Physiological and emotional effects of pentatonic live music played for preterm neonates and their mothers in the Newborn Intensive Care Unit: A randomized controlled trial

•As widely reported, preterm infants experience stress in the NICU. What efforts might aid in reduction of NICU stress?•Anthroposophic Medicine states that pentatonic music is soothing for infants. Evidence at this time is largely anecdotal.•This study shows, that the use of pentatonic music increases HRV parameters, interpreted as increased parasympathetic tone. Despite attempts to increase calmness in the Newborn Intensive Care Unit (NICU), preterm neonates still experience stress. The question arises how to further promote the infants’ wellbeing. Therefore, the immediate effects of pentatonic live music on preterm infants and their mothers were examined. In a two-centre randomized controlled trial with crossover design preterm infants were exposed sequentially to two conditions: live pentatonic harp music (LPHM) used in Anthroposophic Medicine or standard care. The order of the conditions was randomized within each subject. The primary outcome was change of the number of oxygen desaturations < 90%/h, whereas secondary outcomes were: heart rate, respiratory rate, oxygen saturation, heart rate variability (HRV), the perfusion index, pulse-transit-time and maternal anxiety and others not reported on in this article. 21 preterm infants were randomized (14 girls), mean gestational age at measurement 35 + 0 weeks (SD 1 week). The primary outcome parameter showed no significant changes. Regarding the secondary outcomes the comparison of the pre-post-differences between the conditions showed significant effects for the HRV parameters pNN50 (ΔpNN50 = 1.46%, z = −2.47, p = .001) and SDNN (ΔSDNN=−0.06 ms, z = −2.25, p = .002). The music intervention significantly increased the values of pNN50 (Mdn 1.2% vs. 2.6%, p = 0.04) and marginally those of SDNN (Mdn 31.7 ms vs. 36.4 ms, p = 0.05). No changes were found in the other parameters. While the use of music in the NICU had no effect on the number of oxygen desaturations, it increased two HRV parameters indicative of infants’ parasympathetic tone.