Background Parental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants. Methods We conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 – December 2019) (n = 101) and during the pandemic (March 2020 – December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother’s need for psychological support during NICU stay and the duration of psychological follow-up after discharge. Results In our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found. Conclusion Pandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations.

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This article outlines the shifts in NICU music therapy due to the COVID-19 pandemic in Italy, Japan, and Colombia, from the beginning of the outbreak in each of the countries until September 2020. Detailed information will be provided on how the pandemic has changed hospital policies and has had an impact on the families and the music therapy services. Furthermore, the authors discuss current biosecurity protocols, parental visiting guidelines, telehealth strategies, and the financial impact of the pandemic. While the way healthcare workers and healthcare institutions cope with the current situation may be unique according to cultural and societal particularities in each country, many overlaps between the three countries were found.

Background: Music and music therapy, live or recorded, has been gradually introduced in the Neonatal Intensive Care Unit (NICU) of our Hospital in addition to standard medical and nursing care, to improve premature neonates’ neurophysiological development. The present study focused on music genres, starting from the parents’ sound experience and musical tastes that neonates experienced during the pregnancy period. The study explored the effects of different music genres also on Extremely Low Birth Weight (ELBW) neonates since most studies refer to Very Low Birth Weight (VLBW) neonates with birth weight > 1000 gr. The study aims to investigate the influence of different music genres on Heart Rate Variability (HRV) of preterm neonates.Methods: a prospective randomized study was conducted. Preterm neonates (gestational age <32 weeks, birth weight <1500g), were recruited. On the basis of birth order, they underwent a daily randomized music listening program (25 minutes, every day, for 3 days) based on different music genres listening (soft pop-rap, pop-rock and classical music), followed by 1 day of no music monitoring (25 minutes). An electrocardiogram was performed to evaluate HRV parameters in each neonate with and without music exposure.Results: twenty-seven (13 ELBW, birthweight <1000 g and 14 VLBW, birthweight 1000-1500 g) infants were included and HRV parameters were analysed. In the VLBW group no significant results were found between the music genres. In the ELBW group, during Soft Pop-Rap music listening, starting after 5 minutes High Frequency (HF) increase significantly (HF P =0.0096) and Low Frequency (LF) and LF/HF indices decrease significantly (LF P= 0.0096; LF/HF P=0.0068). The same trend was from 15 minutes of music listening high frequency (HF) increased and low frequency (LF) decreased (LF P=0.007; HF P= 0.007), Consequently LF/HF also decreased significantly (LF/HF P = 0.0093).Conclusion: A significant decrease in the activity of the sympathetic and a simultaneous increase of the parasympathetic nervous system were found in the ELBW group during Soft Pop-Rap music listening. Further studies with a larger sample size are needed to confirm these findings and to elucidate the underlying mechanisms.Trial registration: ClinicalTrials.gov Identifier: NCT04049526 The Effects of different music genres on heart rate variability in extremely and very low birth weight new-borns.

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