Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates.


  • Alexandra Ullsten Department of Musicology, Örebro University, Örebro, Sweden; Centre for Clinical Research, Värmland County Council, Karlstad, Sweden http://orcid.org/0000-0002-4436-4258
  • Pernilla Hugoson Department of Music, University of Jyväskylä, FI-40014, Finland, Department of Women´s and Children´s Health, Karolinska Institutet, SE-182 88 Stockholm, Sweden.
  • Malin Forsberg County Council of Dalarna, Mora hospital, SE-792 85 Mora, Sweden
  • Lisa Forzelius County Council of Västernorrland, Sundsvall hospital, SE-856 43, Sundsvall, Sweden.
  • Maria Klässbo Centre for Clinical Research, Värmland County Council, SE-661 81 Säffle, Sweden http://orcid.org/0000-0003-0534-4921
  • Emma Olsson Department of Pediatrics, Faculty of Medicine and Health, Örebro University, SE-701 85 Örebro, Sweden.
  • Ulrik Volgsten Department of Musicology, School of Music, Theatre and Art, Örebro University, SE-701 82 Örebro, Sweden http://orcid.org/0000-0002-5809-3575
  • Björn Westrup Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital-Danderyd, SE-182 88 Stockholm, Sweden.
  • Ulrika Ådén Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, Astrid Lindgren Children's Hospital, SE-171 77 Stockholm, Sweden
  • Lena Bergqvist Department of Clinical Science, Intervention and Technology, unit of pediatrics, Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
  • Mats Eriksson Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden http://orcid.org/0000-0002-5996-2584







This clinical trial tested the pain relieving effect of live lullaby singing on behavioral and physiological pain responses during venepuncture in 38 preterm and full term neonates. Acute and repeated pain, as well as the use of analgesic drugs, may have long-term negative impact on infants’ development and future behaviour. This emphasizes the need for complementary approaches to pain management such as music therapy.

Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioral responses with regard to pain were assessed with Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIIP). Heart rate, respiratory rate and oxygen saturation were measured each tenth second.

Although the live lullaby singing did not show a statistically significant effect on the infants’ pain score, there was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage, showing a non-significant trend towards higher oxygen saturation levels and calmer heart rate in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing. More research is needed to explore such positive trends in the data.

Keywords: newborn infant, preterm infant, pain, music therapy, lullaby




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