DOCOS, Patricia Candice B.

May 14, 2022

4NUR3 – RLE 4 Ma’am Glynis Lee

Title of the Articles:

● Comparing the effectiveness of mother’s live lullaby and recorded lullaby on
physiological responses and sleep of preterm infants: a clinical trial study
● Maternal Voice and Infant Sleep in the Neonatal Intensive Care Unit

Authors:
● Razyeh Namjoo, Roghayeh Mehdipour-Rabori, Behnaz Bagherian and Monirsadat
Nematollahi*
● Renée A. Shellhaas, MD, MS,a Joseph W. Burns, PhD,b John D.E. Barks, MD,a Fauziya
Hassan, MD, MS,a,c Ronald D. Chervin, MD, MSc

APA format of Bibliography:

Razyeh Namjoo, Roghayeh Mehdipour-Rabori, Behnaz Bagherian and Monirsadat Nematollahi

(2020). Comparing the effectiveness of mother’s live lullaby and recorded lullaby on
physiological responses and sleep of preterm infants: a clinical trial study
https://doi.org/10.1515/jcim-2020-0507 Received September 7, 2020; accepted January 5, 2021;
published online May 24, 2021

Shellhaas, Renée A.; Burns, Joseph W.; Barks, John D.E.; Hassan, Fauziya; Chervin, Ronald D.
(2019). Maternal Voice and Infant Sleep in the Neonatal Intensive Care Unit. Pediatrics, 144(3),
e20190288–. doi:10.1542/peds.2019-0288

Source of the Article: PubMed.gov

Key terms used for the search: ((NICU) AND (sleep)) OR (nursing))

Summary
• P – NICU patients
• I – Mother’s voice
• C – None
• O – Increased Sleep and Comfort

Author Title of the Population Intervention/Comparison Outcome Key Results/ Level of

(year) article Issues Evidence
Razyeh Comparing 81 Preterm Intervention #1 Mother’s No Results of Level II
Namjoo, the infants live lullaby statistically the study
Roghayeh effectiveness significant suggested
Mehdipour- of mother’s First group: difference that the mean
Rabori, live lullaby -Infants placed in between the scores of
Behnaz and recorded mother’s arms three groups physiological
Bagherian lullaby on -Recorded voice of a in terms of parameters
and physiological strange woman singing overnight did not have
Monirsadat responses in Persian played using sleep statistically
Nematollahi and sleep of headphones duration significant
(2020) preterm differences
infants: a Second group: Mean in the three
clinical trial -Infants placed in the duration of groups
study mother’s arms, and the overnight
mother sang lullabies sleep of the Mean scores
infants of overnight
Intervention #2 between sleep
-Infants placed only in three groups duration
infant’s arms show a increased in
statistically all three
significant groups,
difference especially in
the infants of
Mean the recorded
duration of lullaby group
the daytime
sleep of the
infants in
the recorded
lullaby
group
showed
statistically
significant
differences
Renée A. Maternal 47 12-hour attended Gold Exposure to Level II
Shellhaas, Voice and late-preter polysomnogram utilized standard the mother’s
MD, MS,a Infant Sleep m and recordings may
Joseph W. in the term Digital language of sleep, decrease
Burns, Neonatal neonates processing device placed ambient likelihood of
PhD,b John Intensive on the infant’s arm of noise, and wakefulness
D.E. Barks, Care Unit the bassinet to record the maternal
MD,a acoustic environment voice The
Fauziya exposure sleep-wake
Hassan, Infants’ mothers reveal that cycle
MD, MS,a,c provided with 2 sounds can development
Ronald D. children’s books and be and the
Chervin, voices were digitally significantly relationship
MD, MSc recorded loud in the of sleep to
(2019) ward the sensory
environment
are affected
by preterm
births

Answer the following guide questions:

1. What Intervention/innovation was used or implemented in the study/ies reviewed?

The intervention implemented in the study is the mother’s voice or lullaby. It is being
studied to know the effects of this method on preterm infants. According to Neil Do (2008),
these populations are at risk for brain damage. There are some factors that contribute to this such
as noise and stimuli, especially to the nervous system. Too much auditory noise can stimulate
unpleasant physiological responses which may include alterations in one’s heart rate, blood
pressure, and blood oxygen saturation. This can also disturb their sleeping pattern which plays a
huge part in their normal growth and development.

This was conducted in the Neonatal intensive care unit of Ali Ibn Abi Talib Hospital in
Rafsanjan during the night shifts to maximize the time that the infants are asleep and not for
therapeutic and diagnostic procedures. Consent was acquired from their mothers. They were
grouped into three (recorded lullaby, mother’s live lullaby, and control). In the first group, they
placed the infants in the mother’s arms and played a recorded voice of a strange woman singing
in Persian. These lullabies were from the Pouya Publications which was verified by child
psychologists. It was played 20 minutes every day for 14 days. The acoustic intensity of the
recording was 45 dB which was the standard and recommended value during the day (Taheri
et.al, 2015). While for the second group, they were also positioned in their mother’s arms. The
mother sang a lullaby. Meanwhile, the infants in the control group were only placed in the
mother’s arms. With this, they have also checked and observed the infant’s sleeping duration. It
was also helpful that the researcher consistently reminded the mothers every day to accomplish
the needed tasks through text messages.

2. What are the implications of the findings to patient care?

After integrating this kind of intervention into the care of NICU patients, the findings
revealed that the recorded lullaby and the mother’s live lullaby did not have a significant
contribution to the psychological criteria compared to the control group. However, the recorded
lullaby technique had a positive effect on sleep at night. This result can help nurses manage their
time in the ward. As we integrate cluster care into our duty, we also follow this to allow and give
the infant more time to rest. This can also promote the bonding of the mother and the infant as
the infant listens and be in his or her mother’s arms.

It is also evidenced that improving prenatal and neonatal care could lead to a lesser
mortality rate of preterm infants, especially that they are at risk for developmental deficiency
(Valizadeh et.al, 2014). This could also lessen their stress which may affect their condition as it
can lead to lower oxygen saturation. In addition, recorded music interventions and parental
lullabies played for two weeks also showed a decrease in the infants' heart rate (Loewy et.al,
2013). Any source of music is beneficial to the physical and mental health of these infants. Yusuf
et.al (2017) also indicated that this is recommended to be included as a routine in NICU care.
This can support the delivery of care to nurses as we try to protect and promote quality care to
these patients who are unstable.

3. Does the intervention support/contradict current nursing practice? Support your answer
using other relevant references (suggestion: use Nursing reference center, current clinical
practice guidelines, books and other references)

There are certain limitations observed in the study as the intervention groups were not
isolated from each other. They weren’t placed in different rooms because there was a lack of
space. But the intervention still supported the current nursing practice today. In a study by Taheri
et.al (2017), it was noted that live lullabies produced a deeper sleep in infants than the recorded
one. This was emphasized in the current study. The duration of sleep at night is vital in an
infant’s life. A study showed that nighttime sleep is a key component in attaining a healthy first
year of life. Infants were noticed to rest better at night with lesser interruptions.

According to Caskey et.al (2014), the mother’s voice or lullaby is correlated to better
long-term language development because the infants are more exposed to language. It is needed
for them to be introduced to this so there should be a promotion of speaking and talking to the
infants. Doctors, nurses, and other healthcare professionals, along with the family, should be
encouraged to do this but should also be reminded not to disrupt the infant’s sleep. This will
assist intimacy and togetherness between mothers and infants as well as their relatives. This
proves how promising this intervention is once more studies will be deployed. It can lead to
more opportunities for researchers to study and discover more about this so that we could help
the healthcare system improve and strengthen.

4. Would this practice change/improve the process of patient care? Patient outcomes?

As mentioned above, all the evidence lead to only one result. A more developed and
well-rested infant. It also impacts the bonding and connection between mothers and infants
which is integral in one’s early years. It promotes intimate relationships and establishes a sense
of security. As nurses, we should assist them with this natural occurrence. It is our responsibility
to consistently and efficiently provide care and attend to their needs. It is the foundation of all
connections.

If an infant gets enough sleep and nutrition, nurses will be able to carry out the orders
smoother and quicker. We would be able to divide our time wisely as we strive to respond to the
calls of our patients. Not only do our patients need to rest but it will also help us rest more. There
will be mutual benefits as it will decrease the burnout of nurses especially that NICU is a busy
ward.

References:

Caskey M, Stephens B, Tucker R, Vohr B (2014). Adult talk in the NICU with preterm infants
and developmental outcomes. Pediatrics. 2014;133(3). Available at:
www.pediatrics.org/cgi/con tent/full / 133/3/e578

Loewy J, Stewart K, Dassler AM, Telsey A, Homel P (2013). The effects of music therapy on
vital signs, feeding, and sleep in premature infants. Pediatrics 2013;131:902–18.

Neal DO (2008). Music as a health patterning modality for preterm infants in the NICU.
University of Minnesota Digital Conservancy; 2008. Available from: https://hdl.
handle.net/ 11299/47227

Taheri L, Jahromi MK, Abbasi M, Hojat M (2017). Effect of recorded male lullaby on
 physiologic response of neonates in NICU. Appl Nurs Res 2017;33:127–30

Taheri L, Sobhanian s, Mosala nejad z, Hojat M (2015). Comparison of the effect of Quran and
Lullaby sounds on infant heart rate changes in neonatal intensive care unit. J Med Surg
Nurs. 2015;4: 10–6.

Valizadeh, L., Avazeh, M., Bagher Hosseini, M., & Asghari Jafarabad, M. (2014). Comparison
of clustered care with three and four procedures on physiological responses of preterm
infants: randomized crossover clinical trial. Journal of caring sciences, 3(1), 1–10.
https://doi.org/10.5681/jcs.2014.001

Yusuf N, Hadisaputro S, Runjati R, Suwondo A, Mashoedi ID, Supriyana S (2017). The

effectiveness of combination of kangaroo mother care method and lullaby music therapy
on vital sign change in infants with low birth weight. Belitung Nurs J 2017;3: 352–9.