Characteristics and results of included studies evaluating music during painful procedures
| Author(year ofpublication),country | Indications | Population:sample size(% male); mean gestational age; setting | Intervention(s)and comparator(s) | Outcome measures | Results | |||||
| Circumcision | ||||||||||
| Marchette (1989), USA20 | To reduce pain during anaesthetised circumcision | 58 (100%); “all newborns” eligible – no other details provided | 3 groups: recorded classical music vs recorded intrauterine sounds vs routine care | HR, TcPao2, heart rhythm, BP×HR, BP, pain (Izard’s Maximally Discriminative Facial Movement Coding System) | No tests of statistical significance were performed. Authors concluded that “interventions were unable to offset the effects of the circumcision pain as indicated by all of the dependent variables”. | |||||
| Marchette (1991), USA21 | To reduce pain during anaesthetised circumcision | 121 (100%); full-term – no other details provided | 6 groups: recorded classical music vs recorded intrauterine sounds vs pacifier vs music+pacifier vs intrauterine sounds+pacifier vs control (no nurses or other pain reduction interventions) | HR, TcPao2, BP×HR, BP, dysrrhythmias, heart rhythm, behavioural state (alertness section of Brazelton Neonatal Behavioral Assessment Scale) | No statistically significant differences across groups in HR, diastolic BP, TcPao2 or behavioural state. Some non-clinically important differences noted across groups in systolic BP. | |||||
| Joyce (2001), USA19 | For pain control during circumcision | 23 (100%); term (37–42 weeks; mean 39 weeks; SD 1.1); newborn nursery | 2 groups*: recorded music (lullabies and nursery rhymes metronomised to real human heartbeat) vs no music | HR, RR, Sao2, salivary cortisol levels, pain (Riley Infant Pain Scale), length of cry | Pain lower for music group throughout procedure and significantly less at end of procedure (p<0.03). HR increased in control group (p<0.009), no significant increase from baseline for music group (p = 0.37). Music group had higher oxygen saturation rates by end of procedure (p<0.02). No effect of music for RR or salivary cortisol levels. | |||||
| Heel prick | ||||||||||
| Bo (2000), China15 | To modulate distress during and after heel prick | 27 (63%); GA⩾28 weeks (mean 37, SD 3.4); special care baby unit | Cross-over design with 4 comparisons: NNS vs music (intrauterine maternal pulse sounds with soothing music) vs NNS+music vs no intervention | Pain (Neonatal Infant Pain Scale), HR, TcPao2 | Statistically significant decrease in HR (p<0.001), improvement in TcPao2 (p<0.001) and reduced pain behaviour (p<0.001) for all three interventions. HR most affected by music intervention. TcPao2 and pain most influenced by NNS+music intervention. | |||||
| Butt (2000), Canada16 | To modulate distress during heel prick | 14 (57%); preterm (29–36 weeks PCA); NICU | Cross-over design with 2 comparisons: recorded music (female vocal and instrumental versions of Brahms’ lullaby) vs no music | HR, Sao2, pain (Neonatal Facial Coding System), behavioural state (ie, Brazelton’s categories of state-of-arousal) | For infants >31 weeks, music effective in terms of decreased HR (p<0.05), behavioural state (p<0.05), and pain (p<0.05) during recover period. No significant effects observed for infants <31 weeks. | |||||
| Whipple (2004), USA18 | To measure pain responses during heel prick | 60 (50%); preterm (32–37 weeks PCA); mean PCA at study 34.6 (SD 1.2); special care nurseries, including NICU | 3 groups: pacifier activated lullaby system (lullabies sung by female child with piano accompaniment) vs pacifier only vs standard care | HR, RR, Sa2, behavioural state (Assessment of Preterm Infants’ Behavior by Als et al24), stress behaviours (defined by Burns et al25) | No statistically or clinically significant differences in HR, RR or Sao2 between groups. Statistically significant differences in behavioural state and stress levels for pacifier activated lullaby system and pacifier only groups compared to standard care control. |
BP, blood pressure; BP×HR, rate pressure product (computed by multiplying HR and systolic BP)21; ES, effect size; GA, gestational age; HR, heart rate; NICU, neonatal intensive care unit; NNS, non-nutritive sucking; PCA, post-conceptual age; RR, respiratory rate; Sao2, oxygen saturation; TcPao2, transcutaneous oxygen.
*Study had four groups: music versus no music and EMLA (Eutectic Mixture of Local Anesthetics) versus no EMLA; data for only the first comparison are included in this review.