Effect of combined music and touch intervention on pain response and β-endorphin and cortisol concentrations in late preterm infants

Abstract

BackgroundPreterm neonates undergo many painful procedures as part of their standard care in the neonatal intensive care unit. However, pain treatment is inadequate in many of these routine procedures. In the present study, we investigated the impact and mechanism of combined music and touch intervention (CMT) on the pain response in premature infants.MethodsSixty-two preterm neonates (gestational age of <37 weeks) were randomly assigned to either the experimental or control group. Infants in the experimental group underwent painful procedures with CMT, and those in the control group underwent painful procedures without CMT. Blood samples were collected from all infants at the beginning of hospitalization and 2 weeks later to assess the cortisol and β-endorphin concentrations. Differences in the levels of cortisol and β-endorphin between two groups were examined using analysis of covariance (ANCOVA).ResultsIn total, 3707 painful procedures were performed on 62 neonates during their hospitalization. The average number of painful procedures in the control group (n = 35.5) was higher than that in the experimental group (n = 29.0) during hospitalization, although no significant difference was reached (P > 0.05). After 2 weeks, the Premature Infant Pain Profile scores were significantly higher in the control group than experimental group (13.000 ± 0.461 vs 10.500 ± 0.850, respectively; P < 0.05). The cortisol concentration was not significantly different between the control and experimental groups either at the beginning of hospitalization (131.000 ± 18.190 vs 237.200 ± 43.860, respectively; P > 0.05) or 2 weeks later (162.400 ± 23.580 vs 184.600 ± 21.170, respectively; P > 0.05). However, the serum β-endorphin concentration was higher in the experimental group than in the control group both at the beginning of hospitalization (1.640 ± 0.390 vs 1.179 ± 0.090, respectively; P < 0.05) and 2 weeks later (2.290 ± 0.740 vs 1.390 ± 0.410, respectively; P < 0.05).ConclusionsCMT might decrease the pain response of preterm neonates by significantly improving the β-endorphin concentration, but not the blood cortisol concentration.Trial registrationCurrent Controlled Trials ISRCTN14131492. Registered on 01 Aug 2016.

Infants born preterm, stress, and neurodevelopment in the neonatal intensive care unit: might music have an impact?

“…In fact, many of our most rigorous studies also had dependent measures that did not demonstrate impacts under musical intervention. Qiu et al . did not find any change in salivary cortisol, Butt and Kisilevsky found no improvement in arterial oxygen saturation level, and Keith et al .…”

“…In fact, many of our most rigorous studies also had dependent measures that did not demonstrate impacts under musical intervention. Qiu et al 10 did not find any change in salivary cortisol, Butt and Kisilevsky 68 found no improvement in arterial oxygen saturation level, and Keith et al 65 found no change in arterial pressure. So, although the high rate of positive findings in the literature points towards music's potential to moderate the stress response, these null findings reiterate the need for continued research in this area with greater attention to systematic replication, proper control conditions, and blinding of experimental and hospital staff.…”

“…The statistically significant effects found in this strongest sampling of the literature can loosely be categorized as behavioral or physiological. Behaviorally, 5 of the 10 selected articles found significant impacts between music listening and controls on behavioral measures such as inconsolable crying, arousal/sleep state, general stress behaviors, and reductions in pain responses to an invasive procedure . Two of the studies noted improvements in feeding, specifically caloric intake, or duration between gavage and oral feeding …”

“…A few research teams have actively tested hypotheses on the mechanisms potentially underlying the effect of music on neonates. Qiu et al . investigated the stress‐relieving theory of music via inclusion of cortisol and β ‐endorphins to determine whether stress hormones are affected.…”

“…Caine 67 found reductions in initial weight loss, while Lubetzky et al 71 found resting energy expenditure, a metabolic measure, significantly reduced. Finally, evaluating physiological markers of stress, Qiu et al 10 found a rise in serum b-endorphins after 2 weeks of a music and touch combination intervention.…”