and night period outside and inside the incubator at the NICU of the University Hospital Zurich was acoustically analyzed. Results: The fan construction inside the incubator generates noise in the frequency range of 1.3–1.5 kHz with a weighted sound pressure level (SPL) of 40.5 dB(A). The construction of the incubator narrows the transmitted frequency spectrum of sound entering the incubator to lower frequencies, but it does not attenuate transient noises such as alarms or opening and closing of cabinet doors substantially. Alarms, as generated by the monitors, the incubator, and additional devices, still pass to the newborn. Conclusions: The incubator does protect only insufficiently from noise coming from the NICUThe transmitted frequency spectrum is changed, limiting the impact of NICU noise on the neonate, but also limiting the neonate’s perception of voices. The incubator, in particular its fan, as well as alarms from patient monitors are major sources of noise. Further optimizations with regard to the sound exposure in the NICU, as well as studies on the role of the incubator as a source and modulator, are needed to meet the preterm infants’ multi-sensory needs. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Figure 1

Article
The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents’ Experience
Children 2021, 8(8), 644; https://doi.org/10.3390/children8080644 - 27 Jul 2021
Viewed by 1119
Abstract
Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between [...] Read more.
Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Graphical abstract

Article
Parental Perception of Vocal Contact with Preterm Infants: Communicative Musicality in the Neonatal Intensive Care Unit
Children 2021, 8(6), 513; https://doi.org/10.3390/children8060513 - 17 Jun 2021
Viewed by 605
Abstract
In this study, we evaluate mothers’ subjective experience of speaking and singing to their infants while they are in their incubators. We also discuss the relevance of the theoretical framework of Communicative Musicality for identifying the underlying mechanisms that may help explain its [...] Read more.
In this study, we evaluate mothers’ subjective experience of speaking and singing to their infants while they are in their incubators. We also discuss the relevance of the theoretical framework of Communicative Musicality for identifying the underlying mechanisms that may help explain its beneficial effects, both for parents and infants. Nineteen mothers talked and sung to their stable preterm infants in the incubators, for 5 min each, in three sessions over a period of 6 days. After each session, mothers were asked to assess in a self-report questionnaire the ease and the effectiveness of addressing their infants by speaking and singing and their prior musical experience. Perceived ease and effectiveness in communication were found to increase progressively from one session to the next. Mothers rated the speech to be increasingly more effective. This intuitive mean of interaction between parents and infants could be encouraged and supported by the nurses and the medical staff. Furthermore, individual musical experience affects perceived ease of communicating vocally with infants after a premature birth and should thus be encouraged during pregnancy. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Figure 1

Article
The Effect of Music on aEEG Cyclicity in Preterm Neonates
Children 2021, 8(3), 208; https://doi.org/10.3390/children8030208 - 09 Mar 2021
Viewed by 791
Abstract
Several methods can be used in the neonatal intensive care unit (NICU) to reduce stress and optimize the quality of life during this period of hospitalization. Among these, music could play an important role. We investigated the effect of different kinds of music [...] Read more.
Several methods can be used in the neonatal intensive care unit (NICU) to reduce stress and optimize the quality of life during this period of hospitalization. Among these, music could play an important role. We investigated the effect of different kinds of music therapies on the brain activity of very preterm infants using amplitude-integrated EEG. Sixty-four patients were included and randomly assigned to three different groups: live music group, recorded music group, and control group. In both intervention groups, music was started after the appearance of the first quiet-sleep phase, with a subsequent duration of 20 min. Changes between the first and second quiet-sleep epochs were analyzed using the amplitude-integrated EEG. When looking at single parameters of the amplitude-integrated EEG trace, no differences could be found between the groups when comparing their first and second quiet-sleep phase regarding the parameters of change from baseline, quality of the quiet-sleep epoch, and duration. However, when looking at the total cyclicity score of the second quiet-sleep phase, a difference between both intervention groups and the control group could be found (live music therapy vs. control, p = 0.003; recorded music therapy vs. control, p = 0.006). Improvement within the first and second quiet-sleep epochs were detected in both music groups, but not in the control group. We concluded that our study added evidence of the beneficial effect of music on the amplitude-integrated EEG activity in preterm infants. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Figure 1

Review

Jump to: Research

Review
The Importance of Rhythmic Stimulation for Preterm Infants in the NICU
Children 2021, 8(8), 660; https://doi.org/10.3390/children8080660 - 29 Jul 2021
Viewed by 677
Abstract
The fetal environment provides the fetus with multiple potential sources of rhythmic stimulation that are not present in the NICU. Maternal breathing, heartbeats, walking, dancing, running, speaking, singing, etc., all bathe the fetus in an environment of varied rhythmic stimuli: vestibular, somatosensory, tactile, [...] Read more.
The fetal environment provides the fetus with multiple potential sources of rhythmic stimulation that are not present in the NICU. Maternal breathing, heartbeats, walking, dancing, running, speaking, singing, etc., all bathe the fetus in an environment of varied rhythmic stimuli: vestibular, somatosensory, tactile, and auditory. In contrast, the NICU environment does not offer the same proportion of rhythmic stimulation. After analyzing the lack of rhythmic stimulation in the NICU, this review highlights the different proposals for vestibular and/or auditory rhythmic stimulation offered to preterm infants alone and with their parents. The focus is on the beneficial effects of auditory and vestibular stimulation involving both partners of the mother–infant dyad. A preliminary study on the influence of a skin-to-skin lullaby on the stability of maternal behavior and on the tonic emotional manifestations of the preterm infant is presented as an example. The review concludes with the importance of introducing rhythmic stimulations in the NICU. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Figure 1

Review
Sensory Stimulation in the NICU Environment: Devices, Systems, and Procedures to Protect and Stimulate Premature Babies
Children 2021, 8(5), 334; https://doi.org/10.3390/children8050334 - 25 Apr 2021
Viewed by 1505
Abstract
Prematurity deprives infants of the prenatal sensory stimulation essential to their correct development; in addition, the stressful environment of the NICU impacts negatively on their growth. The purpose of this review was to investigate the effects of NICU noise pollution on preterm infants [...] Read more.
Prematurity deprives infants of the prenatal sensory stimulation essential to their correct development; in addition, the stressful environment of the NICU impacts negatively on their growth. The purpose of this review was to investigate the effects of NICU noise pollution on preterm infants and parents. We focused on the systems and projects used to control and modulate sounds, as well as on those special devices and innovative systems used to deliver maternal sounds and vibrations to this population. The results showed beneficial effects on the preterm infants in different areas such as physiological, autonomic, and neurobehavioral development. Although most of these studies highlight positive reactions, there is also a general acknowledgement of the current limits: small and heterogeneous groups, lack of structured variable measurements, systematic control groups, longitudinal studies, and normative values. The mother’s presence is always preferred, but the use of music therapy and the devices analyzed, although not able to replace her presence, aim to soften her absence through familiar and protective stimuli, which is a very powerful aid during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Sound in the Neonatal Intensive Care Unit (NICU))
Show Figures

Graphical abstract

Back to TopTop