Ormston Kirsty, Howard Rachel, Gallagher Katie, Mitra Subhabrata, Jaschke Arthur
Noah's Ark Children's Hospice, University College Hospital London, London EN5 4NP, UK.
Institute for Women's Health, University College, London WC1E 6HU, UK.
Brain Sci. 2022 Apr 29;12(5):578. doi: 10.3390/brainsci12050578.
Perinatal brain injury occurs in 5.14/1000 live births in England. A significant proportion of these injuries result from hypoxic ischaemic encephalopathy (HIE) in term infants and intracranial haemorrhage (IVH) or periventricular leukomalacia (PVL) in preterm infants. Standardised care necessitates minimal handling from parents and professionals to reduce the progression of injury. This can potentially increase parental stress through the physical inability to bond with their baby. Recent research highlights the ability of music therapy (MT) to empower parental bonding without handling, through sharing culturally informed personal music with their infant. This review therefore aimed to systematically evaluate the use of MT with infants diagnosed with perinatal brain injury in a neonatal intensive care unit (NICU). Search terms were combined into three categories (audio stimulation (MT), population (neonates) and condition (brain injury), and eight electronic databases were used to identify relevant studies following PRISMA guidelines. Eleven studies using music or vocal stimulation with infants diagnosed with perinatal brain injury were identified and quality assessed using Cochrane ROB2, the ROBINSI Tool and the Newcastle Ottawa Scale. Studies used either voice as live (n = 6) or pre-recorded (n = 3) interventions or pre-recorded instrumental music (n = 2). Studies had two primary areas of focus: developmental outcomes and physiological effects. Results suggested the use of music interventions led to a reduction of infants' pain scores during procedures and cardiorespiratory events, improved feeding ability (increase oral feeding rate, volume intake and feeds per day) and resulted in larger amygdala volumes than control groups. Additionally, MT intervention on the unit supported long-term hospitalised infants in the acquisition of developmental milestones. Vocal soothing was perceived to be an accessible intervention for parents. However, infants with PVL showed signs of stress in complex interventions, which also potentially resulted in an increase in maternal anxiety in one study. MT with infants diagnosed with perinatal brain injury can have positive effects on infants' behavioural and neurological parameters and support parental involvement in their infants' developmental care. Further feasibility studies are required using MT to determine appropriate outcome measures for infants and the support required for parents to allow future comparison in large-scale randomised control trials.
在英格兰，围产期脑损伤的发生率为每1000例活产中有5.14例。这些损伤中有很大一部分是由足月儿的缺氧缺血性脑病（HIE）以及早产儿的颅内出血（IVH）或脑室周围白质软化（PVL）所致。标准化护理要求家长和专业人员尽量减少对婴儿的触摸，以减少损伤的进展。这可能会因家长无法与婴儿进行身体接触而增加他们的压力。最近的研究强调了音乐疗法（MT）通过与婴儿分享具有文化特色的个人音乐，在不进行触摸的情况下增强亲子关系的能力。因此，本综述旨在系统评估在新生儿重症监护病房（NICU）中对诊断为围产期脑损伤的婴儿使用音乐疗法的情况。搜索词被分为三类（音频刺激（音乐疗法）、人群（新生儿）和疾病（脑损伤）），并按照PRISMA指南使用八个电子数据库来识别相关研究。共识别出11项对诊断为围产期脑损伤的婴儿使用音乐或声音刺激的研究，并使用Cochrane ROB2、ROBINSI工具和纽卡斯尔渥太华量表对质量进行了评估。研究使用的干预措施包括现场声音（n = 6）或预先录制的声音（n = 3），或预先录制的器乐（n = 2）。研究主要集中在两个领域：发育结果和生理影响。结果表明，使用音乐干预可降低婴儿在操作过程中的疼痛评分以及心肺事件的发生率，提高喂养能力（提高经口喂养率、摄入量和每日喂养次数），并且与对照组相比，杏仁核体积更大。此外，该病房的音乐疗法干预有助于长期住院的婴儿实现发育里程碑。声音安抚被认为是家长可以采用的一种干预方式。然而，患有PVL的婴儿在复杂干预中表现出压力迹象，在一项研究中这也可能导致母亲焦虑情绪增加。对诊断为围产期脑损伤的婴儿使用音乐疗法可对婴儿的行为和神经学参数产生积极影响，并支持家长参与婴儿的发育护理。需要进一步开展音乐疗法的可行性研究，以确定适合婴儿的结果指标以及家长所需的支持，以便未来能够在大规模随机对照试验中进行比较。
