The Effect of Music Therapy on Weight Gain among Preterm Infants in the Neonatal Intensive Care Unit - Possible Mechanisms


  • Dana Yakobson Department of Neonatology, Meir Medical Center, Kfar Saba, Israel. Doctoral program in Music Therapy, Aalborg University, Aalborg, Denmark
  • Sachar Shalit
  • Shmuel Arnon Meir Medical Center affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel



Preterm infants, especially those born before 32 weeks of gestation, experience extrauterine growth restriction (EUGR). Poor weight gain is associated with adverse neurocognitive outcomes. Many factors influence EUGR, including clinical, behavioral and developmental care modalities. This review describes the clinical and developmental factors that affect weight gain among preterm infants during their stay in the NICU, and evaluates the reported contributions of studies that used music therapy interventions to augment weight gain. We recommend that trials addressing weight gain during MT interventions should be long-term during NICU hospitalization, powered to detect even sub-optimal weight gain, include factors that directly influence weight gain and clinically-relevant morbidities of preterm infants, and incorporate developmental care and family centered care modalities, as much as possible. The use of proper methods to measure weight gain, such as individual Z-scores is recommended. We also recommend that the elements of the music therapy interventions that influence weight gain should be described systematically.  

Author Biographies

Dana Yakobson, Department of Neonatology, Meir Medical Center, Kfar Saba, Israel. Doctoral program in Music Therapy, Aalborg University, Aalborg, Denmark

Music therapist, NICU, Kfar-Saba, Israel

Shmuel Arnon, Meir Medical Center affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Head of the well baby unit, Meir Medical Center, Kfar-Saba, Israel


Ehrenkranz RA, Younes N, Lemons JA, et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics. 1999; 104(2 Pt 1): 280-289.

doi: 10.1542/peds.104.2.280.

Horbar JD, Ehrenkranz RA, Badger GJ, et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000-2013. Pediatrics. 2015; 136(1): e84-e92. doi: 10.1542/peds.2015-0129.

Ofek Shlomai N, Reichman B, Lerner‐Geva L, Boyko V, Bar‐Oz B. Population‐based study shows improved postnatal growth in preterm very‐low‐birthweight infants between 1995 and 2010. Acta Paediatr. 2014; 103: 498-503.

doi: 10.1111/apa.12569.

Guellec I, Lapillonne A, Marret S. et al. Effect of intra- and extrauterine growth on long-term neurologic outcomes of very preterm infants. J Pediatr. 2016; 175: 93-99.e1. doi: 10.1016/j.jpeds.2016.05.027.

Ruys CA, Hollanders JJ, Bröring T, et al. Early-life growth of preterm infants and its impact on neurodevelopment. Pediatr Res. 2019; 85(3): 283-292.

doi: 10.1038/s41390-018-0139-0.

Ong KK, Kennedy K, Castañeda-Gutiérrez E, et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr. 2015; 104(10): 974-986. doi: 10.1111/apa.13128.

Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006; 117(4): 1253-1261. doi: 10.1542/peds.2005-1368.

Johnson MJ, Wootton SA, Leaf AA, Jackson AA. Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis. Pediatrics. 2012; 130(3): e640-649. doi: 10.1542/peds.2011-3379.

Ni Y, Beckmann J, Hurst JR, Morris JK, Marlow N. Size at birth, growth trajectory in early life, and cardiovascular and metabolic risks in early adulthood: EPICure study. Arch Dis Child Fetal Neonatal Ed. 2020; 12: doi: 10.1136/archdischild-2020-319328. Epub ahead of print.

Hickey L, Burnett A, Spittle A, et al. Extreme prematurity, growth and neurodevelopment at 8 years: a cohort study. Arch Dis Child. 2020. doi.10.1136/archdischild-2019-318139. Epub ahead of print. PMID: 32747376.

Goldberg DL, Becker PJ, Brigham K, et al. Identifying malnutrition in preterm and neonatal populations: recommended indicators. J Acad Nutr Diet. 2018; 118(9):1571-1582. doi: 10.1016/j.jand.2017.10.006.

Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr. 2013; 13:92. doi:10.1186/1471-2431-13-92.

Tuzun F, Yucesoy E, Baysal B, Kumral A, Duman N, Ozkan H. Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants, The Journal of Maternal-Fetal & Neonatal Medicine. 2018; 31:17: 2252-2257. DOI: 10.1080/14767058.2017.1339270.

Underwood MA, Wedgwood S, Lakshminrusimha S, Steinhorn RH. Somatic growth and the risks of bronchopulmonary dysplasia and pulmonary hypertension: connecting epidemiology and physiology. Canadian Journal of Physiology and Pharmacology. 2018; 97(3): 197-205.

Kidokoro H, Anderson PJ, Doyle LW, Woodward LJ, Neil JJ, Inder TE. Brain injury and altered brain growth in preterm infants: predictors and prognosis. Pediatrics. 2014; 134(2): e444-e453. doi: 10.1542/peds.2013-2336.

Sisk PM, Lambeth TM, Rojas MA, et al. Necrotizing Enterocolitis and Growth in Preterm Infants Fed Predominantly Maternal Milk, Pasteurized Donor Milk, or Preterm Formula: A Retrospective Study. Am J Perinatol. 2017; 34(7): 676-683. doi: 10.1055/s-0036-1597326.

Ehrenkranz RA, Das A, Wrage LA, et al. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr Res. 2011; 69(6): 522-529. doi: 10.1203/PDR.0b013e318217f4f1.

‏ Stephens BE, Walden RV, Gargus RA, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics. 2009; 123(5): 1337-1343. doi: 10.1542/peds.2008-0211.

Miller M, Vaidya R, Rastogi D, Bhutada A, Rastogi S. From parenteral to enteral nutrition: a nutrition-based approach for evaluating postnatal growth failure in preterm infants. J Parenter Enteral Nutr. 2014; 38(4): 489-497.

doi: 0.1177/0148607113487926.

Rahman A, Kase JS, Murray YL, Parvez B. Neurodevelopmental Outcome of Extremely Low Birth Weight Infants Fed an Exclusive Human Milk Diet Is Not Affected by Growth Velocity. Breastfeed Med. 2020; 15(6): 362-369. doi: 10.1089/bfm.2019.0214.

Kuzma-O’Reilly B, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics. 2003; 111: e461-e470.‏

Panagiotounakou P, Sokou R, Gounari E, Konstantinidi A, Antonogeorgos G, Grivea IN, et al. Very preterm neonates receiving "aggressive" nutrition and early nCPAP had similar long-term respiratory outcomes as term neonates. Pediatr Res. 2019; 86(6): 742-748. doi: 10.1038/s41390-019-0514-5.

Cerda AM, McCourt EA, Thevarajah T, Wymore E, Lynch AM, Wagner BD. Comparison between weight gain and Fenton preterm growth z scores in assessing the risk of retinopathy of prematurity. J AAPOS. 2019; 23(5): 281-283.

doi: 10.1016/j.jaapos.2019.06.007.

Linda DB, Heermann JA. The effect of developmental care on preterm infant outcome. Applied Nursing Research. 1997; 10(4): 190-197.

‏25. Lv B, Gao XR, Sun J, et al. Family-Centered Care Improves Clinical Outcomes of Very-Low-Birth-Weight Infants: A Quasi-Experimental Study. Frontiers in pediatrics. 2019; 7(138).

O'Brien K, Robson K, Bracht M, et al. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health. 2018; 2(4): 245-254. doi: 10.1016/S2352-4642(18)30039-7.

Loewy J, Stewart K, Dassler AM, Telsey A, Homel P. The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics. 2013; 131(5): 902-18. doi: 10.1542/peds.2012-1367.

Ettenberger M, Cárdenas RC, Parker M, Odell-Miller H. Family-centred music therapy with preterm infants and their parents in the Neonatal Intensive Care Unit (NICU) in Colombia—A mixed-methods study. Nordic Journal of Music Therapy. 2017; 26(3): 207–234.

Ettenberger M, Odell-Miller H, Cárdenas RC, Serrano TS, Parker M, Camargo Llanos SM. Music therapy with premature infants and their caregivers in Colombia – A mixed methods pilot study including a randomized trial. Voices: A World Forum for Music Therapy. 2014; 14(2).

Standley JM, Cassidy J, Grant R, Cevasco A, Szuch C, Nguyen J, et al. The effect of music reinforcement for non-nutritive sucking on nipple feeding of premature infants. Pediatr Nurs. 2010; 36(3): 138-45. PMID: 20687305.

Chorna OD, Slaughter JC, Wang L, Stark AR, Maitre NL. A pacifier-activated music player with mother's voice improves oral feeding in preterm infants. Pediatrics. 2014; 133(3): 462-8. doi: 10.1542/peds.2013-2547.

Cevasco AM, Grant RE. Effects of the pacifier activated lullaby on weight gain of premature infants. J Music Ther. 2005; 42(2): 123-39. doi:10.1093/jmt/42.2.123.

Standley JM. The effect of contingent music to increase non-nutritive sucking of premature infants. Pediatr Nurs. 2000; 26(5): 493-499.PMID: 12026338.

Standley JM. The effect of music-reinforced nonnutritive sucking on feeding rate of premature infants. J Pediatr Nurs. 2003; 18(3): 169-173.

doi: 10.1053/jpdn.2003.34.

Ghetti C, Bieleninik Ł, Hysing M, et al. Longitudinal Study of music Therapy's Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an international randomised trial. BMJ Open. 2019; 9(8): e025062. doi: 10.1136/bmjopen-2018-025062.

Haslbeck FB, Bassler D. Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit. J Vis Exp. 2020; 7(155). doi: 10.3791/60412.





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