THE EFFECT OF REPEATED MOZART LISTENING

ON ENERGY EXPENDITURE IN GROWING PRETERM

INFANTS
Ronit Lubetzky, MD, Idit Mizrachi, MD, Francis B. Mimouni, MD,
Dror Mandel, MD

Neonatology and Pediatrics, Dana Dwek Children’s hospital, Tel Aviv Medical
Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Disclosure Statements for Conflicts of Interest:
Nothing to disclose
 Mozart Effect
• Enhancement of performance or a change in neurophysiological
activity that is associated with listening to music.

• Music has been shown to reduce stress even in premature

infants.
 Previous Studies
• In small, healthy growing preterm infants, exposure to music by
W.A. Mozart significantly reduced resting energy expenditure
(REE) by approximately 7.7-13% from baseline, an effect obtained
within 10-30 minutes.
• J.S. Bach music did not have such an effect.

Lubetzky, Pediatrics 2005 Rosenfeld-Keidar, J Perinatol 2014

 Aim and Hypothesis
• Whether or not the Mozart effect is sustained after exposure to
the same music is unknown.

• We conducted the following randomized prospective clinical trial

in order to test the hypothesis that repeated exposure to Mozart
music over consecutive days leads to a sustained reduction in
REE.
 Methods - Patients
• Healthy, growing, AGA, gavage-fed infants at the postmenstrual
age of 30-37 weeks.

• All infants were clinically and thermally stable, and were cared for
in a skin servo controlled incubator.

• Full enteral feeding (150-160 cc/kg weight/day).

• None had any significant complication of prematurity (IVH, PVL,

NEC, BPD), active infection, PDA, or AOP.

• All had normal brain stem auditory responses.

 Methods - Design
• Infants were exposed to the same recorded 30-minutes Mozart
music over 4 consecutive days.

• Music was initiated 10 minutes prior to the beginning of the

metabolic measurements and was continued for the 30 minutes
of REE recording.

• Metabolic studies were conducted while the infants were prone

and asleep, and at the same time of the day (noon time) for all
infants, starting one hour after the completion of the last feed.

• The same food (human milk or formula) and the same amount
were given to the infants on all study days.
 Methods – music melodies
• Sonata for Piano No. 16 in C major, K. 545 "Sonata
semplice": I. Allegro
• Sonata for Piano No. 10 in C major, K. 300h/330: I.
Allegro moderato
• Variations on "Ah vous dirai-je, maman", no.1, 8 and
11, K265/300e
• Sonata for Piano No. 18 in D major, K. 576
"Trumpet", "Hunt": III. Allegretto
• Sinfonia Concertante in C major for Flute, Harp &
Orchestra, K. 297c/299: I. Allegro
• Sonata for Piano No. 11 in A major, K. 300i/331 "Alla
Turca": III. Rondo alla Turca. Allegretto
• Sonata for Piano No. 16 in C major, K. 545 "Sonata
semplice": II. Andante
• Sonata in D for Two Pianos, K448, 1st movement
• The Magic Flute, K620, Papageno Arias No. 2 and 20
 Methods - Design
• During the metabolic study infants were cared for in their own,
convective incubator.

• Air temperature inside the incubator was skin servo-controlled in

order to keep temperature over the back at 37° Celsius.

• Thus, all REE measurements were made in nearly identical

thermal environments.
 Methods - Measurements
• Metabolic measurements were performed by indirect
calorimetry, using the Deltatrac II Metabolic monitor (Datex-
Ohmeda, Helsinki, Finland).

• This instrument uses the principle

of the open circuit system that
allows continuous measurements
of oxygen consumption (Vo2) and
carbon dioxide production (Vco2)
using a constant flow generator.
Methods - Statistical analysis
• This study is a pilot one that was designed to estimate the
effect size of music upon REE. Thus, an empirical number of 10
infants (that is 40 planned measurements) was chosen.

• Comparison of REE values between measurements was

performed using non parametric paired Wilcoxon tests.

• For this purpose, REE results (recorded every minute by the

instrument) were averaged over the first, second and third 10-
minute periods of the consecutive 30-minute total study time.
Results
• Ten preterm infants were recruited into the study.

• A total of 33 REE measurements were performed.

• For technical reasons (mostly the fact that infants were weaned
from incubator by the attending physician), not all 4 studies were
performed in all infants.

• Four consecutive measurements were performed in 5 infants, 3

measurements in 3 infants, and 2 measurements in 2 infants.

• None were excluded from the study.

Results - Demographic and clinical characteristics
Maternal age (years) 36.5 ± 6.8 (30-49)
Gravidity 1 (1-4)
Parity 1 (1-3)
Prenatal steroids (Celestone) 10 (100)
Gender of infants (male:female) 4:6
Gestational age (weeks) 28.5 ± 2.4 (25-32)
Birthweight (grams) 1079 ± 242 (785-1537)
Apgar 1 5 (5-9)
Apgar 5 8.5 (7-10)
HFOV duration (days) 3.3 ± 3.5 (0-11)
CPAP/HHHFNC duration (days) 10.5 ± 16.8 (0-45)
Erythropoietin treatment 6 (60)
Caffeine treatment 5 (50)
Chronological gestational age (weeks) 33 ± 0.9 (32-34)
Chronological age (days) 32.2 ± 20.5 (11-64)
Weight (grams) 1417 ± 91 (1240-1523)
Results - Resting energy expenditure (kcal/kg/day) measurements
REE
mean ± SD Day 1 Day 2 Day 3 Day 4
median
(range)
0 - 10 minutes 84.5 ± 13.1 84.1 ± 11.8 85.0 ± 12.0 90.9 ± 14.1
81 85.9 84.5 90.6
(65.9 to 103.2) (66.2 to 103.3) (68.1 to 105.0) (71.9 to 109.3)
10-20 minutes 82.2 ± 11.9 81.9 ± 12.6 84.8 ± 11.7 89.5 ± 13.1
83.1 81.8 87.5 88.5
(64.0 to 99.8) (65.2 to 100.2) (68.9 to 98.3) (73.0 to 98.3)
20-30 minutes 80.0 ± 11.5 80.7 ± 12.3 84.5 ± 9.8 89.4 ± 14.6
76 78.1 84.4 87.4
(64.4 to 95.5) (65.0 to 101.2) (69.9 - 96.9) (74.4 to 96.9)
Delta average 4.5 ± 4.8 3.4 ± 5.5 0.52 ± 6.6 1.5 ± 6.2
REE 4.6 3.75 -0.95 -2.4
(-2.7 to 12.7) (-5.6 to 10.5) (-6.1 to 14) (-3 to 11.3)
P value <0.017 <0.08 <0.82 <0.61
 Discussion
• In the current study, similar to our previously published studies
we confirm that Mozart music has a reducing effect on REE.

• Contrary to our hypothesis, we found that using the same

recording, this effect is blunted on day 2, and nearly inexistent on
days 3 and 4.

• Habituation is a fundamental form of learning manifested by a

stimulus-specific decrement of neuronal responses to repeated
sensory stimulation with the same or a similar stimulus.

• Limitations.
 Conclusion
• Exposure to Mozart music significantly lowers REE in healthy
preterm infants at the first listening.

• Using the same recording, this effect is blunted on day 2 and

nearly null on days 3 and 4.

• We speculate that auditory habituation is operative

in young healthy preterm infants.