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Multimodal Neurological Enhancement Intervention for Self-regulation in Premature Infants

Cevasco-Trotter, Andrea M. PhD, MT-BC; Hamm, Ellyn L. MM, MT-BC; Yang, Xin PhD; Parton, Jason PhD

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000595
Original Research

Background: The neonatal intensive care unit is often a noisy, overstimulating environment that disrupts infants' regulation of physiological and behavioral states and interrupts caregiver bonding; however, infants benefit from early intervention, including the use of multimodal neurological enhancement (MMNE) intervention to provide appropriate neurodevelopmental stimulation. No one has investigated whether it assists infants in self-regulation.

Purpose: The purpose of this retrospective longitudinal analysis was to examine the effect of a music therapy intervention, MMNE, on self-regulation of premature infants as measured by changes in heart rate (HR).

Methods: A convenience sample of 60 premature infants received 486 MMNE sessions provided by a board-certified music therapist (MT-BC). Documentation, taken during routine clinical services, involved recording infant's HRs from the standard monitor for 3 minutes at baseline, during, and after a 20-minute MMNE intervention.

Results: Infants' mean HRs were decreased during and post-MMNE sessions compared with baseline (P < .004 and P < .001, respectively). Furthermore, infants with a baseline HR above 170 had significant decreases both during and after the MMNE session (P < .001 for both time periods).

Implications for Practice: Results of this study support the existing body of evidence showing the benefits of MMNE with premature infants. Based on our results, MMNE may help infants develop and demonstrate self-regulation as indicated by maintained HRs during and after the intervention as well as a lowered HR for infants who had high HRs prior to MMNE.

Implications for Research: Further research needs to be done regarding how infants process MMNE and its potential to aid sensory processing.

Music Therapy, School of Music, College of Arts and Sciences, The University of Alabama, Tuscaloosa (Dr Cevasco-Trotter); Department of Music Therapy, College of Music, Florida State University, Tallahassee (Ms Hamm); and Department of Information Systems, Statistics, and Management Science, Culverhouse College of Commerce and Business Administration, The University of Alabama, Tuscaloosa, AL (Drs Yang and Parton).

Correspondence: Andrea M. Cevasco-Trotter, PhD, MT-BC, Music Therapy, School of Music, College of Arts and Sciences, The University of Alabama, Box 870366, Tuscaloosa, AL 35487 (

The authors declare no conflicts of interest.

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© 2019 by The National Association of Neonatal Nurses