Premature infants often spend large amounts of time in hospital NICUs, requiring a number of painful procedures. It’s well documented that premature infants are capable of experiencing even higher levels of pain than full term neonates do, due to immature nervous systems. However, doctors are often hesitant to prescribe analgesia due to relative lack of clinical trials in premature infants as well as the risk of multiple serious side effects such as opioid induced ileus, which could further worsen clinical status.(1) Unfortunately, this often means that premature infants are forced to endure high levels of pain in a well-meaning effort by hospitalists to save their lives.(2) Because of this, more research has been put into the effects of music therapy on NICU patients’ outcomes, and more recently, into the power of touch.

Premature neonates can certainly perceive pain despite their lack of understanding of it. Multiple blood draws, heel-prick testing and lumbar punctures are often required in the neonatal setting. Worse yet is that we have no real way of knowing when exactly neonates will forget these traumatic experiences – and while we know that they must forget eventually, because we ourselves have no memories of the hours following our births, traumatic or not, it is off-putting to think of innocent neonates spending their first few hours in this huge new world experiencing pain.

Multiple sensory approaches have been studied and are currently implemented in NICUs as well as well-baby nurseries around the world – including sucrose suckling from gloved fingers, something you might commonly see as a medical student on your paediatrics rotations.(3) Less commonly implemented in our Irish hospitals is the use of musical therapy during painful procedures. Many studies have demonstrated the effectiveness of various types of music on premature neonatal outcomes – from recorded to live music, and from Bach to maternal acapella. Reduction in oxygen saturations, heart rates, respiratory rates and blood pressure levels have been shown, as well as happier babies – with less crying, wriggling and overall calmer facial expressions.(4) Chou et. al even demonstrated increased oxygen saturations in premature infants undergoing endotracheal suctioning exposed to recorded mixed tapes of maternal singing and womb sounds – pretty cool, but also pretty unlikely that RCSI students will ever see it happening at Temple Street!(5)

One recently published study by Qui et. al focused on the effects of combined music and touch (CMT) intervention on beta endorphins, cortisol levels, and pain modification in premature infants in the NICU setting.  Touch intervention was the Gentle Human Touch protocol, where trained nurses simply placed warmed hands above the eyebrow land and encompassing the neonates waist. While the study did not demonstrate any remarkable changes in cortisol levels, beta endorphins were significantly increased, which may be one of the mechanisms by which pain modulation occurs.(6)

Whatever the scientific mechanisms involved, it is nice to know that pain modulation can occur via semi-unconventional ways, especially for our littlest patients. Who knows, in the next few years our paeds wards might be filled with womb sounds! More lullabies and cuddles could never be a bad thing, anyway.  

References:

1.      Hall RW, Anand KJ. Pain management in newborns. Clin Perinatol. 2014;41(4):895-924.
2.      Simons SP, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D. Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Archives of Pediatrics & Adolescent Medicine. 2003;157(11):1058-64.
3.      Shann F. Suckling and sugar reduce pain in babies. (1474-547X (Electronic)).
4.      Keith DR, Russell K Fau – Weaver BS, Weaver BS. The effects of music listening on inconsolable crying in premature infants. (0022-2917 (Print)).
5.      Chou LL, Wang Rh Fau – Chen S-J, Chen Sj Fau – Pai L, Pai L. Effects of music therapy on oxygen saturation in premature infants receiving endotracheal suctioning. (1682-3141 (Print)).
6.      Qiu J, Jiang YF, Li F, Tong QH, Rong H, Cheng R. Effect of combined music and touch intervention on pain response and beta-endorphin and cortisol concentrations in late preterm infants. BMC Pediatr. 2017;17(1):38.