Seven Ways The Hearables Revolution Can Promote Healing In NICUs During Covid-19

One in ten pregnancies in the United States end up arriving earlier than due, many resulting with a stay in the NICU (Neonatal Intensive Care Unit).  There can be many reasons for this, and no parent has NICU as part of a birth plan.  It can be a very intense and emotional experience, particularly in times of Covid-19.

The NICU can be a bewildering place for any parent there for the first time. It is a noisy place with loud, beeping machines, lots of colored tubes, pipes, and wires connecting to tiny, fragile babies, and a high concentration of doctors and nurses in a high security part of a hospital. It is also a place where you’ll find some of the kindest, most compassionate, and talented medical workers who are fighting their hardest night and day to give immense love and care to some of the most fragile human beings. NICUs tend to be equipped with the latest medical equipment and have some of the best-trained doctors and nurses working there.

This creates a very emotional environment for parents, siblings, and families who find themselves there, often without much prior warning. There is often a range of emotions that goes along with birth that results in a stay in the NICU – whether days, weeks, or months.

Several articles address what this can feel like for families with a child in the NICU.

Fortunately, there have been significant advances in NICU medical care, and modern medicine is now able to address a wider and wider range of medical conditions. In addition to receiving critical medical care, a child’s development in the NICU is equally important. A nurturing environment is critical for newborn babies in the NICU to hit critical development milestones such as overcoming illnesses, independent breathing, regulation of critical body organs, feeding and body weight.

NICUs in the Age of Covid-19

While In the age of Covid-19, more stringent visitation policies have resulted in restricted access of family members to a NICU baby’s bedside (such as one parent a time over a 24 hour period). Whilst distressing for many families, it has also spurred new and innovative solutions to support both babies and families. 

Music and Health Expert at Singularity University’s Exponential Medicine, Frank Fitzpatrick, has been exploring sound and musical-based therapy to help babies heal and grow, and parents connect.  Fitzpatrick, who has over 30 years of experience as an award-winning music professional and leading voice in wellness and human development, explains how music and sound can also be used to help caregivers and support families create a healthier attachment between babies and their parents.

Here are seven ways that Fitzpatrick suggests sound, music and harmony in hospitals can become an important part of the healing journey.

1. Reducing noise in the NICU

The first thing that strikes you in the NICU is how loud the environment is. There are constantly alarms and beeping going off (e.g., from babies knocking sensors off), other vitals alerts from medical equipment, bubbling sounds from ventilators, the sound of plumbing in sinks with the constant handwashing due to Covid-19, the rustling of paper handtowels, beeping associated with gavage feeding tubes.  Small babies often flinch during such noises.  There are many reports about the importance of regulating noise in the NICU. The sound levels in NICUs can range from 7 dB to 120 dB, often exceeding the maximum acceptable level of 45 dB, recommended by the American Academy of Pediatrics.

Some of the best NICUs now have noise monitoring technologies in place around each child’s crib, so parents and medical staff can monitor the amount of noise around their child, and track this even during the times they are not by the child’s bedside.

2. Reducing dissonance in necessary sounds

In addition to the decibel sound level, most of the beeps are out of tune with one another creating a very discordant sensory environment. 

Musician Yoko Sen was once admitted into an adult Intensive Care Unit two years back and has now created a business focused on tuning the sounds within ICUs to make them more harmonious. These sounds still function to alert medical workers to give their attention to particular babies but can create an overall more harmonious working environment.

Harmonious sounds compared with discordant sounds can make a large impact on a young child’s development if spending a significant period in a NICU. Getting equipment manufacturers to tune the pitch or offer adjustable frequency settings of the sounds could make for a more harmonious NICU.

3. Choice of device

With Covid-19 impacting the ability of families to travel, several families are using recording devices in the NICU to connect with the newborn and parents sitting by the bedside. There are a lot of restrictions with equipment that can be brought into a NICU. Important care must be taken that any sound or recording equipment does not interfere with sensitive medical monitoring equipment as well as the fragility of newborns.

Equipment with wifi or bluetooth technologies could have harmful side effects to newborns with thinner skulls so care must be taken to select equipment with no external connectivity, while avoiding unnecessary cabling that could also become a hazard. Similarly, there are studies that warn against using phones and tablets that have blue light can overstimulate the baby or damage sensitive developing eyes.

It is not just the sounds that matter, but the ability of such devices to record, store and produce the right timber, range and quality of sound. High fidelity and simple to use audio devices that meet these needs and restrictions can lead to better outcomes.

Devices with a lower frequencies (deeper bass) is preferred, as often this most closely replicate the vibrations passed on during skin-to-skin contact (Kangaroo Care).

4. Choice of Musical Content

There are many theories of what sounds or music should be played to newborns. This is an area of open and rapidly evolving research.

There is no ‘one size fits all’ solution, and it may depend on what a particular newborn’s needs are.  

One conclusion that researchers are aligned on is that jarring and discordant sounds can lead to undesirable outcomes in the wellbeing and development of the child, so there are perhaps some lessons on which types of sounds not to play.

5. Connecting with familiar voices

With Covid-19, families are more separated than ever before. The larger extended family network may not be able to travel to meet a newborn.  Many parents have had to be separated depending on specific visitation policies of NICUs.

Having voice recordings of parents singing soft lullabies and speaking softly can help a child relax, feel safe, and develop a more secure attachment, especially with the mother, as the child develops.

It can sometimes be helpful for extended family and friends to feel a connection with a newborn by making such recordings as well, provided they are soothing and in accordance with the sensitive hearing and more vulnerable nervous system of a premature baby. 

6. Sound as a reward

Most NICUs use sound as a method for highlighting a warning, such as a particular sensor or reminder for feeding. How about if this was reframed, and positive achievements are also rewarded with pleasant tones?

Some researchers are now using music as a reward for hitting various developmental milestones.  Researchers at Florida State University have developed a musical pacifier where a baby who meets particular skills (such as the much-needed suck/swallow/breathe cycle that determines their ability to nurse) is then rewarded with pleasing music. These tools are all in early stages of development, but could be an indication of the new hearables market that is emerging.

7. A ‘Green Room’ for NICU visitors and hospital workers

Fitzpatrick highlights that – as many of NICU workers already know – anxiety and tension that fearful visitors bring into a NICU ward, or even the stress they carry from being out on the streets and navigating their way through the sometimes confusing pathways of the hospital, can also affect the energy that a newborn feels in unintended ways.

A meditative and musically soothing ‘green room’ for parents and family to pass through and take pause just before their visit could help them be more relaxed and present themselves. This, in turn, could make a world of difference in the highly sensitive world of the newborn.

Finally, we should not forget about the committed front line medical staff working in the NICU’s and how music and sound impact their psychological, emotional and physical wellbeing as they enter and exit the NICU, as well as take breaks in staff rooms or similar ‘green rooms.’

As Frank Fitzpatrick says, “It takes a healthy village to raise a healthy child. And using music and sound as a path for optimal wellbeing can help all of us in that village.”

Going Beyond the NICU

Whilst there are a lot of other factors that play a role in the NICU, attention on sound, harmony and music within a NICU can also help create a positive developmental environment for babies and parents, which become particularly important in the era of physical distancing due to Covid-19.

What can work in a NICU can also be applied to other areas of hospitals and healthcare. Even areas such as treatments for Alzheimer’s and Dementia, which Fitzpatrick sees as another large opportunity for applying these techniques and technologies.

In the Age of Covid-19 where distancing is forcing medical workers, therapists and family to be more distant, perhaps this is the sort of innovation that can fuse hardware, content creation and medicine into a new therapeutic sound revolution.