Effects of maternal singing or voice on language and social-emotional development of preterm infants: protocol for a systematic review

Introduction Preterm birth remains a major risk factor for language delay, which may impact learning throughout life. Systematic reviews have shown conflicting effects of maternal voice exposure on premature infants’ physiological parameters, oral feeding and preterm cognitive and neurobehavioural development. Although simple measures to promote language development include exposure to music and maternal voice, the beneficial effects of maternal singing and voice on language and social-emotional development of preterm infants have not been systematically reviewed to confirm these findings. The overall aim of this systematic review is to assess the effects of maternal singing or voice, live or recorded, on the language and social-emotional development of preterm infants compared with standard of care. We will also determine the specific effects of maternal singing or voice on preterm infants’ physiological and behavioural parameters and on maternal stress and mother-infant bonding. Methods and analysis A search strategy will be developed to identify randomised controlled trials published in any language from inception till July 2025 on Medline OVID, EMBASE and CINAHL. We will also search the reference lists of relevant studies and reviews. Two reviewers will independently extract data on study design, baseline characteristics, details of the interventions employed and primary and secondary outcomes using a pre-piloted standardised data extraction form. The risk of bias and quality of evidence assessment will be done independently and in duplicate using the Cochrane Risk of Bias tool and Grading of Recommendations Assessment, Development and Evaluation approach, respectively. Random-effects models will be performed in case meta-analysis is possible, otherwise a qualitative summary will be provided. We will use RevMan 5.1 for data synthesis. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ethics and dissemination Since this is a systematic review or previously published studies, it is exempt from IRB approval and was approved by the school’s Graduate Studies Committee (GSC) studies. The results of this systematic review will be disseminated at relevant conferences and submitted for publication in a peer-reviewed journal. PROSPERO registration CRD42024613086.