Preterm babies appear to experience less pain and feed more when listening to music, a recent study suggests. Experts led by Dr. Manoj Kumar of the University of Alberta, Canada, analyzed nine clinical trials and found that music had a beneficial effect on lessening pain for preterm babies undergoing painful procedures such as heel prick blood tests. It also appeared to benefit full-term babies during operations.
The research, published in the Archives of Disease in Childhood, included trials published between 1989 and 2006 looking at music and heart rate, oxygen levels and pain levels. Most of the trials used lullabies with or without added sounds such as heartbeats or womb noises. One used live music, a specially composed wordless lullaby sung by a female voice and accompanied by a harp.
The trials covered a range of populations studied in different ways, making it difficult to reach definitive conclusions, but the authors found “much preliminary evidence for therapeutic benefits of music for specific indications.”
Dr. Kumar said, “One study noted that the use of a pacifier-activated lullaby system in the preterm infants helped improve their oral feeding rates.”
The team writes: “In summary, there is preliminary evidence to suggest that music may have beneficial effects in terms of physiological parameters, behavioral states and pain reduction during painful medical procedures.
“However, most trials conducted to date are of poor methodological quality. Additional methodologically rigorous, randomized controlled trials are warranted to confirm and to further elucidate the benefits of music for neonates before any specific recommendation for the use of music can be made in the neonatal population.”
Neonatal units in several countries are increasingly using music as a method to improve behavioral and health outcomes, or to manage pain during common procedures. Benefits are thought to include calmer infants and parents, more chance of reaching a stable condition, faster weight gain and shorter stays in hospital.
A team from Bern in Switzerland looked at the advantages of playing music to newborns in neonatal intensive care units. They explain that these babies are exposed to a high number of painful procedures. “Since repeated and sustained pain can have consequences for the neurological and behavior-oriented development of the newborn, the greatest attention needs to be paid to systematic pain management in neonatology,” they write.
The team add that non-drug treatment methods are increasingly being investigated for pain prevention and pain relief. They searched the research and identified 13 good-quality studies and two previous analyses of music and other approaches including swaddling and maternal touch.
They found that some techniques do have “an evident favorable effect on pulse rate, respiration and oxygen saturation, on the reduction of motor activity, and on the excitation states after invasive measures.” But, “unambiguous evidence of this still remains to be presented,” they conclude.
Different forms of music have been used in trials: music with intrauterine sounds (womb noises), instrumental music or a capella singing (without instruments). Regardless of the type of music, a positive effect on the pain response was invariably recorded, say the Swiss team.
Outcomes included the regulation and reduction of the pulse rate, more rapid physical recovery, a rise in oxygen levels and a reduction in the excitation state. Music was particularly effective at decreasing the pain response when combined with sucking on pacifiers. But the researchers running these trials were in agreement that music should not be played for more than 15 minutes per session, in order to avoid sensory overload.
A very recent study from Tel Aviv, Israel, looked at the so-called “Mozart effect.” Based on the finding that weight gain seems to improve in preterm infants who are exposed to music, the study investigated whether the effect is caused by a boost to metabolic efficiency.
They played half an hour of Mozart on two consecutive days to ten healthy preterm infants, and no music to a further ten infants. While hearing the music, the infants’ energy expenditure reduced significantly, by ten to 13 percent. “Exposure to Mozart music significantly lowers resting energy expenditure in healthy preterm infants,” the authors write. “We speculate that this effect of music on resting energy expenditure might explain, in part, the improved weight gain that results from this ‘Mozart effect.'”
Diana O. Neal of Minnesota Intercollegiate Nursing Consortium comments that music has been found to “reduce the pervasiveness and severity of problems associated with prematurity.” She believes there is considerable evidence in support of using appropriate music with preterm infants. Further rigorous research on the subject is still needed, she adds.
Kumar, M. et al. Music for medical indications in the neonatal period: A systematic review of randomised controlled trials. Archives of Disease in Childhood, published online May 27, 2009.
Cignacco, E. et al. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. European Journal of Pain, Vol. 11, February 2007, pp. 139-52.
Lubetzky, R. et al. Effect of music by Mozart on energy expenditure in growing preterm infants. Pediatrics, Vol. 125, January 2010, pp. e24-8.
Neal, D. O. and Lindeke, L. L. Music as a nursing intervention for preterm infants in the NICU. Neonatal Network, Vol. 27, September-October 2008, pp. 319-27.