Her first words

At Brigham and Women’s Hospital, study seeks to assess effect of mothers’ voices on premature babies

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By Carolyn Y. Johnson
Globe Staff / March 20, 2011

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Amir Lahav peered into the incubators where his premature twins slept, their frighteningly tiny bodies entwined with tubes and wires. This was a world very different from the womb, he thought.

It wasn’t just the ventilators and the IV lines that made him anxious for Mia and Agami, born 3 1/2 months too soon. A musician and a neurology researcher, Lahav also worried about the din of the neonatal intensive care unit. The soundscape of the womb had been replaced by beeping alarms, pagers, ventilators, and talking.

“Every time the door was open, there was so much noise coming in from the room,’’ Lahav said.

He persuaded Dr. Steven Ringer, chief of newborn medicine at Brigham and Women’s Hospital, to allow him to play a recording of his wife, Galit, speaking to the infants. When the parents could not be there to snuggle the babies directly on their skin, the recording could be played on a small speaker in their incubators. He hoped it would make the hospital sound more like the womb, in which babies can hear their mother’s muffled voice and heartbeat.

At the time, in 2007, Lahav was thinking with his gut, not his head. But he began to realize this was a critical period — a time when the twins’ developing brains were especially malleable, with neurological connections being formed and molded as easily as Play-Doh. He wondered whether the abrupt change in the acoustic environment could be one reason that premature babies are more likely to have developmental problems later, including learning disabilities, cognitive or language deficits, or attention problems.

So when the infants finally left the neonatal intensive care unit after about 2 1/2 months, Lahav returned with a proposal to rigorously test whether exposing preemies to maternal sounds could affect their health — both in the hospital and later in life.

Researchers have found that music can have effects on the brain. A small 2007 study led by Dr. Claudius Conrad at Massachusetts General Hospital found that critically ill patients who listened to music had reduced stress hormone levels, lower blood pressure and heart rate, and less need for sedation. Dr. Gottfried Schlaug, a neurologist at Beth Israel Deaconess Medical Center, has found that a therapy that combines tapping with one hand while singing words and phrases on two pitches can help stroke patients regain speech.

“There seems to be this interesting connection with sound and music and brain function, so it certainly makes sense on the common-sense level,’’ Ringer said. “It’s a tremendous leap from there to saying it can facilitate neurodevelopment, but to me, it’s an intriguing enough question that it’s worth examining it.’’

A few studies have looked at the effect of a mother’s voice on preterm infants and they hint at possible benefits. Lahav persuaded Ringer to allow him to explore the question systematically and he was hired as director of the neonatal audio facilitation program at the Brigham. He and his team worked up ways to record and safely deliver sounds similar to those in the womb. Last summer they launched the trial, in which babies are randomly assigned to receive either a 45-minute dose of maternal sounds four times a day or normal care.

Maggie, born 10 weeks early, was one of the preemies selected. Nicole Lamar went to the neonatal intensive care unit recording studio where she read a book, talked to Maggie, and sang a song. Her heartbeat was recorded as well.

Lamar said she didn’t have time to prepare her thoughts, but found words pouring out; after all the stress of the previous few days, she suddenly had so much she wanted to say.

The recordings were passed through filters and Lamar’s heartbeat was superimposed, to approximate how it might sound in the womb, resulting in a soothing, muffled message of love: “Hi Maggie, it’s Mama. I wanted to tell you about all the people who are waiting for you at home,’’ she said, introducing her to her big sister, Addie.

Initially, Lamar said, all the concerns are short-term: “Are her lungs going to be OK?’’ But gradually, parents begin to worry longer term, and about brain development. “They really can’t offer any assurance that long term she will be OK,’’ Lamar said. “You want to give your child every opportunity.’’

The results aren’t in yet — the study is in its earliest stages, with Lahav still enrolling the 100 babies he hopes to sign up, and seeking grants to support the research. Lahav says there are encouraging though extremely preliminary data: Babies listening to maternal sounds seem to have fewer spells of apnea or bradycardia, episodes in which breathing stops or heartbeat slows.

Interest is growing in the idea. Dr. Frank Pigula, a cardiac surgeon at Children’s Hospital Boston, has begun to collaborate with Lahav and wants to test whether altering the environment in the cardiac intensive care unit, where babies born with congenital heart defects recover from surgery, could help their developing brains grow and organize.

Alterations to care in the neonatal intensive care unit have already been shown to have beneficial effects. Heidelise Als, director of neurobehavioral infant and child studies in the psychiatry department at Children’s, has developed a care method that emphasizes skin-to-skin contact and detailed observation and attention to the baby’s stress levels. Studies that track babies who receive this type of care have found a range of effects, from improved feeding and growth to better cognitive abilities and motor skills.

Als said any study that demonstrates a way to improve vulnerable premature babies’ health long term would be exciting, but she also worries that a technological intervention is the opposite of what research has already shown to be beneficial.

“My fear is the results will be, ‘You won’t need to be there. You can record your voice and give it to your baby,’ ’’ Als said. “That would be the saddest and most devastating result.’’

But for parents like Lamar and her husband, Nathan, who spend as much time as they can each day with Maggie and find it heartbreaking to leave, the study is already having positive results by providing a little comfort.

“Every day I feel like my head conflicts with my heart,’’ Nicole Lamar said. “My head knows this is the best place for her to be, to get strong. In my heart, I want to scoop her up and take her home.’’

Carolyn Y. Johnson can be reached at

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