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

Authors

  • 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

DOI:

https://doi.org/10.47513/mmd.v9i2.546

Abstract

 

Abstract

 

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

 

 

References

Anand KJS & Hickey PR. Pain and its effects in the human neonate and fetus. New England journal of medicine.1987;317(21): 1321-1329.

Carbajal R, Rousset A, Danan C, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. Jama. 2008;300(1): 60-70.

Simons SH, van Dijk M, Anand KJS, Roofthooft D, van Lingen RA & Tibboel D. Do we still hurt newborn babies?: A prospective study of procedural pain and analgesia in neonates. Archives of pediatrics & adolescent medicine. 2003;157(11): 1058-1064. doi:10.1001/archpedi.157.11.1058.

Goksan S, Hartley C, Emery F, et al. fMRI reveals neural activity overlap between adult and infant pain. Elife. 2015; 4: e06356.

Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013; 4(4): e0025.

Brummelte S, Grunau RE, Chau,V, et al. Procedural pain and brain development in premature newborns. Annals of neurology. 2012;71(3): 385-396.

Doesburg SM, Chau CM, Cheung TP, et al. Neonatal pain-related stress, functional cortical activity and visual-perceptual abilities in school-age children born at extremely low gestational age. PAIN®. 2013;154(10): 1946-1952.

de Graaf J, van Lingen RA, Simons SH, et al. Long-term effects of routine morphine infusion in mechanically ventilated neonates on children’s functioning: five-year follow-up of a randomized controlled trial. Pain. 2011;152(6): 1391-1397.

Leroy PL, Costa LR, Emmanouil D, van Beukering A, Franck LS. Beyond the drugs: nonpharmacologic strategies to optimize procedural care in children. Curr Opin Anaesthesiol. 2016;29 (Suppl 1):S1-S13. doi: 10.1097/ACO.0000000000000312.

Franck LS, Greenberg CS, Stevens B. Pain assessment in infants and children. Pediatric Clinics of North America. 2000;47(3): 487-512.

Czarnecki ML, Turner HN, Collins, PM, Doellman D, Wrona S, Reynolds J. Procedural pain management: A position statement with clinical practice recommendations. Pain Management Nursing. 2011;12(2): 95-111.

Anand KJS, Hall RW. Love, pain, and intensive care. Pediatrics. 2008;121(4): 825-7.

Loewy, J. The use of music psychotherapy in the treatment of pediatric pain. In: Dileo, C, Ed. Music therapy and medicine: theoretical and clinical applications. Silver Spring, MD: American Music Therapy Association; 1999:189-206.

Haslbeck FB. Music therapy for premature infants and their parents: An integrative review. Nordic Journal of Music Therapy. 2012a;21(3): 203-226.

Lai HL, Chen CJ, Peng TC, et al. Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants’ responses. International Journal of Nursing Studies. 2006;43(2): 139-146.

Schwilling D, Vogeser M, Kirchhoff F, et al. Live music reduces stress levels in very low birth weight infants. Acta Paediatrica. 2015;104(4): 360-367.

Whipple J. The effect of music-reinforced nonnutritive sucking on state of preterm, low birthweight infants experiencing heelstick. Journal of Music Therapy. 2008;45.3:227-272.

Keith DR, Kendra R, Weaver BS. The effects of music listening on inconsolable crying in premature infants. Journal of music therapy. 2009;46.3: 191-203.

Bieleninik L, Ghetti C, Gold C. Music Therapy for Preterm Infants and Their Parents: A Meta-analysis. Pediatrics; 2016;138(3):e20160971

Arnon S, Shapsa A, Forman L. et al. Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth. 2006;33.2: 131-136.

Cassidy JW, Standley JM. The effect of music listening on physiological responses of premature infants in the NICU. Journal of Music Therapy; 1995;32(4): 208-227.

Filippa M, Devouche E, Arioni C, Imberty M, Gratier M. Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatrica. 2013; 102(10):1017-1020.

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(5): 902-918.

Rand K, Lahav A. Maternal sounds elicit lower heart rate in preterm newborns in the first month of life. Early human development. 2014;90.10: 679-683.

Standley JM, Moore RS. Therapeutic effects of music and mother's voice on premature infants. Pediatric Nursing. 1995;21(6): 509-512.

Teckenberg-Jansson P, Huotilainen M, Pölkki T, Lipsanen J, Järvenpää AL. Rapid effects of neonatal music therapy combined with kangaroo care on prematurely-born infants. Nordic Journal of Music Therapy. 2011;20(1): 22-42.

Bo LK, Callaghan P. Soothing pain-elicited distress in Chinese neonates. Pediatrics. 2000;105(4): e49-e49.

Butt ML, Kisilevsky BS. Music modulates behaviour of premature infants following heel lance. The Canadian journal of nursing research= Revue canadienne de recherche en sciences infirmières. 2000;31(4): 17-39.

Bergomi P, Chieppi M, Maini A, Mugnos T, Spotti D, Tzialla C, Scudeller L. Nonpharmacological Techniques to Reduce Pain in Preterm Infants Who Receive Heel-Lance Procedure: A Randomized Controlled Trial. Research and theory for nursing practice. 2014;28(4): 335-348.

Shabani F, Nayeri ND, Karimi R, Zarei K, Chehrazi M. Effects of music therapy on pain responses induced by blood sampling in premature infants: A randomized cross-over trial. Iranian Journal of Nursing and Midwifery Research. 2016;21(4): 391-396.

Chou LL, Wang RH, Chen SJ, Pai L. Effects of music therapy on oxygen saturation in premature infants receiving endotracheal suctioning. Journal of Nursing research. 2003; 11(3): 209-216.

Ghetti CM. Music therapy as procedural support for invasive medical procedures: toward the development of music therapy theory. Nordic Journal of Music Therapy. 2012;21(1): 3-35.

Pölkki T, Korhonen A. The effectiveness of music on pain among preterm infants in the NICU: A systematic review. The JBI Database of Systematic Reviews and Implementation Reports. 2014;12(4): 354-373.

Tramo MJ, Lense M, Van Ness C, Kagan J, Settle MD, Cronin JH. Effects of Music on Physiological and Behavioral Indices of Acute Pain and Stress in Premature Infants Clinical Trial and Literature Review. Music and Medicine. 2011;3(2):72-83.

de L'Etoile SK. Infant behavioral responses to infant-directed singing and other maternal interactions. Infant Behavior and Development. 2006;29(3):456-470.

Garunkstiene R, Buinauskiene J, Uloziene I, Markuniene E. Controlled trial of live versus recorded lullabies in preterm infants. Nordic Journal of Music Therapy. 2014;23(1):71-88.

Nöcker-Ribaupierre M. Ed. Music Therapy for Premature and Newborn Infants. Gilsum: Barcelona Books; 2004.

O'Neill CT, Trainor LJ, Trehub SE. Infants' responsiveness to fathers' singing. Music Perception. 2001;18(4): 409-425.

Loewy J, MacGregor B, Richards K, Rodriguez J. Music therapy pediatric pain management: Assessing and attending to the sounds of hurt, fear and anxiety. In: Loewy J, Ed, Music therapy and pediatric pain. New Jersey: Jeffrey Books;1997: 45-56.

Turry AE. The use of clinical improvisation to alleviate procedural distress in young children. In: Loewy J, Ed., Music therapy and pediatric pain. New Jersey: Jeffrey Books;1997: 89-96.

Fernandes A, Campbell-Yeo M, Johnston CC. Procedural pain management for neonates using nonpharmacological strategies: Part 1: sensorial interventions. Advances in Neonatal Care. 2011;11.4: 235-241.

Stevens BJ, Gibbins S, Yamada J, et al. The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. The Clinical journal of pain. 2014;30(3): 238-243.

Olsson E, Ahlsén G, Eriksson M. Skin‐to‐skin contact reduces near‐infrared spectroscopy pain responses in premature infants during blood sampling. Acta Paediatrica. 2015:1-5.

Melzack R, Wall PD. Pain mechanisms: A new theory. Science. 1965;150:971–979.

Ullsten A, Eriksson M, Klässbo M, Volgsten U. Live music therapy with lullaby singing as affective support during painful procedures: A case study with microanalysis. Nordic Journal of Music Therapy. 2016:1-25.

Mondanaro J, Sara GA. Music and medicine: Integrative models in the treatment of pain. New York: Satchnote Press; 2013.

Bernatzky G, Presch M, Anderson M, Panksepp J. Emotional foundations of music as a non-pharmacological pain management tool in modern medicine. Neuroscience & Biobehavioral Reviews. 2011;35(9):1989-1999.

Shoemark H. Contingent singing: The musicality of companionship with the hospitalized newborn infant. In: Baker F, Uhlig S, Eds., Voicework in music therapy. Research and practice. London: Jessica Kingsley Publishers. 2011;231-251.

Arnon S, Diamant C, Bauer S, Regev R, Sirota G, Litmanovitz I. Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety. Acta Paediatrica. 2014;103(10): 1039-1044.

Schlez A, Litmanovitz I, Bauer S, Dolfin T, Regev R, Arnon S. Combining kangaroo care and live harp music therapy in the neonatal intensive care unit setting. The Israel Medical Association journal: IMAJ. 2011;13(6): 354-358.

Loewy J. NICU music therapy: song of kin as critical lullaby in research and practice. Annals of the New York Academy of Sciences. 2015;1337: 178-185.

Axelin A, Eriksson M, Gradin M. Smärta [Pain]. In Jackson K, Wigert H. Eds., Familjecentrerad neonatalvård. Lund: Studentlitteratur; 2013: 111-119.

Neal D, Lindeke L. Music as a nursing intervention for preterm infants in the NICU. Neonatal Network. 2008;27.5: 319-327.

Philbin MK. The influence of auditory experience on the behavior of preterm newborns. Journal of perinatology: official journal of the California Perinatal Association. 2000;20(8 Pt 2): 77-87.

Holsti L, Grunau RE. Initial validation of the Behavioral Indicators of Infant Pain (BIIP). Pain. 2007;132(3): 264-272.

Campbell‐Yeo M. ‘First, do no harm’– the use of analgesia or placebo as control for babies in painful clinical trials. Acta Paediatrica. 2016;105.2: 119-120.

Rock AML, Trainor LJ, Addison TL. Distinctive messages in infant-directed lullabies and play songs. Developmental Psychology. 1999;35(2): 527-534.

Fernald A. Intonation and communicative intent in mothers' speech to infants: Is the melody the message? Child Development. 1989:1497-1510.

Bergeson T.R, Trehub SE. Absolute pitch and tempo in mothers' songs to infants. Psychological Science. 2002;13(1): 72-75.

Nakata T, Trehub SE. Infants’ responsiveness to maternal speech and singing. Infant Behavior and Development. 2004;27(4): 455-464.

Published

2017-04-16

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