الفهرس 
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Abstract
Rapid somatic and neurologic growth for the infants occurs during the last trimester of pregnancy and the first three months of life. These potentially critical periods of accelerated growth are interrupted when premature infants are delivered before completion of 37 weeks of gestation. They are forced to extra- uterine existence before proper development of life – sustaining systems. The initial censorious period of transition from intra to extra- uterine environment may last for only few hours. While, adaptation to extra- uterine life may take several weeks to many months depending on degree of prematurity. Pediatric nurses are increasingly aware that the acoustic environment in the NICU may affect infants’ adaptation and well-being,where unpredictable noise adversely affects sleep and physiological stability. Meaningful auditory stimulation, such as music and recorded mothers’ heart beats, might contribute to the neurodevelopment of premature infants and helps to maintain their normal physiophysical parameters and feeding tolerance.
The aim of the current study is to determine the effect of mothers’ heart beats versus soft music on prematureinfants’ physiophysical parameters and feeding tolerance.
The study was conducted in Neonatal Intensive Care Units of the Maternity University Hospital at El-Shatby and the Specialized University Hospital at Smouha in Alexandria.A convenience sampling of 90 premature infants comprised the subjects. Infants were being randomly assigned to three equal groups: two study groups and one control (each group consisted of 30 premature infants). Study group (I):Thirty premature infants who heard their mothers’ heart beats in addition to the routine care of the unit. Study group (II):Thirty premature infants who heard soft music in addition to the routine care of the unit. Control Group: Thirty premature infants who received only the routine care of the unit.
Three tools were used to collect data of the present study,namely:biosociodemographic characteristics and medical history of premature infants assessment sheet, premature infants physiophysical parameters assessment tool and feeding tolerance of premature infants assessment tool.They were developed by the researcher after reviewing the relevant literature.
The main results of the present study were as follows:
The highest percentage of the premature infants had gestational age ranged from 30 to less than 32 weeks of gestation for both of the studied groups (40% for each) and 60% for the control group.
Approximately two third of the premature infants who heard soft music and control group were females (66.7% for each) compared to 56.7% for those heard mothers’ heart beats.
Mean birth weight of premature infants who heard their mothers’ heart beats,soft music and control group was 1153.67±127.51, 1140.17±116.53, 1185.40±121.51 respectively.
Slightly more than one third of premature infants who heardheart beats and soft music weightranged from 900 gm to less than 1000 gm (36.7% for each). While, 40% of premature infants in the control group weighing 1100gm to less than 1200gm.
The range of temperature ,especially upper value, of premature who heard mothers’ heart beats were lower than those of control group withno statistical significant differences were shown between both groups throughout the study period except at 8th and 13th day(P = 0.001,0.000).
No statistical significant differences were shown between premature infants who heard soft music and control group throughout the study period except at 7th and 8th day, where means body temperature for premature infants who heard soft music were 35.68±0.119 and 35.71±0.187 respectively compared to the means of those on control group as they were 36.81±0.526 and 36.69±0.501 respectively (P = 0.000 for both).
Although temperature of both study groups were within normal value,range of temperature in most of the study period of premature who heard their mothers’ heart beats were lower than those who heard soft music.
The mean heart rates of both the premature infants who heard their mothers’ heart beats and the premature in the control group were within normal range but, the means heart rate of premature infants who heard mothers’ heart beats were less than those in the control group in all the studied days with no statistical significant differences found between both groups throughout the study period except at 14th day.
The means and the upper value of heart rates of premature infants who heard soft music were less than those in the control group.No statistical significant differences were found between both groups throughout the study period except at 14th day, where mean heart rate for premature infants who heard soft music was 142.73±8.828 compared to the mean of those in control group as it was 152.33±20.22.
Although means of heart rates of premature infants who heard their mothers’ heart beats and those who heard soft music were within the normal value, the mean values and the range, especially upper value of those who heard their mothers’ heart beats were less than those who heard soft music in most of the studied days. The differences were not statistically significant.
The means respiratory rate of premature infants who heard mothers’ heart beats were less than those in the control grouphowever, the means respiratory rates were within the normal range in both groups in all studied days with no statistical significant differences were shown between both groups throughout the study period except at 12th, 13th and 14th day.
Means and range especially upper value of respiratory rates of premature who heard soft music were lower than those on control group in all the study period with no statistical significant differences found between both groups throughout the study period except at 7th, 12th, 13th and 14th day.
No statistical significant differences were shown those who heard their mothers’ heart beats and those who heard soft music except in 4th day where mean respiratory rate for premature infants who heard heart beats was 53.03±9.114 compared to the mean of those heard soft music as it was 58.47±7.357 and P=0.014.
The mean and the range of oxygen saturation were higher on premature infants who heard their mothers’ heart beats than those on control group. The differences in the mean were statistically significant between both groups throughout all the study period except at 12th day.
The mean oxygen saturation for premature infants who heard soft music was better than that those who were in control group.However, the oxygen saturation means for both groups within the normal range with statistical significant differences between both groups throughout the study period (P= 0.000) except at 11th day of the study.
No statistical significant differences were found between premature infants heard mothers’ heart beats and those who heard soft music as regard mean oxygen saturation as p ≥ 0.05. The range of oxygen saturation in both groups was within the normal value.
The mean and the range of weight and MAC were higher on premature infants who heard their mothers’ heart beats than those in the control group as there were statistical significant differences between both groups on 7th, 14th, 21th and 28th days.
The mean weight and MAC of premature infants who heard soft music were more than those of the control group in 7th, 14th, 21th, and 28th days. There were statistical significant differences between both groups in all the studied days except in 4th and 7th day regarding weight and in 4th day only regarding MAC.
Although, the mean and the range of weight were better in premature infants who heard their mothers’ heart beats than those who heard soft music throughout the studied days, there were no statistical significant differences shown between both groups throughout the study period except at 14th and 28th days.
The mean and the range of MAC in premature infants who heard their mothers’ heart beats were higher than those who heard soft music with statistical significant differences between both groups in all the studied days except in 4th and 14th days.
There were statistical significant differences regarding method of feeding between either premature infants who heard their mothers’ heart beats or soft music and those in the control group throughout the study period.
There were no statistical significant regarding method of feeding differences between premature infants who heard their mothers’ heart beats and those heard soft music throughout the study period regarding method of feeding.
The mean milk volume/ feed and total feeding volume/ day were higher foreither premature infants who heard mothers’ heart beats orsoft musicthan those of the control one in all the studied days with statistical significant differences between both groups throughout the study period.
The mean milk volume/ feed and the total feeding volume/ day was more in premature infants who heard mothers’ heart beats than those who heard soft music throughout the studied days except in 33th day.
There were statistical significant differences between premature infants who heard their mothers’ heart beats and those in control group as well as between premature infants who heard soft music and those in control group regarding gastric residual volume in 4th, 13th, 23th as P ranged from 0.038 to 0.000.
There was no statistically significant difference between the premature infants who heard their mothers’ heart beats and those who heard soft music throughout the study period except on the13th day.
There were statistical significant differences between premature infants who heard their mothers’ heart beats and those on control group regarding vomiting in all studied days and between premature infants who heard soft music and those in control group as well.
No statistical significant differences was found between premature infants who heard their mothers’ heart beats and those in control group regarding presence of visible bowel loops.
None of premature infants who heard soft music in the 4th day have visible loops compared to 80% of those in the control group after feeding and the difference was statistically significant difference where p was 0.009.
The effect of soft music was slightly better than mothers’ heart beats after feeding and there was no statistical significant difference between both groups regarding presence of vomiting and visible bowel loops in all studied days.
There were no statistical significant differences between premature infants who heard their mothers’ heart beats and those on the control group regarding constipation in all studied days except in 23th day where P was 0.038 and regarding diarrhea there were no statistical significant differences through the study period.
There were no statistical significant differences between premature infants who heard soft music and those on control group regarding presence of constipation or diarrhea in all studied days except in 23th day for constipation as P was 0.038 and on the 4th day for diarrhea where p was 0.019.
Although the effect of soft music was slightly better than mothers’ heart beats after feeding in 4th day of the study for both presence of constipation and diarrhea and in 13th day for presence of diarrhea, it was obvious that there was no statistical significant difference between both groups in all the studied days.
There were statistical significant differences between premature infants who heard their mothers’ heart beats and those on control group as well as between premature infants who heard soft music and those in control group regarding tachycardia in all studied days as P ranged from 0.038 to 0.000.
There were statistical significant differences between the premature infants who heard their mothers’ heart beats and those in the control group as well as between premature infants who heard soft music and those in control group regarding presence of apnea in all study period except in the 33th day (P was 0.150).
There was no statistical significant difference between premature infants who heard mothers’ heart beats and soft music throughout the studied days regarding presence of tachycardia and apnea.
There were statistical significant differences regarding abdominal distension between premature infants who heard mothers’ heart beats and those in control group as well as between premature infants who heard soft music and those in control group throughout the study period as P was ranged from 0.000 to 0.009.
There were no statistical significant differences regarding abdominal distension between premature infants who heard mothers’ heart beats and soft music throughout the study period.