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| ORIGINAL ARTICLE |
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| Year : 2019 | Volume
: 14
| Issue : 6 | Page : 83-86 |
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Music therapy in neonates for procedural pain
Ashi Jain, Kratika Upadhyay, Bhavna Lakhkar
Department of Paediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Du), Wardha, Maharastra, India
| Date of Submission | 06-Dec-2019 |
| Date of Decision | 10-Dec-2019 |
| Date of Acceptance | 15-Dec-2019 |
| Date of Web Publication | 30-Sep-2020 |
Correspondence Address:
Dr. Ashi Jain
Ashi Jain, Suyash Hospital Jiwaji Club Road, Gwalior, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_211_19
Aim:This study aims to evaluate vocal and music in preventing pain in newborn babies. Objectives: 1) to use NIPS score while BCG immunisation. 2) to use above score while using vocal and Instrumental music during BCG Immunisation. 3) to compare above scores. Place -post natal ward of AVBRH Subjects- normal term new born. Inclusion criteria- All newborns in postnatal ward. Exclusion criteria-preterm and sick babies. Methods:Total of 50 patients werestudied.they all were scored using Nips score before immunisation. First group was scored without any intervention. 2nd group with vocal and 3rd with instrumental music during immunisation .the scores were compared music therapy was found to be useful in reducing pain. Conclusion: Music therapy was found to be useful for reducing pain in newborns.
Keywords: BCG vaccination, music therapy, neonates, neonatal infant pain scale score, piano music, Rockabye baby music, sound meter
How to cite this article:
Jain A, Upadhyay K, Lakhkar B. Music therapy in neonates for procedural pain. J Datta Meghe Inst Med Sci Univ 2019;14, Suppl S2:83-6 |
| Introduction | |  |
Procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behavior and neurological outcome; pain control and prevention remain controversial issues.
Scientific research in recent years has continued to confirm that neonates are more sensitive to nociceptive stimuli than older children. Neonates are capable of mounting robust physiological, behavioral, hormonal, and metabolic responses to such stimuli, responses that can have adverse short- and long-term effects.
Intervention using music can change the environment in order to improve health and well-being of neonates. Music therapy is the systematic application of music to produce positive changes in behavioral and physiological signals through the lowering of heart rate, respiration rate, blood pressure, metabolism level, oxygen consumption, and muscle stiffness. In neonates, pain due to injections during vaccination is the most common cause of iatrogenic pain.
A neonate does have an inability to verbally communicate pain, but their behavioral cues well demonstrate their pain. In neonates, pain due to injections during vaccination is the most common cause of iatrogenic pain. Pain relief can be by pharmacological as well as nonpharmacological modalities, such as music therapy. It is thought that analgesic effects of music stem from indirect effect on attention, whereas distraction averts concentration, enabling slower process of painful stimuli.[1]
The noninvasive, enjoyable, flexible, and active nature of music makes it particularly applicable as a treatment medium for children. Music therapy can easily be introduced to nursing care fields since it is an acceptable form of treatment, which is economically viable and easily available; besides these advantages, there are scarcely any cultural, legal, or moral concerns about its use. Therefore, this study was conducted to define the effects of music therapy on pain responses induced by bacille calmette guerin (BCG) immunization in neonates.
The use of pain control for neonates undergoing painful procedures is still limited; however, according to recent reports, neonates at the neonatal intensive care unit (NICU) experience a mean 16 painful procedures a day, most of which are still performed without effective pain control measures, as demonstrated by the recent surveys.
Among premature infants, lullabies and classical music appear to increase weight gain, decrease episodes of oxygen desaturation, decrease distressed behaviors, and increase nonnutritive sucking, all of which may decrease length of hospital stay in premature infants, and exposure to harp music resulted in significantly lower salivary cortisol levels and lower respiratory rates. While listening to music, infant's become quiet and appear to fall asleep; these decreases in activity may reduce caloric expenditure, enhance weight gain, and hasten hospital discharge.[2] The effects of country western, pop, jazz, and other types of music on premature infants have not been systematically compared with the effects of lullabies and classical music, nor has live music been compared directly with recorded music in this setting.[3]
Music as a way of therapy can specifically address issues related to emotion and interaction, and therefore, it appears that music therapy may be appropriate in particular in the treatment of negative symptoms in infants. Moreover, it can be used as a form of social communication, promoting interaction of these infants.
Aim
The aim was to study the effect of music therapy for pain relief in neonates during BCG vaccination.
Objectives
- To assess pain using neonatal infant pain scale (NIPS) score during BCG vaccination [Table 1]
- To use NIPS score while using vocal and instrumental music to see if pain can be reduced
- To compare the above scores.
| Materials and Methods | | |
A total of 50 normal, full-term newborns were the study participants in postnatal ward of Acharya Vinoba Bhave Rural Hospital and Jawaharlal Nehru Medical College, Wardha [Table 2] and [Figure 1]. | Figure 1: Distribution of newborns. No intervention - Group A, vocal music instrumental (Rockabye baby) - Group B, piano music - Group C
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Inclusion criteria
All term babies receiving BCG vaccination after informed parental consent. Babies with weight more than 2500 g, gestational age of at least 38 weeks and a maximum of 40 weeks, having no congenital disorder or any auditory disability during physical examination, having no intracranial hemorrhage or neurological problems, and no sedatives administered within the last 24 h were included in the study.
Exclusion criteria
Parents' unwillingness to pursue the study for any reason, incidence of any problems in the infant or unexpected increase or decrease in the neonates vital signs (babies without parental consent), and babies with congenital anomalies were excluded from the study.
It was designed to be interventional study. The researcher measured pain responses induced by BCG immunization in these selected neonates. In this study, pain response means physiological and behavioral pain responses. To measure physiological response factors, heart rate and oxygen saturation were recorded, and to measure behavioral response factors, sleep–wake state and facial expressions of pain were used. The tools used in this study included a questionnaire containing demographic information, a form for recording physiological signals, a form for recording sleep–wake state, and the neonatal facial coding system scale. Statistical method used mean, mode, and median. P value was measured while comparing means and proportion <0.05 considered statistically significant. SPSS 19 version (IBM SPSS Statistics, USA) was used for the statistical analysis.
Approval from the Institutional Ethics Committee was obtained.
Group A
Baby was well fed. Once baby and staffs were ready for the procedure, baseline values needed for score were collected. The procedure of BCG immunization was carried out, and second person was scoring the baby during the procedure.
Group B
Baby was well fed. Once baby and staffs were ready for the procedure, baseline values needed for score were collected. Rockabye baby music was played at 60Db measured by an app called sound meter. The procedure of BCG immunization was carried out and second person was scoring the baby during the procedure. Music was started after collecting baseline values and was continued during the procedure. The scoring was done during the procedure.
Group C
Baby was well fed. Once baby and staffs were ready for the procedure, baseline values needed for score were collected. Piano music was played at 60Db measured by an app called sound meter. The procedure of BCG immunization was carried out and second person was scoring the baby during the procedure. Music was started after collecting the baseline values and was continued during the procedure. The scoring was done during the procedure.
| Results | | |
A total number of babies included in this study are fifty.
In this study, we found the mean value for Group A was 4.69, for Group B, it was 3.47, and for Group C, it was 4.47 [Table 3].
The median value for Group A was 4.5, for Group B, it was 3, and for Group C, it was 5 [Table 4].
The mode value for Group A was 5, for Group B, it was 4, and for Group C, it was 5.
The P value of Group A versus Group B was <0.001, for Group A versus Group C, it was <0.31, and for Group B versus Group C, it was <0.001.
The lowest value of P was seen in Group B (vocal music).
| Discussion | | |
Pain can cause detectable physiological, behavioral, and hormonal changes and contribute to the altered development of the pain system during later childhood and adolescence.[4],[5] Instead, live music such as singing is an excellent type of music when it is steady, constant, quiet, soothing and directed to the infants. It has been emphasized that recorded sound should not replace human voice exposure in the NICU;[6] therefore, health-care providers should provide ample opportunity for the infant to hear parent's voices live, such as singing or humming, in interactions between the parent and the infant at the bedside. The American Academy of Pediatrics Committee on Environmental Health has recommended safe levels of sound, and these recommendations have been updated by an expert team of practitioners. Recommendations specify that continuous sound should not exceed an hourly equivalent sound level of 50 A-weighted decibels (dBA), and music as an auditory stimulus not exceed 75 dB in NICU. If earphones or other devices are used, sound sources should be kept at reasonable distances from the infant's ear, played for brief periods and at levels below 55 dB. Music listening can be initiated with or without the involvement of a music therapist. In this review, music can be implemented for neonates by a music therapist or any health-care provider, and it will include both recorded and live music.[7] Music therapy techniques have the potential to provide pain relief for neonates.[8] Most studies included in this review demonstrated an improvement in behavioral pain responses including facial expressions, duration of crying or latency to first cry, and physiological parameters (e.g., heart rate, oxygen saturation). Further research is needed to determine the best nonpharmacological intervention, duration of the intervention,[9] and dose response for optimal pain relief in newborn infants.[8],[10],[11],[12]
| Conclusion | | |
Pain is felt by neonates during BCG vaccination; vocal music is able to reduce the pain significantly.
Low score was seen in instrumental music also, may be a larger sample size or the use of a different instrument will show benefits. These should help improving the health-care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available.
Newborn infants in an NICU undergo many painful but necessary procedures during hospitalizations. The implications of the pain associated with these procedures and the types of pain relief given to the infants have considerable implication for both short- and long-term outcomes.[13]
Recommendations
To reduce pain felt by neonates during vaccination, music therapy should be put into use.
Other references.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 2. | Twycross A. Managing Pain during theFirst Year of Life; 2006. |
| 3. | Evans S, Tsao JC, Zeltzer LK. Paediatric pain management: Using complementary and alternative medicine. Rev Pain 2008;2:14-20. |
| 4. | Witt N, Coynor S, Edwards C, Bradshaw H. A guide to pain assessment and management in the neonate. Curr Emerg Hosp Med Rep 2016;4:1-10. |
| 5. | Simonse E, Mulder PG, van Beek RH. Analgesic effect of breast milk versus sucrose for analgesia during heel lance in late preterm infants. Pediatrics 2012;129:657-63. |
| 6. | Peczeniuk H, Suzanna A. Music Therapy in the NICU: Interventions and Techniques in Current Practice and a Survey of Experience and Designation Implications; 2012. |
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| 9. | Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2012;12:CD004950. |
| 10. | Nimbalkar SM, Chaudhary NS, Gadhavi KV, Phatak A. Kangaroo Mother Care in reducing pain in preterm neonates on heel prick. Indian J Pediatr 2013;80:6-10. |
| 11. | Bergomi P, Chieppi M, Maini A, Mugnos T, Spotti D, Tzialla C, et al. Nonpharmacological techniques to reduce pain in preterm infants who receive heel-lance procedure: A randomized controlled trial. Res Theory Nurs Pract 2014;28:335-48. |
| 12. | Codipietro L, Ceccarelli M, Ponzone A. Breastfeeding or oral sucrose solution in term neonates receiving heel lance: A randomized, controlled trial. Pediatrics 2008;122:e716-21. |
| 13. | da Motta Gde C, da Cunha ML. Prevention and non-pharmacological management of pain in newborns. Rev Bras Enferm 2015;68:123-7, 131-5. |
[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4]
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