基于正交试验的早产儿听觉刺激优化方案研究

Optimization of auditory stimulation on premature infants based on orthogonal design

摘要

目的 探索早产儿听觉刺激频率、时长及音乐种类的最优参数组合,为实施早产儿听觉刺激干预提供依据。方法 采用L₂₇(3¹³)正交试验法,选取2024年4—9月于南京市妇幼保健院新生儿科住院的189例早产儿为研究对象,随机分成27组。通过极差分析法和方差分析法探讨影响早产儿听觉刺激的3个因素(音乐种类、刺激频率、刺激时长)对早产儿的体重、身长、头围、达到完全经口喂养时间、达到全肠道喂养时间、新生儿行为神经测定(NBNA)评分的变化。结果 剔除不合格病例后,最终纳入早产儿180例。音乐种类对早产儿体重、头围、身长的增长、达到完全经口喂养时间及NBNA评分有显著影响(F=4.673、4.618、4.528、5.673、7.528,P＜0.05),刺激频率对早产儿体重、头围、身长的增长、达到完全经口喂养时间及全肠道时间有显著影响(F=4.760、5.142、6.318、5.966、4.748,P＜0.05),刺激时长对NBNA评分有显著影响(F=7.424,P=0.015)。音乐种类及时长的交互作用对NBNA评分有显著影响(F=4.031,P=0.044)。结论 3次/d、每次30min的母亲现场哼唱乐是早产儿听觉刺激的最优参数组合,建议临床开展早产儿发育支持护理时优先采用该方案。

Abstract

Objective To determine the optimal parameter combinations of auditory stimulation frequency, duration, and music type for premature infants, in order to provide evidence for clinical interventions. Methods An L₂₇(3¹³) orthogonal experimental design was adopted. A total of 189 premature infants hospitalized in the Neonatal Intensive Care Unit (NICU) of NanjingWomen and Children′s Healthcare Hospital from April to September 2024 were enrolled in this study, and were randomly assigned to 27 groups. Range analysis and analysis of variance (ANOVA) were utilized to evaluate the effect of three factors related to auditory stimulation (music type, stimulation frequency, and duration) on weight, length, and head circumference gain, as well as the time to achieve full oral feeding, the time to achieve full enteral feeding, and Neonatal Behavioral Neurological Assessment (NBNA) scores. Results After excluding 9 ineligible cases, a total of 180 preterm infants were ultimately enrolled in the study.The type of music significantly affected the gains in body weight, head circumference, and body length, as well as the time to achieve full oral feeding and NBNA scores (F=4.673, 4.618, 4.528, 5.673, 7.528, P<0.05). Stimulation frequency significantly influenced the gains in body weight, head circumference, and body length, along with the time to achieve full oral feeding and the time to achieve full enteral feeding (F=4.760, 5.142, 6.318, 5.966, 4.748, P<0.05). The duration of stimulation significantly impacted NBNA scores (F=7.424, P=0.015). Furthermore, a significant interaction between music type and duration on NBNA scores was observed (F=4.031, P=0.044). Conclusions The optimal parameter combination for auditory stimulation in premature infants is maternal live lullaby singing administered three times a day for 30 minutes per session. It is recommended to prioritize this protocol in clinical developmental supportive care for premature infants.

关键词

早产儿 / 听觉刺激 / 音乐疗法 / 生长发育 / 正交设计

Key words

premature infants / auditory stimulation / music therapy / growth and development / orthogonal design

[1] 张沂洁,朱燕,陈超.早产儿发生率及变化趋势[J].中华新生儿科杂志,2021,36(4):74-77.
Zhang YJ,Zhu Y,Chen C.Incidence and changing trend of preterm infants[J]. Chin J Neonatol,2021,36(4):74-77.(in Chinese)
[2] Lawn JE,Blencowe H,Oza S,et al.Every newborn:Progress, priorities, and potential beyond survival[J].Lancet,2014,384(9938):189-205.
[3] Zeraati H,Nasimi F,Rezaeian A,et al.Effect of multi-sensory stimulation on neuromuscular development of premature infants: A randomized clinical trial[J].Iran J Child Neurol,2018,12(3):32-39.
[4] Als H. Toward a synactive theory of development: Promise for the assessment and support of infant individuality[J].Infant Ment Health J,1982,3(4):229-243.
[5] 沈巧,郑显兰,史源,等.中国新生儿疼痛管理循证指南(2023年)[J].中国当代儿科杂志,2023,25(2): 109-127.
Shen Q,Zheng XL, Shi Y, et al.Evidence-based guideline for neonatal pain management in China(2023)[J].Chin J Contemp Pediatr,2023,25(2):109-127.(in Chinese)
[6] Shahbazi F, Fattahi-Darghlou M, Moslehi S, et al.Effect of music therapy on behavioral and physiological neonatal outcomes: A systematic review and dose-response meta-analysis[J]. PLoS One, 2025, 20(1):e0316674.
[7] Costa VS, Bündchen DC, Sousa H, et al.Clinical benefits of music-based interventions on preterm infants′ health: A systematic review of randomised trials[J].Acta Paediatr,2022,111(3):478-489.
[8] 李丹麑.新生儿复苏发展历史[J].中华围产医学杂志,2023,26(6):526-530.
Li DN. History and development of neonatal resuscitation[J].Chin J Perinat Med,2023,26(6):526-530.(in Chinese)
[9] 向庆东.基于正交设计实验的骨癌痛大鼠电针镇痛治疗方案优选[D].武汉:湖北中医药大学, 2019.
Xiang QD.Optimum selection of electro-acupuncture analgesic treatment for bone cancer pain in rats based on orthogonal design experiment[D].Wuhan:Hubei University of Chinese Medicine,2019.(in Chinese)
[10] Foroushani SM, Herman CA, Wiseman CA, et al.Evaluating physiologic outcomes of music interventions in the neonatal intensive care unit:A systematic review[J].J Perinatol,2020,40(12):1770-1779.
[11] Haslbeck FB, Mueller K, Karen T, et al. Musical and vocal interventions to improve neurodevelopmental outcomes for preterm infants[J].Cochrane Database Syst Rev,2023(9):CD013472.
[12] Mikulis N, Inder TE, Erdei C. Utilising recorded music to reduce stress and enhance infant neurodevelopment in neonatal intensive care units[J].Acta Paediatr,2021,110(11):2921-2936.
[13] Palaskar P, Ramekar SD, Sant N, et al. Ideal mode of auditory stimulation in preterm neonates in neonatal intensive care unit: A systematic review[J].Cureus,2023,15(2):e34496.
[14] Stouffer JW, Shirk BJ,Polomano RC.Practice guidelines for music interventions with hospitalized pediatric patients[J].J Pediatr Nurs,2007,22(6):448-456.
[15] Yue W, Han X, Luo J, et al.Effect of music therapy on preterm infants in neonatal intensive care unit: Systematic review and Meta-analysis of randomized controlled trials[J]. J Adv Nurs, 2021, 77(2):635-652.
[16] Ghetti C, Bieleninik L, Hysing M, et al. Longitudinal study of music therapy′s effectiveness for premature infants and their caregivers (LongSTEP):Protocol for an international randomised trial[J]. BMJ Open, 2019, 9(8):e025062.
[17] 鲍秀兰,刘维民.新生儿行为神经测定和观察在早产儿及小婴儿脑发育评估和早期干预中的应用[J].中国实用儿科杂志,2017,32(11):820-822.
Bao XL, Liu WM.Application of neonatal behavioral neurological assessment and observation to the assessment of brain development and early intervention in preterm and young infants[J].Chin J Pract Pediatr,2017,32(11):820-822.(in Chinese)
[18] Calderon-Noy G, Gilboa A.Music therapy with neonatal intensive care unit-discharged mother-infant dyads: Developing a method for nurturing communicative parental efficacy (CoPE with music)[J].Int J Environ Res Public Health,2021,18(16):8553.
[19] Filippa M, Monaci MG, Spagnuolo C, et al.Maternal speech decreases pain scores and increases oxytocin levels in preterm infants during painful procedures[J].Sci Rep,2021,11:17301.
[20] National Association of Neonatal Nurses.Trauma-informed care in the NICU: Evidence-based practice guidelines for neonatal clinicians[M].New York: Springer Publishing Company,2017:101-136.
[21] Menke BM, Hass J, Diener C, et al. Family-centered music therapy-Empowering premature infants and their primary caregivers through music:Results of a pilot study[J].PLoS One,2021,16(5):e0250071.
[22] Alabbasi Y,Parker L,Weaver M,et al.Maternal voice exposure and its effect on premature infants′ feeding milestones: A systematic review[J].Adv Neonatal Care,2023,23(2):E40-E49.

基金资助

南京医科大学科技发展基金一般项目(NMUB20230073)