The effects of music therapy on preterm infants: when the human aspect supports medicine
Quentin, Hugo, Mia and Térésa are the premature babies of the Department of Neonatology at Laennec hospital in Creil, the first one to integrate music therapy into pediatric care. Let's have a chat with Stéphanie Lefebvre, one of the few music therapists in France specialised in neonatology.
It's 2:30 pm. Stéphanie Lefebvre is getting ready for another working day. She puts on her clogs, takes off her jewellery and gathers her hair into a ponytail. She washes her hands for several minutes before wearing her white coat. Then, she grabs some instruments: an ocean drum and a thumb piano; she carefully disinfects them before leaving the locker room and heading to the Neonatal Intensive Care Unit.
We are at Laennec hospital in Creil, the only hospital in France that integrated music therapy into pediatric care in 2007. Stéphanie Lefebvre is a music therapist and has been supporting the initiative since its beginnings. She devotes herself to this service twice a week, for three hours.
First in the NICU, which takes care of very premature infants. There, some of the babies were born at only 28 weeks of gestation and they only weigh 800 grammes. They are treated with a strong medical approach: these babies entered the world too soon, therefore are closely monitored. Due to the often unpleasant treatments - blood tests, catheter placement - and a sound environment that can be too aggressive, preterm infants are under a lot of stress. Ten days in NICU can expose a baby to 300 uncomfortable noises, specifies Stéphanie.
Stéphanie assesses the state of her first little patient: a premature baby at 33 weeks who usually cries during treatments. His heart rate is elevated, he is very agitated. Stéphanie's role will be to keep him calm so he can go back to sleep. She approaches the incubator and opens the door very gently; she puts her hand on the baby's head and starts vocalizing softly, while monitoring his vital signs.
“The point of music therapy in this particular case is to allow the infant to manage the sleep-wake transition and to better tolerate the treatments, which can be quite unpleasant. Very premature infants have a hypersensitive hearing and touch, thus adaptation to the environment can be very difficult”.
Stéphanie adapts to the situation of each infant: before choosing the type of intervention, she includes an observation step depending on the baby's state, their needs and their conditions. When she’s in the NICU, she does not speak or sing that much, but rather focuses on humming, using vowels rhythmically to create an embracing universe which reminds them of the sound environment in the womb. Supported by the sound of the ocean drum, this soothing sound simulates the sound vibrations that the baby feels through the uterine wall, as well as their mother's heartbeat, the sound of blood flowing, bowel sounds. Soothing a baby means first of all acting at the physiological level: controlling the breathing and their heartbeat, limiting calorie expenditure in order to optimise the benefits of the baby's food intake for their growth and development.
“It is an active approach: what I do is based on the indications or contraindications that I find, it is different for each baby. With preemies, there are two obstacles that must be taken into account: overstimulation and complete silence; both of them are harmful to the baby. In the natural environment, the sounds around the baby also contribute to their development. If they are not suitable or they are absent, this development will not be accomplished. All the parameters are strictly defined: it is vital to ensure that the intensity and frequency of your voice are neither too high nor too low. Shrill and sharp sounds are banned; in fact, in the department, we take care of the sound environment - we even limit alarm noises or aggressive sounds caused by the handling of the equipment”.
Music allows to promote positive parenthood
Peggy Lejoncourt is a neonatal psychologist and works in particular on the parent-child bond which is often compromised and fragile in the case of very premature infants: since the baby isn't stable yet, he or she cannot be carried, lulled or fed by his or her mother.
In the department, particular attention is given to the involvement of parents during treatments to facilitate early contact with the infant, so to promote positive parenthood and start forging a bond. “Premature birth is a big shock for parents. Sometimes they are disappointed, because a premature infant is not the baby they had imagined. The fact of seeing the baby open their eyes reacting to the sounds created by Stéphanie reassures them, because they realise that their baby communicates with the environment”, explains Cécile Barelle, a pediatric nurse.
Stéphanie takes care of premature infants throughout their stay in the department of neonatology. Babies gradually build a relationship with the music therapist during the sessions, which contributes to their neurobehavioural and psycho-emotional development: “In terms of survival rates, we have made enormous progress. The main issue with the NICU and neonatology is to do the same in terms of child development. Music therapy plays an important role, just like psychomotricity nurses and physiotherapists, both in the short term and in the prevention of consequences that may arise in the future”.
Mia was admitted to the Neonatal Intensive Care Unit after only five-and-a-half months of gestation. Stéphanie has been monitoring her since the beginning. Today, Mia weighs 4.41 pounds (2 kg) and is about to join the kangaroo service, which takes care of those babies who achieved breathing autonomy and are stable in terms of weight, therefore enabling them to leave the incubator.
Clinging to her mother's breast, Mia is learning to suckle. When Stéphanie starts singing, she stops for a while, then starts again with more vigour. Stéphanie chose a sweet lullaby but with a certain rhythm, to encourage Mia to keep suckling.
“We noticed that music triggers the sucking reflex in infants, which is very important for those preemies who find it very difficult to drink their mother's milk”.
For Mia, Stéphanie proposes lullabies accompanied by a thumb piano. At some point, Mia’s mother starts singing too. For those babies who don't need the incubator anymore, Stéphanie is allowed to hold them, although if the parents are there she focuses on their involvement. Mia’s mother found it very reassuring to see how she reacted to the first sessions, because she was quite concerned about the lack of communication with her baby.
A pioneer discipline waiting for recognition
Stéphanie Lefebvre is one of the few music therapists specialised in neonatology and has received her training in Germany. In France, music therapy for premature infants is limited to occasional intervention, whereas, according to Stéphanie, the benefits can only be observed gradually and through time. But, in general, music therapy in France gets little recognition:
“This is the second year that the Faculty of Medicine in Montpellier gives training on music therapy for premature infants, which means that something is changing slowly. But we are at an early stage, and the difficulties related to the budget cuts context in public hospitals certainly do not help us. In German-speaking countries – Germany, Switzerland and Austria – music therapy for preemies has solid foundations, with considerable budget allotted to research and about thirty hospitals already applying it”.
Since she is not considered as part of the medical staff, Stéphanie cannot be hired by the Creil hospital, and is paid by the Pediatrics and Neonatology Association of the GHPSO, which every year is raising funds for what she does. She can only work two afternoons per week, whereas the need within the department of neonatology in Creil is much greater.
The NICU of the Creil hospital has made research on child development, which includes music therapy, a priority; it has also become the main service of the region in this field. An essential human contribution in order to address the needs of premature babies contributing to their development, as stated by Cécile Barelle:
“The progress of music therapy in recent years and increased research with scientific evidence through medical imaging are slowly making a difference. Now universities and practitioners should work together so that music therapy and, more generally, art therapy - which has proved to be successful in the field - be recognised, just like medical care”, concludes Stéphanie.