During the most vulnerable period in a child’s life, preterm and sick infants are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of analgesic drugs may have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. This paper reviews the use of live lullaby singing as an adjuvant to the control of premature infant pain. The objectives of this case study were to analyse the live lullaby singing for two premature infants during venipuncture in comparison to standard care only, and the infants’ physiological and affective responses emerging before, during and after this procedure. The empirical data stem from a quantitative clinical study. From this larger study, two premature infants were selected. Through microanalysis, with in-depth analysis of video footage, and pain assessment with Behavioral Indicators of Infant Pain (BIIP), painful standard care procedures with and without live lullaby singing, were analysed. The results show that live lullaby singing with premature infants is a communicative interaction which may optimize the homeostatic mechanisms of the infant during painful procedures. This case study shows the importance of predictability of the affective support, right from the start of the live singing intervention. It is important in a painful context that vocal interactions provide regular and comforting intensity, shape and temporal structures.

Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Parental infant-directed singing is a multisensory, biopsychosocial communication that applies to ill and vulnerable hospitalised infants. The primary musical features of infant-directed singing are ideal for emotional coordination and sharing between parent and infant without the risk of over-stimulation. In this article, we suggest that parental infant-directed singing is regarded as a nonpharmacological emotion regulation intervention, which may modify the painful experience for both the infant and the parent before, during and after painful procedures in the neonatal intensive care context. Parents have the biopsychosocial resources to alleviate their infant’s pain through infant-directed singing, if they are empowered to do so and coached in this process. A music therapist specialised in neonatal music therapy methods can mentor parents in how to use entrained and attuned live lullaby singing in connection to painful procedures. Pain and the vast amount of painful procedures early in infancy, combined with early parent–infant separation and lack of parental participation in the care of the infant during neonatal intensive care, place arduous strain on the new family’s attachment process and on the infant’s and parents’ mental health, both from a short and long-term perspective. Therefore, we argue with biopsychosocial rationales, that live parental infant-directed singing should be promoted in neonatal pain care worldwide. Consequently, parents should be welcomed round the clock and invited as prescribed pain management for their infant.

This clinical trial tested the pain relieving effect of live lullaby singing on behavioral and physiological pain responses during venepuncture in 38 preterm and full term neonates. Acute and repeated pain, as well as the use of analgesic drugs, may have long-term negative impact on infants’ development and future behaviour. This emphasizes the need for complementary approaches to pain management such as music therapy. Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioral responses with regard to pain were assessed with Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIIP). Heart rate, respiratory rate and oxygen saturation were measured each tenth second.Although the live lullaby singing did not show a statistically significant effect on the infants’ pain score, there was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage, showing a non-significant trend towards higher oxygen saturation levels and calmer heart rate in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing. More research is needed to explore such positive trends in the data.Keywords: newborn infant, preterm infant, pain, music therapy, lullaby

Background: There is a knowledge-to-practice gap regarding parent-delivered pain management, and few studies have investigated parents’ and nurses’ participation in and acceptance of combined parent-delivered pain-alleviating interventions such as skin-to-skin contact (SSC), breastfeeding, and parental musical presence. This study investigated parents’ and nurses’ perceptions of and reflections on experiencing combined parent-delivered pain management. Methods: This qualitative study applies a collaborative participatory action research design using ethnographic data collection methods such as focus groups, video observations, and video-stimulated recall interviews with parents and nurses. Results: The results concern three main categories, i.e., preparation, participation, and closeness, as well as various sub-categories. Preparations were central to enabling combined parent-delivered pain management. Participation was facilitated by parental musical presence, in which parents shifted their attention toward their infant. Closeness and presence during neonatal care helped parents become active during their infant’s painful procedures. Parental lullaby singing created a calm and trusting atmosphere and after the procedure, both parents and nurses felt that they had successfully supported the infant through a potentially painful procedure. Conclusions: Mental and practical preparation is central to implementing combined parent-delivered pain management. When parents and nurses explored the interventions, they found the methods feasible, promoting self-efficacy and confidence in both parents and nurses.

Background: While parent-delivered pain management has been demonstrated to effectively reduce neonatal procedural pain responses, little is known about to what extent it is utilized. Our aim was to explore the utilization of parents in neonatal pain management and investigate whether local guidelines promote parent-delivered interventions. Methods: A web-based survey was distributed to neonatal units worldwide. Results: The majority of the 303 responding neonatal intensive care units (NICUs) from 44 countries were situated in high-income countries from Europe and Central Asia. Of the responding units, 67% had local guidelines about neonatal pain management, and of these, 40% answered that parental involvement was recommended, 27% answered that the role of parents in pain management was mentioned as optional, and 32% responded that it was not mentioned in the guidelines. According to the free-text responses, parent-delivered interventions of skin-to-skin contact, breastfeeding, and parental live singing were the most frequently performed in the NICUs. Of the responding units, 65% answered that parents performed some form of pain management regularly or always. Conclusions: There appears to be some practice uptake of parent-delivered pain management to reduce neonatal pain in high-income countries. Additional incorporation of these interventions into NICU pain guidelines is needed, as well as a better understanding of the use of parent-delivered pain management in low- and middle-income countries.

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