Parent-led, infant-directed singing not linked to mother infant bonding

A new trial found that though parent-led, infant-directed singing was safe and well-accepted, it has not shown any clinical significance on mother-infant bonding, maternal anxiety levels, maternal depression, or infant development. The trial results were published in the journal JAMA Network Open. 

Preterm delivery can disrupt or delay parent-infant bonding, which is an essential contributor to the quality of the early parent-infant connection and long-term baby health. Preterm infants in neonatal intensive care may have compromised parental bonding as it is influenced by parent-infant physical proximity, maternal emotional state, and infant communicative capacity. A music therapist collaborates with parents to intentionally employ music processes to enhance the stability and development of their newborn, while also promoting parental health and the creation of parent-infant relationships as literature has shown short-term improvements in infant physiological parameters and maternal anxiety. As the long-term results are lacking, researchers conducted a trial to determine if parent-led, infant-directed singing, supported by a music therapist and initiated in the neonatal intensive care unit (NICU), improves parent-infant bonding at 6 and 12 months. 

Between 2018 and 2022, a randomized clinical trial was carried out in level III and IV NICUs in five countries. Premature babies born before 35 weeks of gestation and their parents were eligible for the trial. Follow-up was done at home or in clinics for 12 months as part of the LongSTEP trial. The last follow-up was done at the infant-corrected age of 12 months. The data was analyzed from August 2022 to November 2022. Participants were randomly assigned to either music therapy (MT) plus standard care or standard care alone during NICU admission or MT plus standard care or standard care alone after discharge, using computer-generated randomization (ratio 1:1, block sizes of 2 or 4 varying randomly), stratified by site (51 to MT NICU, 53 to MT post-discharge, 52 to both, and 50 to neither). MT included parent-led, infant-directed singing customized to infant responses and assisted by a music therapist three times per week during hospitalization or seven sessions spread over six months after discharge. 

The primary outcome was mother-infant bonding at 6 months corrected age, as evaluated by the Postpartum Bonding Questionnaire (PBQ), with a follow-up at 12 months corrected age, and group differences were examined on an intention-to-treat basis.

Key findings: 

• Of 206 enrolled infants, there were 206 mothers with mean [SD] age, of 33 [6] years, and 194 fathers with a mean [SD] age of 36 [6] years randomized at discharge.
• About 196 (95.1%) participants completed assessments at 6 months and were analyzed.
• Estimated group effects for PBQ at 6 months corrected age were 0.55 for MT in the NICU, 1.02 for MT post-discharge, and −0.20 for the interaction (12 months: MT in NICU, 0.17; MT post-discharge, 1.78; interaction, −1.68).
• No clinically significant in-group differences were found for secondary variables. 

Thus, parent-led, infant-directed singing facilitated by a music therapist did not have clinically important effects on parental mental health or infant development. 

Further reading: Ghetti CM, Gaden TS, Bieleninik Ł, et al. Effect of Music Therapy on Parent-Infant Bonding Among Infants Born Preterm: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2315750. doi: 10.1001/jamanetworkopen.2023.15750