Effects of Parental Singing on Language and Social-Emotional Development of Preterm Infants: Systematic Review

Abstract

Introduction: Preterm infants are at a higher risk of language and neurodevelopment delays. Primary studies showed that vocal interventions, singing or recorded maternal voice, showed improved developmental milestones among premature infants later in life. Vocal interventions increased physiological and feeding outcomes in the NICU; maternal well-being, implicating that increasing vocal interventions early in life, as early as they are in the NICU, enhance the long-term language, and cognitive outcomes of premature infants. The purpose of this systematic review is to synthesize evidence from primary studies to determine the effect of maternal voice interventions (live or recorded, singing or speech) on infant language development at 5 years and social- emotional behavior at 2-3 years as primary outcomes and infant physiologic and feeding outcomes as well as maternal stress, anxiety and bonding as secondary outcomes.

Methods: We searched three databases MEDLINE, CINAHL, and Embase from inception until August 2025 for randomized controlled trials of live or recorded maternal singing or speech interventions in the NICU settings for premature infants born < 37 weeks of age testing their impact on language and social emotional development. Two reviewers independently screened the studies on Covidence for title and full-text inclusion, extracted data on participant demographics, intervention dose, and outcomes, and evaluated the risk of bias. The discrepancies have been resolved by a third reviewer. The risk of bias was assessed using the Cochrane Rob 2 tool. All reporting procedures followed the PRISMA guidelines.

Results: Six RCTs were included in this review. Ghetti et al. (2023) focusing on live maternal singing showed no significant outcomes on maternal bonding and anxiety at 6 and 12 months of infant age, but significant decrease in maternal stress at 6 and 12 months of infant age McGowan et al. (2024) focusing on live maternal singing and talking showed increased adult word counts by 52% and increased language scores at 2 years of infant age. Nöcker-Ribaupierre et al. (2015) focusing on recorded maternal singing and talking showed improved Griffiths Development Quotient at 5 months and speech understanding at 6 years and 3 months. Kaynak and Yilmaz (2024) showed a high risk of bias due to unreported randomization, allocation concealment was infrequently reported, and participant blinding was not feasible across studies, with outcome assessor blinding reported in only two. Additional concerns included high risk of bias from missing data and selective reporting in several studies, while two studies demonstrated low risk through adequate follow-up, trial registration, and standardized reporting.

Discussion: Maternal singing and voice intervention in the NICU improve neurodevelopmental stability in preterm infants. Parent-led vocal programs decrease language delay risks by age two, while a maternally recorded voice improves speech comprehension by six years and developmental quotients at five months. Secondary benefits include physiological outcomes and maternal stress and anxiety. Nurses can encourage maternal singing in the NICU by incorporating singing into care routines, offering brief seminars to parents regarding vocal interventions, distributing lullaby aids, and giving consistent advice. Nurses can also play a role on the long-term benefits for mothers and infants depend on ongoing support and practice during postnatal and well-baby visits.