PURPOSE:
Preterm neonates in Neonatal Intensive Care Units (NICUs) are routinely exposed to high levels of stress, which may adversely affect neurodevelopment and long-term outcomes. The SONATA project introduces an innovative, midwife-led research protocol that investigates whether a structured music intervention can reduce neonatal stress, as assessed through salivary biomarkers.

DISCUSSION:
The SONATA protocol is an approved (IRB: 44834 - 03/06/2024), randomized controlled trial (NCT06650189), involving moderate and late preterm neonates in two Greek NICUs. Neonates receive a 5-day consecutive recorded music intervention (10 minutes/day), guided by a certified music therapist. Salivary biomarkers are collected before and after each session to assess physiological stress response. The intervention is non-invasive, developmentally appropriate, and delivered in a controlled acoustic environment consistent with NICU design recommendations. In parallel, the study uses validated psychometric tools and prenatal music exposure data to investigate potential associations with neonatal stress regulation.

EVIDENCE WHERE RELEVANT:
Although still in progress, the protocol builds on prior research indicating that music can support autonomic stability and stress reduction in preterm neonates. The use of longitudinal biomarker sampling adds an objective, measurable dimension to evaluating intervention impact. Salivary cortisol is a known marker of neonatal stress, but few studies focus solely on music, and none within midwife-led NICU care.

KEY MESSAGE:
This protocol demonstrates how NICU midwives can lead in implementing innovative, family-centered practices grounded in developmental care principles. Music intervention is a low-cost, scalable strategy that empowers midwives to reduce neonatal stress, support holistic wellbeing, and improve outcomes for preterm neonates. The SONATA project highlights a valuable opportunity for midwives to enhance clinical care and advocate for comprehensive, evidence-based, non-pharmacological approaches in neonatal critical care. It invites global midwifery communities to reimagine NICUs not only as critical care spaces but as healing environments that foster resilience from the very beginning of life. Poster session 2 (Group A)