Effect of lullaby on volume, fat, total protein and albumin concentration of breast milk in premature infants’ mothers admitted to NICU: a randomized controlled trial

Abstract

Background Listening to music can reduce or manage stress, fatigue, and accompanying symptoms in mothers. Music increases oxytocin secretion which affects breast milk. This study aimed to examine the effect of lullaby on volume, fat, total protein and albumin concentration of breast milk in mothers of premature infants admitted to the NICU. Methods This clinical trial was performed on 100 primiparous mothers whose premature infants were hospitalized in the NICU of Ayatollah Rouhani Hospital from January 2020 to December 2020. Using block randomization method, the participants were divided into three groups: control (A), playing lullaby for mother (B) and playing lullaby for a mother while holding a photo of her own baby (C). The mothers of the intervention groups listened to lullabies through headphones for 30 minutes every morning for 6 days. On the first and the sixth day of birth, the volume of breast milk (ml) and two milliliters of breast milk samples of all three groups were measured and compared in terms of fat, albumin concentration and total protein (mg/DL). ANOVA, Paired T-Test and ANCOVA model (the included variables were: basic value of dependent variable, group type, Maternal age, Birth weight, Gestational age and Maternal weight) was used for analytical statistics. Results The difference between the mean compositions of breast milk before and after the intervention in three groups of A, B and C: in terms of the breast milk volume were 66.33 ± 4.80, 71.30 ± 4.18 and 75.91 ± 6.80 ml; in terms of triglyceride level was 177.84 ± 50.57, 210.72 ± 34.55 and 224.17 ± 12.97 mg/DL, cholesterol level was 14.57 ± 3.70, 21.96 ± 3.82 and 26.26 ± 5.16 mg/DL, albumin concentration was 0.90 ± 0.30, 1.22 ± 0.19 and 1.46 ± 0.28 mg/DL and total protein level was 1.61 ± 0.61, 2.20 ± 0.57 and 2.72 ± 0.30 mg/DL. Finally, the results of ANCOVA analysis for the effects of the intervention, taking into account the baseline values, showed that the intervention was effective and had the greatest effect on cholesterol levels. Conclusion In this small trial, there was a statistically significant association between trial arm and biochemical composition of breastmilk though further studies are needed to see if these changes result in meaningful clinical outcomes to the infant. Trial registration IRCT, IRCT20191114045439N1. Registered 14 January 2020- prospective, https://en.irct.ir/trial/43671

Relaxation Therapy and Human Milk Feeding Outcomes

“…Nine of 16 studies had high risk of bias for at least 1 outcome. Five studies reported at least 1 outcome with low risk of bias.…”

“…Ten randomized clinical trials (RCTs) contributed to this outcome, measuring milk quantity expressed in neonatal intensive care unit (NICU) settings or drunk by a healthy infant at the breast (deuterium isotope or test weighing) . The studies used lactation-specific–guided relaxation, music, breathing exercises, and a mindfulness app . Five studies were at high risk of bias for this outcome (due to insufficient washout period in a crossover study, missing outcome data or selection of reporting).…”

“…There was high-certainty evidence of no difference in milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 3 studies, 205 participants) (Figure 3B). Three RCTs contributed to this outcome, reporting change in milk protein from baseline, spanning an intervention period of 6 days to 8 weeks. One study was classified as some concerns for risk of bias due to missing data.…”

“…One study was classified as some concerns for risk of bias due to missing data. Although 1 study dominates the meta-analysis, removing this study produced the same conclusion (MD, 0 g/100 mL; 95% CI, −0.05 to 0.05; 139 participants).…”

“…Three protocols are designated as reports of included studies. The updated search added 15 reports of 12 studies to the 4 eligible studies found in the original search. Of the 16 included studies, there were a total of 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years).…”