May 29, 2008 -- Singing a lullaby to a baby may not sound like cutting-edge scientific research, and to many parents it comes naturally. But one doctor believes a simple melody might actually be a powerful tool in reducing pain and speeding the recovery of premature babies.
"There are millions of babies born every year in the U.S.," said Dr. Mark Tramo, a professor of neurology at Harvard Medical School. "And the number of premature babies that are being born is increasing remarkably, [but] what's being done to ameliorate the pain and suffering that they go through?"
After Tramo's daughter, Cadence, was born three weeks premature, he felt music played a part in helping her recover in intensive care.
"She had a feeding tube," said Tramo, "and I arrived on the scene around three in the morning and I said 'No, no, no. I'll try and feed Cadence.' So I kind of palmed her and held her in my hand. And started feeding her… and like a lot of songs you write it just comes to you. So I started singing 'Bright, bright world, clear, clear day, I'm a little baby drinking.'"
His daughter never needed a feeding tube again, which got Tramo thinking about the relationship between two of his life's passions — medicine and music.
The Medicine of Music
"Well I started playing [guitar] when I was 6," Tramo said. "Beatles arrived when I was 7, and then when I was in medical school we had a rock band at Yale. The entertainment business isn't the most reliable business even if you make it. My parents would have killed me after paying for Yale."
Tramo went on to teach neuroloogy at Harvard Medical School. While there, he conducted an experiment at Massachusetts General Hospital for Children to see whether he could confirm his theory that music is good medicine.
"What we did was find that traditional Western lullabies were able to decrease the stress and pain response to procedures," he said. "Relative to a control group, more than twice as much."
Tramo studied premature babies who routinely have their blood drawn using a painful procedure called a heelstick.
"The procedure itself requires the warming of a heel so that you increase the blood supply," said Peggy Settle, Nursing Director for the Neonatal Intensive Care Unit (NICU) and co-author of Tramo's study. "And then they use a lancet to actually a use a pin prick … into the edge of a baby's heel so that you can obtain blood to send off to a blood test. It's a preferred method of obtaining blood in the newborn population."
Quiet Lullaby Quells Baby in Pain
The technique is also very painful, especially for infants. While "Nightline" was visiting the NICU, they observed as a preemie who was less than 24 hours old was administered a heelstick.
"The baby started crying, and the heart rate went up when the heel was punctured," said Tramo. "The heart rate went up about 10 beats per minute. And you could see the stress — this baby's stress response included crying."
Tramo measures a baby's level of pain by behavioral responses such as grimacing or crying, as well as physical responses.
"And what you see is the heart rate go up," said Tramo. "If you're monitoring the blood pressure, that would go up too. [The] respiratory rate could change. So you can use the heart as a window into the brain."
After the nurse bandaged the baby's heel, a speaker was placed in the incubator and a quiet lullaby was played. The baby's heart-rate decreased, a response Tramo has observed in case after case during the course of his study.
"So our study showed the heart rate went down more than twice as much after the heel stick if they got music than if they didn't," said Tramo. "In the realm of measurements we make, more than twice as much is a big effect."
Which Lullabies Work Best?
There is also evidence that premature babies exposed to music may actually get out of intensive care sooner.
"There's some terrific data that's been published in nursing journals," said Tramo. "And what their data show thus far is babies gain weight faster and stay in the intensive care unit environment shorter time if they are receiving some kind of calibrated structured sound, vis a vis music."
But why a lullaby? Why not something edgier, like Guns N' Roses?
"The rhythmic structure is simple, and the tempo's relatively slow," said Tramo. "The melody is diatomic or pentatonic, meaning that it's very simple, so it's relatively easy to digest for the hearing system. [The harmony] is very simple."
Research suggest humans are programmed to respond to music. Proof of this, Tramo says, is that there is no known human culture without music.
"We have an innate predisposition to be able to apprehend an emotion and meaning in music," said Tramo. "When you listen to a baby babble, and they're experimenting with their voice and learning how to make vocal sounds by usuing the vocal apparatus as an instrument — the first musical instrument was voice — they have pitch in their voice, there's melody to what they're doing and some rhythm to it."
Babies Know Good Music
This could explain why mothers across cultures instinctively sing to their babies, even when they aren't actually singing a song at all.
"Well I think we have a lot to learn from mothers, as usual," said Tramo. "[Mothers have] learned to communicate to the baby using the kinds of sounds that the baby makes when the baby babbles or tries to communicate."
Tramo believes that even the youngest humans innately know good music when they hear it.
"I think it's a challenge to think about music as a scientific or music as a therapeutic intervention in this patient population," said Settle. "Many interventions in newborn intensive care units have not been exposed to rigorous scientific study."
He also believes more extensive studies are long overdue.
"It's very hard right now to get any sort of third party payer support for non-pharmacological and non-surgical interventions," said Tramo. "Apollo was the god of both music and medicine in the Greek tradition. Music is such an essential part of the human condition, it can't be ignored. It's really something that we need to know about, and it's what makes us human."
This is why for Mark Tramo, reuniting the art of song with the science of healing is his life's calling.
Dr. Mark Tramo will discuss these findings and others that point to the human brain's innate and universal capacity for music on Saturday, May 24 as part of the World Science Festival (CLICK HERE for more information).
CLICK HERE to visit Tramo's Web site for more information.