Effect of music (Brahms lullaby) and non-nutritive sucking on heel lance in preterm infants: A randomized controlled crossover trial

Abstract

Objectives: This study examined a more effective pain management method, without sucrose, on heel lance in preterm infants using the Premature Infant Pain Profile (PIPP). Design: In a nonblinded, randomized controlled, two-period, two-sequence crossover trial, 25 infants were randomly allocated to intervention (a Brahms lullaby with non-nutritive sucking, facilitated tucking and holding) or standard care (facilitated tucking and holding). Setting: Local Perinatal Medical Centre's NICU in Japan, July 2014 until June 2015. Outcome measures: The primary outcome variable was PIPP, and secondary outcomes were heart rate (HR), oxygen saturation, and abnormal HR (> baseline mean plus 2 SDs, or <120 minus 2 SDs). Results: The infants were 33.8 weeks gestational age at birth, 1,983.7 g birth weight, and 32 to 35 weeks postconceptual age. At all 10 measurement points, constructed of every 30 seconds postheel lance, mean PIPP of infants during the intervention (3.6 to 2.4) was significantly lower than during the standard care (8.0 to 4.6) (range, P=0.0039 to P<0.0001). All PIPP reduction rates from the 30 seconds point were similar between the two groups. The HR of preterm infants at the 120 seconds points were significantly lower (P=0.0151), and the HRs of 6 points were considerably lower during the intervention than during the standard care (range, P≤0.0879 to P≥0.049). The abnormal HR total number was significantly lower during the intervention (2) than the standard care (23) (frequency ratio=0.087, P<0.0001). Conclusion: This method demonstrated stronger analgesia, early pain relief, and maintenance of homeostasis on heel lance in preterm infants.

Event-related potentials evoked by skin puncture reflect activation of Aβ fibers: comparison with intraepidermal and transcutaneous electrical stimulations

“…Repeated painful procedures in neonates reduce the volume of white and gray matter (Brummelte et al, 2012) and lead to behavioral abnormalities (Grunau et al, 2009;Vinall et al, 2014); these adverse effects may last until adolescence (Nosarti et al, 2002;Nosarti et al, 2008;Anderson & Doyle, 2003;Grunau, Whitfield & Fay, 2004;Schmidt et al, 2010;Loe et al, 2011;Lax et al, 2013;Walker et al, 2018). Many researchers have attempted to relieve the pain of skin puncture in the heel in neonates (Pillai Riddell et al, 2015;Stevens et al, 2017) using interventions such as pacifiers, holding, music, and a combination of these (Gao et al, 2018;Peng et al, 2018;Perroteau et al, 2018;Uematsu & Sobue, 2019;Campbell-Yeo, 2019;Davari et al, 2019). However, some have suggested that the Premature Infant Pain Profile (Stevens et al, 1996;Gibbins et al, 2014) used to evaluate neonatal pain in these studies has issues in terms of pain detection sensitivity (Hartley et al, 2015).…”

No effect of a musical intervention on stress response to venepuncture in a neonatal population

“…When randomised to the Control arm of the study, infants received at least 0.3 mL of Sweet‐Ease Natural Sucrose Solution (24% sucrose and purified water solution) via syringe immediately prior to venepuncture and were allowed to suck a soother. In the Intervention arm, a Bluetooth speaker was placed adjacent to the infant which was pre‐set to play Brahms’ Lullaby Opus 49 No.4, as selected in line with previous similar studies . The music was delivered on a continuous loop at a sound level between 45 and 50 decibels in line with recommendations from the American Academy of Paediatrics (AAP) regarding sound levels in the NICU.…”

“…Bluetooth speaker was placed adjacent to the infant which was pre-set to play Brahms' Lullaby Opus 49 No.4, as selected in line with previous similar studies. 26,27 The music was delivered on a continuous loop at a sound level between 45 and 50 decibels in line with recommendations from the American Academy of Paediatrics (AAP) regarding sound levels in the NICU. In cases where the infant was on an open-top resuscitaire for the venepuncture and the ambient noise level exceeded 50 decibels, the sound level was increased to a maximum of 58 decibels.…”

Psychosocial and Neurobiological Vulnerabilities of the Hospitalized Preterm Infant and Relevant Non-pharmacological Pain Mitigation Strategies

“…on another non-pharmacological intervention. One group of researchers illustrated that the addition of the combination of a lullaby and NNS on top of facilitated tucking and holding significantly reduced pain scores during heel lance ( 97 ). Another group showed that compared to NNS alone, the combination of NNS and mother's milk odor was associated with significantly lower behavioral pain scores during venipuncture and reduced crying after venipuncture ( 98 ).…”