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Erdei C, Schlesinger K, Pizzi MR, Inder TE. Music Therapy in the Neonatal Intensive Care Unit: A Center's Experience with Program Development, Implementation, and Preliminary Outcomes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:533. [PMID: 38790528 PMCID: PMC11120361 DOI: 10.3390/children11050533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The role of music in the NICU continues to evolve, with recent studies documenting the positive impact of music therapy for hospitalized infants and families. With many potential benefits and no substantial adverse effects reported to date in medically stable infants, we aimed to create a clinical guideline to integrate this therapy into the NICU operations. METHODS we launched and implemented a pilot music therapy clinical program within a subunit of a level-III NICU, building upon available evidence. RESULTS In this report, we describe our experience with initial program development and early outcomes in terms of population served, frequency of music therapy, and therapeutic modalities employed to implement service delivery. CONCLUSION we highlight the importance of establishing practices that are aligned with currently available data and recommendations, in order to facilitate delivery of a safe, evidence-based, meaningful therapeutic experience with monitoring of preliminary effects of the therapy on all those involved in the experience.
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Affiliation(s)
- Carmina Erdei
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
- Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Kim Schlesinger
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
| | - Meredith R. Pizzi
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
| | - Terrie E. Inder
- Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA; (K.S.); (M.R.P.); (T.E.I.)
- Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Pediatrics, Division of Neonatology, Children’s Hospital of Orange County, 1201 W La Veta Ave, Orange, CA 92868, USA
- Pediatrics, University of California Irvine, 1001 Health Sciences Rd, Irvine, CA 92697, USA
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Mata Ferro M, Falcó Pegueroles A, Fernández Lorenzo R, Saz Roy MÁ, Rodríguez Forner O, Estrada Jurado CM, Bonet Julià N, Geli Benito C, Hernández Hernández R, Bosch Alcaraz A. The effect of a live music therapy intervention on critically ill paediatric patients in the intensive care unit: A quasi-experimental pretest-posttest study. Aust Crit Care 2023; 36:967-973. [PMID: 36868934 DOI: 10.1016/j.aucc.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/29/2022] [Accepted: 01/07/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Music therapy as a nonpharmacological means of managing patient pain, anxiety, and discomfort is a recognised technique, although it is not widely used in the paediatric intensive care unit (PICU). AIM The aim of this study was to assess the clinical effect of a live music therapy intervention on vital signs and levels of discomfort and pain for paediatric patients in the PICU. METHODS This was a quasi-experimental pretest-posttest study. The music therapy intervention was carried out by two music therapists who were specifically trained, each possessing a master's degree in the field of hospital music therapy. Ten minutes before the start of the music therapy session, the investigators recorded the vital signs of the patients and assessed their levels of discomfort and pain. The procedure was repeated at the start of the intervention; at 2, 5, and 10 min during the intervention; and at 10 min following the conclusion of the intervention. RESULTS Two hundred fifty-nine patients were included; 55.2% were male, with a median age of 1 year (0-21). A total of 96 (37.1%) patients suffered a chronic illness. The main reason for PICU admission was respiratory illness, at 50.2% (n = 130). Significantly lower values were observed for heart rate (p = 0.002), breathing rate (p < 0.001), and degree of discomfort (p < 0.001) during the music therapy session. CONCLUSIONS Live music therapy results in reduced heart rates, breathing rates, and paediatric patient discomfort levels. Although music therapy is not widely used in the PICU, our results suggest that using interventions such as that used in this study could help reduce patient discomfort.
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Affiliation(s)
- María Mata Ferro
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Anna Falcó Pegueroles
- Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
| | | | - M Ángeles Saz Roy
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain
| | | | | | | | | | | | - Alejandro Bosch Alcaraz
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain; Department of Public Health, Mental Health and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Spain.
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Apostolidi DM, Pantelaki N, Sarantaki A, Dragioti E, Metallinou D. Neonatal Palliative Care as an Integral Component of the Greek National Healthcare System: Time to Act. Cureus 2023; 15:e45498. [PMID: 37859910 PMCID: PMC10584402 DOI: 10.7759/cureus.45498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/21/2023] Open
Abstract
Neonatal palliative care aims to provide multidisciplinary support to families and neonates suffering from life-threatening or life-limiting diseases. Many countries worldwide have recognized the importance of enhancing the quality of life in critically ill neonates and thus have created and systematically implemented palliative care protocols in neonatal intensive care units (NICUs). Europe has a very low neonatal mortality rate, which has been steadily decreasing over the last 30 years. Greece in particular, a country located in Southeast Europe, reported a neonatal mortality rate of 2.29/1,000 live births in 2020. Nevertheless, neonatal palliative care facilities are scarce on a national level. In this paper, several reasons are presented to support the integration of neonatal palliative care in the Greek national healthcare system with the vision to ensure that all neonates and their families will receive in the near future the care, support, and dignity they deserve when facing life-threatening or life-limiting illnesses.
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Affiliation(s)
- Dimitra Maria Apostolidi
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Nikoletta Pantelaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Antigoni Sarantaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, University of Ioannina, Ioannina, GRC
- Department of Medicine and Health Sciences, Linköping University, Linkoping, SWE
| | - Dimitra Metallinou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, GRC
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Alexander D, Quirke MB, Berry J, Eustace-Cook J, Leroy P, Masterson K, Healy M, Brenner M. Initiating technology dependence to sustain a child's life: a systematic review of reasons. JOURNAL OF MEDICAL ETHICS 2022; 48:1068-1075. [PMID: 34282042 PMCID: PMC9726963 DOI: 10.1136/medethics-2020-107099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Decision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the range of influences on these decisions. METHODS Medline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence. RESULTS 53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care. CONCLUSIONS There is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside 'end-of-life' care. This review provides a sound basis for empirical research into the important influences on a child's potential technology dependence.
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Affiliation(s)
- Denise Alexander
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary Brigid Quirke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jay Berry
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | | | - Piet Leroy
- Pediatric Intensive Care Unit & Pediatric Procedural Sedation Unit, Maastricht UMC+, Maastricht, The Netherlands
| | - Kate Masterson
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Martina Healy
- Paediatric Intensive Care, Our Lady's Hospital Crumlin, Crumlin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Deming RS, Mazzola E, MacDonald J, Manning S, Beight L, Currie ER, Wojcik MH, Wolfe J. Care Intensity and Palliative Care in Chronically Critically Ill Infants. J Pain Symptom Manage 2022; 64:486-494. [PMID: 35840043 DOI: 10.1016/j.jpainsymman.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Increasingly, chronically critically ill (CCI) infants survive to discharge from Neonatal Intensive Care Units (NICUs). Little is known about their care intensity and the primary and specialty palliative care families receive at and following discharge. OBJECTIVES To describe care intensity and primary and specialty palliative care received by NICU CCI infants at discharge and one year. METHODS Chart abstraction of CCI infants at three academic centers discharged at ≥42 weeks corrected gestational age with medical technology between 2016 and 2019, including demographics, care intensity, and primary and specialty palliative care received at discharge and one year. RESULTS Among 273 infants, NICU median stays were 45 [IQR 23-92] days. Primary diagnoses included congenital and/or genetic conditions (68.5%), prematurity (28.2%), and birth events (3.3%). At discharge, surgical feeding tubes (75.1%) and tracheostomies (24.5%) were the most common technologies. Infants received a median of 6 [IQR 4-9] medications and were followed by a median of 8 [IQR 7-9] providers. At one year, 91.4% continued with one or more technologies, similar numbers of medications and specialty providers. In the NICU, nearly all families had social work involvement, 78.8% had chaplaincy and 53.8% child life; 19.8% received specialty palliative care consultation. At one year, only 13.2% were followed by palliative care. CONCLUSIONS CCI infants receive intensive medical care including multiple medical technologies, medications, and specialty follow up at discharge and remain complex at one year of life. Most receive primary interprofessional palliative care in the NICU, however these infants and their families may have limited access to specialty palliative care in the short- and long-term.
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Affiliation(s)
- Rachel S Deming
- Department of Psychosocial Oncology and Palliative Care (R.S.D., E.M., L.B., J.W.), Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Emanuele Mazzola
- Department of Psychosocial Oncology and Palliative Care (R.S.D., E.M., L.B., J.W.), Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jeanne MacDonald
- Department of Pediatrics (J.M.), Massachusetts General Hospital for Children, Boston, MA, USA
| | - Simon Manning
- Department of Pediatric Newborn Medicine (S.M.), Brigham and Women's Hospital, Boston, MA, USA
| | - Leah Beight
- Department of Psychosocial Oncology and Palliative Care (R.S.D., E.M., L.B., J.W.), Dana-Farber Cancer Institute, Boston, MA, USA
| | - Erin R Currie
- School of Nursing (E.R.C.), University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica H Wojcik
- Divisions of Newborn Medicine and Genetics and Genomics, Department of Pediatrics (M.H.W.), Boston Children's Hospital, Boston, MA, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (R.S.D., E.M., L.B., J.W.), Dana-Farber Cancer Institute, Boston, MA, USA; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, MA, USA
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