Perinatal brain injury occurs in 5.14/1000 live births in England. A significant proportion of these injuries result from hypoxic ischaemic encephalopathy (HIE) in term infants and intracranial haemorrhage (IVH) or periventricular leukomalacia (PVL) in preterm infants. Standardised care necessitates minimal handling from parents and professionals to reduce the progression of injury. This can potentially increase parental stress through the physical inability to bond with their baby. Recent research highlights the ability of music therapy (MT) to empower parental bonding without handling, through sharing culturally informed personal music with their infant. This review therefore aimed to systematically evaluate the use of MT with infants diagnosed with perinatal brain injury in a neonatal intensive care unit (NICU). Search terms were combined into three categories (audio stimulation (MT), population (neonates) and condition (brain injury), and eight electronic databases were used to identify relevant studies following PRISMA guidelines. Eleven studies using music or vocal stimulation with infants diagnosed with perinatal brain injury were identified and quality assessed using Cochrane ROB2, the ROBINSI Tool and the Newcastle Ottawa Scale. Studies used either voice as live (n = 6) or pre-recorded (n = 3) interventions or pre-recorded instrumental music (n = 2). Studies had two primary areas of focus: developmental outcomes and physiological effects. Results suggested the use of music interventions led to a reduction of infants’ pain scores during procedures and cardiorespiratory events, improved feeding ability (increase oral feeding rate, volume intake and feeds per day) and resulted in larger amygdala volumes than control groups. Additionally, MT intervention on the unit supported long-term hospitalised infants in the acquisition of developmental milestones. Vocal soothing was perceived to be an accessible intervention for parents. However, infants with PVL showed signs of stress in complex interventions, which also potentially resulted in an increase in maternal anxiety in one study. MT with infants diagnosed with perinatal brain injury can have positive effects on infants’ behavioural and neurological parameters and support parental involvement in their infants’ developmental care. Further feasibility studies are required using MT to determine appropriate outcome measures for infants and the support required for parents to allow future comparison in large-scale randomised control trials.

Background: Parents of infants admitted to neonatal intensive care require support to minimize the impact on their mental health and to encourage engagement with their infants to support infant neurodevelopment. Many interventions aim to address this need, but there is a lack of research considering the accessibility of these for a multicultural population. Aim: To systematically identify sources of psychotherapeutic support available for parents with infants admitted to neonatal care (NNU, neonatal intensive care unit [NICU] and special care units), assess their accessibility and acceptability and identify challenges and facilitators. Study design: Six electronic databases with no restrictions on language or date were used to identify relevant studies following Preferred Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines. Publications were included in the review if they reviewed parent experience of an intervention actively in place to support parent experience during the neonatal unit stay. Any studies where the intervention's primary aim was infant focused, such as developmental care, were excluded. All publications were quality‐assessed using quality appraisal tools appropriate for their design type. Data were extracted line by line using Sekhon et al.'s theoretical acceptability framework and questionnaire. Results: A total of 3309 studies were found, of which 36 studies met the inclusion criteria. Included studies were published worldwide between 2000 and 2023 and explored 15 different interventions. Challenges for parental engagement were due to preconceived ideas about intervention requirements and parents' ability to participate in them. Timely information and providers' experience in delivering the intervention were reported to support engagement and as being valuable for enhancing participant knowledge. The emotional content of interventions was found to be challenging by parents across most studies. This was prominent in interventions designed to be carried out in a group format and where keepsakes were created. However, the value of these interventions was in reducing parents' feelings of isolation through increased social support and providing a starting point for conversations with wider family and friends about the family's neonatal experience. Participant demographics were poorly reported, with only two studies taking into consideration the ethicality of the intervention. Conclusion: Poor reporting of participant demographics, and a focus on mothers as participants, means findings are not transferrable to the wider population of parents in neonatal units. Future studies should consider how to ensure that research and interventions are accessible to multicultural populations to improve the understanding of the acceptability of interventions. Better knowledge of neonates and the NNU setting amongst intervention providers could increase the accessibility of psychotherapeutic support for parents. Training for providers on how to manage sensitive conversations may also be beneficial to support parents during interventions. Relevance to Clinical practice: The impact of neonatal admission on parental mental health is increasingly recognized and reported. Interventions have been developed to reduce the negative impact on the mental health of parents. There continue to be significant health inequalities as a result of many services not taking into account the acceptability and accessibility of interventions in this setting for their multicultural populations. This review highlights the need for better reporting of participant demographics in research and the inclusion of those seldom heard to ensure interventions are culturally, religiously and linguistically appropriate for multicultural populations.

Introduction: Neonatal intensive care is a traumatic environment for parents, infants and staff. Services need to collaborate with their users to develop acceptable and sustainable support. Music therapy can have positive impacts on physiological and psychological outcomes for infants and has the potential to help create a supportive service environment. This study aimed to co-design a culturally sensitive music therapy intervention to support the development of continuing bonds for parents with infants with uncertain futures on neonatal units.Methods: An Experience-based Co-design approach was implemented to identify areas of challenge within neonatal units before designing solutions informed by a music therapy approach. Across four co-design meetings, six parents, five staff and three charity representatives worked collaboratively and co-analysed qualitative data to develop a culturally sensitive music therapy intervention.Results: Three themes were identified from the data: trauma, identity and staff-parent relationships. A logic model was constructed which guided the intervention development, leading to a trauma-informed intervention comprising a) a musical gift created by external family and friends supported by a music therapist b) parent and staff playlists c) a journal to guide use of music and encourage self-reflection and d) ‘ask me’ staff badges to start staff-parent conversations.Discussion: This is the first co-designed neonatal music therapy intervention. Through increasing social connections and promoting individuals' strengths, it has the potential to increase psychological safety for both parents and staff.

Many seriously ill infants admitted to neonatal intensive care units (NICU) have an uncertain future. The neonatal experience can be overwhelming and traumatic for parents and professionals caring for them. The infant may develop later psychosocial difficulties due to trauma. Services often fail to consider their cultural and religious accessibility for families. Music therapy (MT) is increasingly being considered for implementation on neonatal units to help address these challenges. However, the true acceptability of the therapy, particularly for parents with infants with uncertain futures, is unknown. Four focus groups (14 parent participants), 13 parent interviews, and 2 focus groups with 8 healthcare professionals (HCPs) were conducted to explore their lived experiences of uncertainty in the NICU and their perceptions of the use of MT in this environment. Parents experienced a prolonged period of liminality of identity as they faced multiple traumas and had minimal opportunities to connect with their infant. HCPs described the felt obligation to maintain a professional persona and an emotional disconnect to manage daily trauma. MT was considered to have the potential to support connection between baby–parent–professionals and the external world, as well as internal personal resources. Concerns about using MT included further disruption to family time in the NICU and potential disempowerment by professionalizing one of the few aspects of infant care to which parents could still contribute. Future neonatal MT approaches should ensure parents and HCPs are psychologically supported. Acknowledging family values and heritage is likely to increase feelings of acceptance and engagement.