Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

A prospective randomized crossover trial studying the effects of maternal heartbeat and voice sounds on resting energy expenditure in preterm infants

Journal of Perinatology volume 46, pages 410–415 (2026)Cite this article

Subjects

Abstract

Objective

To compare resting energy expenditure (REE) among premature infants exposed to recorded maternal heartbeat and voice (MHV) vs. ambient noise.

Study design

A prospective, randomized crossover pilot trial evaluating the effect of MHV on REE using indirect calorimetry in hemodynamically stable premature infants born at 26–34 weeks’ gestation. MHV recordings were digitally overlapped, and exposure sequence was randomized.

Result

Among 34 measurements from seventeen subjects, REE was significantly lower during MHV exposure compared to ambient noise (61.4 ± 10.3 vs. 70.9 ± 10.3 kcal/kg/day, p = 0.0001). Mean heart rate was also significantly lower with MHV (144 ± 13 vs. 150 ± 11 bpm, p = 0.028), with no differences in other vital signs.

Conclusion

REE of premature infants decreased during exposure to MHV when compared with ambient noise. MHV may serve as a potential noninvasive therapeutic intervention to improve metabolic efficiency in premature infants, potentially helping with improved growth.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Change in resting energy expenditure per kilogram of weight with MHV and ambient sound exposures.
Fig. 2: Fractional change in resting energy expenditure for entire cohort.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Hepper PG, Shahidullah BS. Development of fetal hearing. Arch Dis Child Fetal Neonatal Ed. 1994;71:F81–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Noise: a hazard for the fetus and newborn. American Academy of Pediatrics. Committee on Environmental Health. Pediatrics. 1997;100:724–7.

  3. Pineda R, Guth R, Herring A, Reynolds L, Oberle S, Smith J. Enhancing sensory experiences for very preterm infants in the NICU: an integrative review. J Perinatol. 2017;37:323–32.

    Article  PubMed  CAS  Google Scholar 

  4. Brandon DH, Holditch-Davis D, Belyea M. Preterm infants born at less than 31 weeks’ gestation have improved growth in cycled light compared with continuous near darkness. J Pediatr. 2002;140:192–9.

    Article  PubMed  Google Scholar 

  5. Morag I, Xiao YT, Bruschettini M. Cycled light in the intensive care unit for preterm and low birth weight infants. Cochrane Database Syst Rev. 2024;12:CD006982.

    PubMed  PubMed Central  Google Scholar 

  6. Vasquez-Ruiz S, Maya-Barrios JA, Torres-Narvaez P, Vega-Martinez BR, Rojas-Granados A, Escobar C, et al. A light/dark cycle in the NICU accelerates body weight gain and shortens time to discharge in preterm infants. Early Hum Dev. 2014;90:535–40.

    Article  PubMed  Google Scholar 

  7. Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry. 2014;75:56–64.

    Article  PubMed  Google Scholar 

  8. Parga JJ, Bhatt RR, Kesavan K, Sim MS, Karp HN, Harper RM, et al. A prospective observational cohort study of exposure to womb-like sounds to stabilize breathing and cardiovascular patterns in preterm neonates. J Matern Fetal Neonatal Med. 2018;31:2245–51.

    Article  PubMed  CAS  Google Scholar 

  9. Webb AR, Heller HT, Benson CB, Lahav A. Mother’s voice and heartbeat sounds elicit auditory plasticity in the human brain before full gestation. Proc Natl Acad Sci USA. 2015;112:3152–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Loewy J, Stewart K, Dassler AM, Telsey A, Homel P. The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics. 2013;131:902–18.

    Article  PubMed  Google Scholar 

  11. Rand K, Lahav A. Maternal sounds elicit lower heart rate in preterm newborns in the first month of life. Early Hum Dev. 2014;90:679–83.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Scala M, Seo S, Lee-Park J, McClure C, Scala M, Palafoutas JJ, et al. Effect of reading to preterm infants on measures of cardiorespiratory stability in the neonatal intensive care unit. J Perinatol. 2018;38:1536–41.

    Article  PubMed  Google Scholar 

  13. Provenzi L, Broso S, Montirosso R. Do mothers sound good? A systematic review of the effects of maternal voice exposure on preterm infants’ development. Neurosci Biobehav Rev. 2018;88:42–50.

    Article  PubMed  Google Scholar 

  14. Zimmerman E, Keunen K, Norton M, Lahav A. Weight gain velocity in very low-birth-weight infants: effects of exposure to biological maternal sounds. Am J Perinatol. 2013;30:863–70.

    Article  PubMed  Google Scholar 

  15. Lubetzky R, Mimouni FB, Dollberg S, Reifen R, Ashbel G, Mandel D. Effect of music by Mozart on energy expenditure in growing preterm infants. Pediatrics. 2010;125:e24–8.

    Article  PubMed  Google Scholar 

  16. Birnholz JC, Benacerraf BR. The development of human fetal hearing. Science. 1983;222:516–8.

    Article  PubMed  CAS  Google Scholar 

  17. Lim R, Brichta AM. Anatomical and physiological development of the human inner ear. Hear Res. 2016;338:9–21.

    Article  PubMed  CAS  Google Scholar 

  18. Pujol R, Hilding D. Anatomy and physiology of the onset of auditory function. Acta Otolaryngol. 1973;76:1–10.

    Article  PubMed  CAS  Google Scholar 

  19. Querleu D, Renard X, Versyp F, Paris-Delrue L, Crepin G. Fetal hearing. Eur J Obstet Gynecol Reprod Biol. 1988;28:191–212.

    Article  PubMed  CAS  Google Scholar 

  20. Sohmer H, Perez R, Sichel JY, Priner R, Freeman S. The pathway enabling external sounds to reach and excite the fetal inner ear. Audiol Neurootol. 2001;6:109–16.

    Article  PubMed  CAS  Google Scholar 

  21. Starr A, Amlie RN, Martin WH, Sanders S. Development of auditory function in newborn infants revealed by auditory brainstem potentials. Pediatrics. 1977;60:831–9.

    Article  PubMed  CAS  Google Scholar 

  22. da Rocha EE, Alves VG, da Fonseca RB. Indirect calorimetry: methodology, instruments and clinical application. Curr Opin Clin Nutr Metab Care. 2006;9:247–56.

    PubMed  Google Scholar 

  23. Verma S, Bailey SM, Mally PV, Howell HB. Longitudinal measurements of resting energy expenditure by indirect calorimetry in healthy term infants during the first 2 months of life. Am J Perinatol. 2019;36:918–23.

    Article  PubMed  Google Scholar 

  24. Freymond D, Schutz Y, Decombaz J, Micheli JL, Jequier E. Energy balance, physical activity, and thermogenic effect of feeding in premature infants. Pediatr Res. 1986;20:638–45.

    Article  PubMed  CAS  Google Scholar 

  25. Hulzebos CV, Sauer PJ. Energy requirements. Semin Fetal Neonatal Med. 2007;12:2–10.

    Article  PubMed  Google Scholar 

  26. Mehta NM, Bechard LJ, Dolan M, Ariagno K, Jiang H, Duggan C. Energy imbalance and the risk of overfeeding in critically ill children. Pediatr Crit Care Med. 2011;12:398–405.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Singer P, Singer J. Clinical guide for the use of metabolic carts: indirect calorimetry-no longer the orphan of energy estimation. Nutr Clin Pract. 2016;31:30–8.

    Article  PubMed  CAS  Google Scholar 

  28. Sion-Sarid R, Cohen J, Houri Z, Singer P. Indirect calorimetry: a guide for optimizing nutritional support in the critically ill child. Nutrition. 2013;29:1094–9.

    Article  PubMed  Google Scholar 

  29. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N. JPEN J Parenter Enter Nutr. 2016;40:159–211.

    Article  CAS  Google Scholar 

  30. Howell HB, Farkouh-Karoleski C, Weindler M, Sahni R. Resting energy expenditure in infants with congenital diaphragmatic hernia without respiratory support at time of neonatal hospital discharge. J Pediatr Surg. 2018;53:2100–4.

    Article  PubMed  Google Scholar 

  31. Moreira ME, Vieira AA, Mendes Soares FV, Bastos Lopes R, Gomes P, Abranches AD, et al. Determining the least time required for measuring energy expenditure in premature neonates. J Perinat Med. 2007;35:71–5.

    Article  PubMed  Google Scholar 

  32. Soares FV, Moreira ME, Abranches AD, Ramos JR, Gomes Junior SC. Indirect calorimetry: a tool to adjust energy expenditure in very low birth weight infants. J Pediatr. 2007;83:567–0.

    Article  Google Scholar 

  33. Summer SS, Pratt JM, Koch EA, Anderson JB. Testing a novel method for measuring sleeping metabolic rate in neonates. Respir Care. 2014;59:1095–100.

    Article  PubMed  Google Scholar 

  34. Sohmer H, Freeman S. The pathway for the transmission of external sounds into the fetal inner ear. J Basic Clin Physiol Pharmacol. 2001;12:91–9.

    Article  PubMed  CAS  Google Scholar 

  35. Das R, Jana N, Arora N, Sengupta S. Ultrasound assessment of fetal hearing response to vibroacoustic stimulation. J Matern Fetal Neonatal Med. 2020;33:2326–32.

    Article  PubMed  Google Scholar 

  36. Lee GY, Kisilevsky BS. Fetuses respond to father’s voice but prefer mother’s voice after birth. Dev Psychobiol. 2014;56:1–11.

    Article  PubMed  Google Scholar 

  37. Ockleford EM, Vince MA, Layton C, Reader MR. Responses of neonates to parents’ and others’ voices. Early Hum Dev. 1988;18:27–36.

    Article  PubMed  CAS  Google Scholar 

  38. Kent WD, Tan AK, Clarke MC, Bardell T. Excessive noise levels in the neonatal ICU: potential effects on auditory system development. J Otolaryngol. 2002;31:355–60.

    Article  PubMed  Google Scholar 

  39. Filippa M, Devouche E, Arioni C, Imberty M, Gratier M. Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatr. 2013;102:1017–20.

    Article  PubMed  Google Scholar 

  40. Filippa M, Monaci MG, Spagnuolo C, Serravalle P, Daniele R, Grandjean D. Maternal speech decreases pain scores and increases oxytocin levels in preterm infants during painful procedures. Sci Rep. 2021;11:17301.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Malchaire J, d, Palella AAFR BI. Evaluation of the metabolic rate based on the recording of the heart rate. Ind Health. 2017;55:219–32.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cooper L, Morrill A, Russell RB, Gooding JS, Miller L, Berns SD. Close to me: enhancing kangaroo care practice for NICU staff and parents. Adv Neonatal Care. 2014;14:410–23.

    Article  PubMed  Google Scholar 

  43. Lemmen D, Fristedt P, Lundqvist A. Kangaroo care in a neonatal context: parents’ experiences of information and communication of nurse-parents. Open Nurs J. 2013;7:41–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pathak BG, Sinha B, Sharma N, Mazumder S, Bhandari N. Effects of kangaroo mother care on maternal and paternal health: systematic review and meta-analysis. Bull World Health Organ. 2023;101:391–402G.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Cooper JA, Watras AC, O’Brien MJ, Luke A, Dobratz JR, Earthman CP, et al. Assessing validity and reliability of resting metabolic rate in six gas analysis systems. J Am Diet Assoc. 2009;109:128–32.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Crouter SE, Antczak A, Hudak JR, DellaValle DM, Haas JD. Accuracy and reliability of the ParvoMedics TrueOne 2400 and MedGraphics VO2000 metabolic systems. Eur J Appl Physiol. 2006;98:139–51.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank all the patients and their families for participating in this study. Additionally, we would like to thank Dr. Jonathan Lebowitz for his contribution.

Funding

The Stefan Bennett Fellowship Research Fund in Neonatology and KiDS of NYU provided funding for this study.

Author information

Authors and Affiliations

  1. Division of Neonatology, Hassenfeld Children’s Hospital at NYU Langone, New York City, NY, USA

    Gurpreet Kaur, Sean M. Bailey, Heather Howell, Pradeep Mally & Sourabh Verma

  2. Division of Therapeutic Recreations, Child Life and Creative Arts Therapies, Sala Institute for Child & Family Centered Care, Hassenfeld Children’s Hospital at NYU Langone, New York City, NY, USA

    Stacey Schneider & Elena Savvides

  3. Division of Pediatric Gastroenterology, Hassenfeld Children’s Hospital at NYU Langone, New York City, NY, USA

    Bridget Kiernan

  4. Department of Pediatrics, Family Healthcare Network, Visalia, CA, USA

    Rishika Sharma

Authors
  1. Gurpreet Kaur
    View author publications

    Search author on:PubMed Google Scholar

  2. Sean M. Bailey
    View author publications

    Search author on:PubMed Google Scholar

  3. Stacey Schneider
    View author publications

    Search author on:PubMed Google Scholar

  4. Elena Savvides
    View author publications

    Search author on:PubMed Google Scholar

  5. Heather Howell
    View author publications

    Search author on:PubMed Google Scholar

  6. Bridget Kiernan
    View author publications

    Search author on:PubMed Google Scholar

  7. Rishika Sharma
    View author publications

    Search author on:PubMed Google Scholar

  8. Pradeep Mally
    View author publications

    Search author on:PubMed Google Scholar

  9. Sourabh Verma
    View author publications

    Search author on:PubMed Google Scholar

Contributions

GK, SS, ES, HH, and SV conceptualized and designed the study, collected data, coordinated and supervised data collection, carried out analysis, drafted the initial manuscript, and reviewed and revised the manuscript. SB, BK, RS and PM conceptualized and designed the study, designed the data collection instruments, and critically reviewed and revised the manuscript.

Corresponding author

Correspondence to Sourabh Verma.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaur, G., Bailey, S.M., Schneider, S. et al. A prospective randomized crossover trial studying the effects of maternal heartbeat and voice sounds on resting energy expenditure in preterm infants. J Perinatol 46, 410–415 (2026). https://doi.org/10.1038/s41372-025-02453-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-025-02453-4

Search

Advanced search

Quick links