title: Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety.
abstract: OBJECTIVE
  Kangaroo care (KC) and maternal singing benefit preterm infants, and we investigated whether combining these benefitted infants and mothers.
  
  
  METHODS
  A prospective randomised, within-subject, crossover, repeated-measures study design was used, with participants acting as their own controls. We evaluated the heart rate variability (HRV) of stable preterm infants receiving KC, with and without maternal singing. This included low frequency (LF), high frequency (HF) and the LF/HF ratio during baseline (10 min), singing or quiet phases (20 min) and recovery (10 min). Physiological parameters, maternal anxiety and the infants' behavioural state were measured.
  
  
  RESULTS
  We included 86 stable preterm infants, with a postmenstrual age of 32-36 weeks. A significant change in LF and HF, and lower LF/HF ratio, was observed during KC with maternal singing during the intervention and recovery phases, compared with just KC and baseline (all p-values <0.05). Maternal anxiety was lower during singing than just KC (p = 0.04). No differences in the infants' behavioural states or physiological parameters were found, with or without singing.
  
  
  CONCLUSIONS
  Maternal singing during KC reduces maternal anxiety and leads to autonomic stability in stable preterm infants. This effect is not detected in behavioural state or physiological parameters commonly used to monitor preterm infants.
authors.affiliation: Department of Neonatology, Meir Medical Center, Kfar Saba, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Arnon
authors.forename: Chagit
authors.initials: C
authors.lastname: Diamant
authors.forename: Sofia
authors.initials: S
authors.lastname: Bauer
authors.forename: Rivka
authors.initials: R
authors.lastname: Regev
authors.forename: Gisela
authors.initials: G
authors.lastname: Sirota
authors.forename: Ita
authors.initials: I
authors.lastname: Litmanovitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000517:prevention & control; D001341:Autonomic Nervous System / Q000502:physiology*; D018592:Cross-Over Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D060127:Kangaroo-Mother Care Method; D008297:Male; D008425:Maternal Behavior / Q000523:psychology*; D011446:Prospective Studies; D063346:Singing; D055815:Young Adult
keywords: Autonomic stability; Heart rate variability; Kangaroo care; Maternal singing; Preterm infants