Mothers' voices and white noise on premature infants' physiological reactions in a neonatal intensive care unit: A multi-arm randomized controlled trial

The effect of classical and harp music on comfort, physiological parameters and cerebral oxygenation among premature infants: A multi-arm randomized controlled trial

BACKGROUND

Music has many positive effects on premature infants. Studies on the comfort and cerebral oxygenation of music in premature infants are limited.

AIM

To examine the effects of classical and harp music on the comfort, heart rate, respiratory rate, oxygen saturation and cerebral oxygenation of premature infants in a neonatal intensive care unit (NICU).

STUDY DESIGN

This was a three-group randomized controlled trial.

METHODS

This study was conducted on 84 medically stable premature infants in an NICU of a medical faculty hospital. There were three groups: the classical music group (n = 28), the harp music group (n = 28) and the routine care group (n = 28). Two or three days a week, on different days, three sessions a day, a total of 15 sessions and 30 min of classical or harp music practice were performed. The sound levels of the classical or harp music were controlled between 50 and 55 dB. No music was applied to premature infants in the routine care group. For each session, physiological parameters, cerebral oxygenation and comfort level were evaluated and measured at pretest and post-test.

RESULTS

According to the time and group interaction, high comfort levels were observed in the classical/harp music group (p = 0.001,η 2 $$ {\eta}^2 $$  = 0.196, CI = 0.169-0.222), heart rate (p = 0.001,η 2 $$ {\eta}^2 $$  = 0.018, CI = 0.009-0.030) and respiratory rate were low in the classical music group (p = 0.001,η 2 $$ {\eta}^2 $$  = 0.019, CI = 0.010-0.031) and oxygen saturation was high in the classical music group (p = 0.027,η 2 $$ {\eta}^2 $$  = 0.006, CI = 0.001-0.013). There was a statistically significant difference between the average cerebral oxygenation values by group (p = 0.001,η 2 $$ {\eta}^2 $$  = 0.029, CI = 0.017-0.043).

CONCLUSIONS

Classical or harp music is beneficial for increasing the comfort level of premature infants. Classical music is useful for stabilizing and improving heart rate, respiratory rate and oxygen saturation in premature infants.

RELEVANCE TO CLINICAL PRACTICE

Music is effective in increasing the comfort of premature infants and stabilizing their physiological parameters and can be applied by neonatal intensive care nurses.

Increased sound levels in the cardiac ICU are associated with an increase in heart rate, blood pressure, and sedation

BACKGROUND

Several organizations including the Environmental Protection Agency, World Health Organization and American Academy of Pediatrics recommend that hospital sound levels not exceed 45 decibels. Yet, several studies across multiple age groups have observed higher than recommended levels in the intensive care setting. Elevated sound levels in hospitals have been associated with disturbances in sleep, patient discomfort, delayed recovery, and delirium.

METHODS

We measured sound levels in a pediatric cardiac intensive care unit and collected vital signs data, sedation dosing and delirium scores. During a 5-week study period, sound levels for 68 patients in 22 private and 4 semi-private rooms were monitored.

RESULTS

Sound levels were consistently above stated recommendations with an average daytime level of 50.6 decibels (maximum, 76.9 decibels) and an average nighttime level of 49.5 decibels (maximum, 69.6 decibels). An increase in average and maximum sound levels increased the probability of sedation administration the following hour (p-value < 0.001 and 0.01, respectively) and was predictive of an increase in heart rate and blood pressure (p-value < 0.001).

CONCLUSION

Sound levels in the CICU were consistently higher than recommended. An increase in heart rate, blood pressure and sedation utilization may suggest a stress response to persistent and sudden loud sounds. Given known negative impacts of excessive noise on stress, sleep, and brain development, as well as the similar adverse effects from the related use of sedative medications, reducing excessive and sudden noise may provide an opportunity to improve short- and long-term hemodynamic and neurodevelopmental outcomes in the pediatric cardiac intensive care unit.

Comparison of the Effect of the White Noise and Sound Reduction on Behavioral Responses of Premature Infants Under Noninvasive Ventilation: A Clinical Trial

BACKGROUND

With the increasing survival rates of premature infants and their associated respiratory problems, noninvasive ventilation has gained popularity in neonatal intensive care units. On the other hand, this equipment can be stressful for infants. Objective: This study aimed to compare the effects of white noise and sound reduction on the behavioral responses of premature infants under noninvasive ventilation. Methods: This study was a randomized controlled crossover trial. Forty-two infants who met the inclusion criteria received white noise and noise reduction in a randomized sequence with a 30-minute washout period between conditions. During the noise reduction condition, infants were placed in the fetal position with earplugs. During the white noise condition, nature sounds from the White Noise Baby Sleep app were played into the incubator. Infant behavioral responses were recorded using the Anderson Behavioral State Scale on 3 consecutive days before, during, and after the intervention. Results: The independent t test showed no statistically significant difference between the 2 groups at baseline. The repeated measures analysis of variance test showed that the mean behavioral response scores of preterm infants in the sound reduction group and the white noise group differed significantly across the 3 stages on all 3 days. However, the results of mixed-effects model indicated that the sound reduction group experienced a significant decrease in behavioral response compared to the white noise group. Conclusion: Therefore, the present study suggests that sound reduction is a more effective nonpharmacological method for improving behavioral responses and reducing restlessness of premature infants under noninvasive ventilation.

Effects of White Noise and Therapeutic Touch on Pain and Comfort in Newborns during Heel Lance: A Randomized Controlled Study

BACKGROUND

Nonpharmacological methods such as white noise and therapeutic touch can be used in pain management in neonates.

PURPOSE

This randomized controlled study evaluated the effects of white noise and therapeutic touch during heel lance procedures on pain, comfort levels, and physiological parameters in healthy neonates.

METHODS

This parallel, randomized controlled study was conducted in the Obstetrics and Gynecology Service of a regional hospital. The sample comprised 160 neonates with gestational ages of >35 weeks randomly assigned to 4 groups (white noise [WN], therapeutic touch [TT], white noise + therapeutic touch [WT], and control [CG] group). Pain and comfort levels were evaluated according to the Neonatal Infant Pain Scale, and the COMFORTneo Scale. The primary outcomes were pain and comfort levels, and the secondary outcomes were heart rate and SpO2 levels. The Kruskal-Wallis test was used to compare the scale scores among groups.

RESULTS

There were significant differences among groups in terms of Neonatal Infant Pain Scale and COMFORTneo scores (P < .05). The pain scores for the white noise, therapeutic touch, and white noise + therapeutic touch groups were 4.2 ± 2.0, 5.2 ± 1.6, and 3.3 ± 1.7, respectively. There was a significant difference in average heart rate during the heel lance procedure among the groups (P < .05). Pain scores of the intervention groups were lower compared to the control group.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The combination of white noise and therapeutic touch was more effective in reducing pain and increasing comfort levels. Nurses could reduce procedural pain by applying these pain relief methods.

The effect of early postnatal auditory stimulation on outcomes in preterm infants

Preterm infants are deprived of in utero sensory stimulation during the third trimester, an important period of central nervous system development. As a result, maturational trajectories are often reduced in infants born preterm. One such system affected is the brain including the auditory and respiratory control pathways. During normal pregnancy the intrauterine environment attenuates external auditory stimuli while exposing the fetus to filtered maternal voice, intra-abdominal sounds, and external stimuli. In contrast, during the third trimester of development, preterm infants are exposed to a vastly different soundscape including non-attenuated auditory sounds and a lack of womb related stimuli, both of which may affect postnatal brain maturation. Therefore, fostering a nurturing postnatal auditory environment during hospitalization may have a significant impact on related outcomes of preterm infants. Studies using a range of postnatal auditory stimulations have suggested that exposure to sounds or lack thereof can have a significant impact on outcomes. However, studies are inconsistent with sound levels, duration of exposure to auditory stimuli, and the gestational age at which infants are exposed. IMPACT: Auditory stimulation can provide a low cost and low risk intervention to stabilize respiration, improve neuronal maturation and reduce long-term sequelae in preterm infants. The potential benefits of auditory stimulation are dependent on the type of sound, the duration of exposure and age at time of exposure. Future studies should focus on the optimal type and duration of sound exposure and postnatal developmental window to improve outcomes.

Effect of white noise during nasal continuous positive airway pressure application on newborn's pain and stress levels, physiological parameters, and crying durations: A randomized controlled study

PURPOSE

The study was conducted to determine the effects of white noise during nasal continuous positive airway pressure (CPAP) application on the newborn's pain and stress levels, physiological parameters, and crying durations.

DESIGN AND METHODS

The study used a randomized, controlled experimental design. The study was completed with 80 newborns (40 in the intervention group and 40 in the control group). The Newborn Descriptive Data Form, ALPS Newborn Pain and Stress Assessment Scale, and Follow-up Form were used to collect the study data. Routine nasal CPAP application was performed to newborns in the control group. White noise was played to newborns in the intervention group before, during, and after the nasal CPAP application. The study was approved by an ethics committee.

RESULTS

It was found that the newborn's pain and stress levels of the intervention group were lower than the control group before, during, and after the nasal CPAP application (p < 0.05). Before nasal CPAP application, the intervention group's SpO2 average was lower than that of the control group (p < 0.01). During nasal CPAP application, the intervention group's heart rate, SpO2, and crying duration averages were found to be lower than the control group (p < 0.05). After nasal CPAP application, the intervention group's crying duration average was lower than the control group (p < 0.01).

CONCLUSIONS

It was found that white noise before, during, and after the nasal CPAP application reduced newborns' pain and stress levels.

PRACTICE IMPLICATION

It is recommended that white noise be used as an easily applicable, economical, safe, and non-pharmacological method to reduce the pain and stress caused by nasal CPAP application in newborns.

CLINICAL TRIALS REGISTRATION

The study was registered at Clinical-Trials.gov (NCT05440669).

Effect of White Noise on Pain Response, Heart Rate, and Oxygen Saturation During Heel Puncture in Premature Infants: A Randomized Controlled Trial

OBJECTIVE

This study aimed to investigate the effect of white noise on pain response, heart rate, and oxygen saturation during heel puncture in premature infants.

METHODS

A randomized, controlled, pretest-posttest design was used. The participants were premature infants admitted to the neonatal intensive care unit of a university hospital in Gyeonggi Province. Sixty premature infants were assigned to either an experimental ( n = 30) or control ( n = 30) group. The experimental group was exposed to white noise during heel puncture, and the measured variables were pain response, heart rate, and oxygen saturation. The data were analyzed using the independent t test, chi-squared test, and analysis of covariance.

RESULTS

Premature infants in the experimental group had a lower pain response and heart rate than the control group ( F = 81.26, P < .01; F = 7.05, P = .01), and higher oxygen saturation than the control group ( F = 4.76, P = .03).

CONCLUSION

These results demonstrated that the white noise intervention is an effective nursing intervention to reduce the pain response and stabilize heart rate and oxygen saturation in premature infants during heel puncture.

Effects of White Noise on Pain Scores and Salivary Cortisol Levels in Surgical Neonates: A Randomized Controlled Trial

BACKGROUND

Neonates experience varying intensities of pain after surgery. While white noise has been used for postoperative pain relief in infants, its effects on neonates after surgery need further exploration.

PURPOSE

This study aimed to evaluate the effects of white noise on pain scores and salivary cortisol levels in surgical neonates.

METHODS

In this randomized controlled trial, 64 neonates scheduled for surgery were recruited and assigned by block randomization into 2 groups. The intervention group listened to white noise at 50 dB, while the control group listened to white noise at 0 dB, for 30 minutes 6 times for 48 hours postoperatively. Pain scores, measured by the COMFORTneo Scale, and salivary cortisol levels were compared.

RESULTS

Although pain scores decreased after surgery in all subjects, no statistically significant difference was observed between the 2 groups (P = .937). There was a significant difference between pre- and postintervention pain scores in the intervention group only (P = .006). Salivary cortisol levels decreased after intervention in the intervention group, but there was no significant difference between pre- and postintervention levels in the 2 groups (P = .716).

IMPLICATIONS FOR PRACTICE

Given the reduction in pain scores and salivary cortisol concentrations after white noise intervention, white noise shows potential as an adjunctive soothing measure for neonates after surgery.

IMPLICATIONS FOR RESEARCH

Future studies are needed to confirm the efficacy and utility of white noise intervention in clinical settings.

The effects of massage therapy and white noise application on premature infants' sleep

AIM

Sleep is vital to premature infants' physical, social and emotional development. The significance of sleep duration, efficiency, and function in premature infants regarding growth development, behavior and neurological development has been increasing.

MATERIALS AND METHODS

This study was conducted in a randomized controlled experimental design with three groups. Premature infants at 28-37 weeks of gestation who were admitted to the Neonatal Intensive Care Unit of Şanlıurfa Mehmet Akif İnan Training and Research Hospital Haliliye Annex Building were the research population. The sample of the present study consisted of 120 premature infants in the massage therapy group (40), white noise group (40), and control group (40).

RESULTS

The sleep duration and sleep efficiency of the premature infants in the massage group increased compared to before the application, whereas the number of awakenings and WASO values decreased. The sleep duration of premature infants in the massaged group increased by some five hours. In the white noise group, the sleep duration increased by about two hours than the pre-treatment, and there was an increase in sleep efficiency. White noise application provided a significant decrease in the number of awakenings and WASO values in premature infants.

CONCLUSION

In this experimental study, which was designed with three groups, it was revealed that massage and white noise application in premature infants were significant non-pharmacological methods to increase sleep duration and sleep efficiency. It was concluded that massage therapy and white noise application is one of the considerable interventions regarding sleep duration, efficiency and functions in premature infants who left the intrauterine period early.

Influence of White Sound on Sleep Quality, Anxiety, and Depression in Patients with Schizophrenia

BACKGROUND

Patients with schizophrenia frequently experience issues such as poor sleep quality, anxiety, and depression. White sound has been identified as a potential therapeutic strategy to enhance sleep quality and alleviate negative emotions. This study aimed to investigate the effectiveness of white sound in improving sleep quality, anxiety, and depression among patients with schizophrenia.

MATERIALS AND METHODS

This retrospective analysis included clinical data from 212 patients with schizophrenia divided into two groups based on their treatment approach. Group C (control, without white sound, n = 106) received standard pharmacological treatments, while group W (white sound, n = 106) was exposed to white sound (40-50 dB) for 2 hours nightly at 9:00 pm. All patients were assessed using the Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive and Negative Syndrome Scale (PANSS) before and after 12 weeks of intervention.

RESULTS

After 12 weeks, group W showed significant improvements in sleep latency, sleep efficiency, and overall PSQI scores compared to group C (P < 0.05). Furthermore, the HAMD and HAMA scores were significantly lower in group W (P < 0.05), indicating reduced levels of anxiety and depression. The negative symptoms score was significantly lower in group W (P < 0.05) after treatment.

CONCLUSION

White sound shows promise in improving sleep quality, and alleviating anxiety and depression in patients with schizophrenia.

Effects of white noise on preterm infants in the neonatal intensive care unit: A meta-analysis of randomised controlled trials

AIM

To critically assess the effects of white noise on the pain level, weight gain and vital signs (heart rate, respiratory rate and oxygen saturation) of preterm infants in neonatal intensive care units (NICUs).

DESIGN

A systematic review and meta-analysis of randomised controlled trials (RCTs).

METHODS

Ten databases (PubMed, Cochrane Library, Embase, Web of Science, CINAHL, PsycINFO, SinoMed, China National Knowledge Infrastructure, VIP and Wanfang Data) were systematically reviewed from inception to July 2022. Two reviewers evaluated the risk of bias separately using the Cochrane Collaboration criteria and extracted data using a predesigned information form.

RESULTS

The meta-analysis included eight eligible RCTs. According to statistical analysis, white noise significantly affected the pain level, weight gain, heart rate, respiratory rate and oxygen saturation in preterm infants. Regardless of the outcome measurement timing, gestational age and birth weight of preterm infants, subgroup analysis demonstrated that white noise reduced the pain level, heart rate and respiratory rate and promoted weight gain in preterm infants in NICUs.

CONCLUSION

White noise is a practical and potentially useful therapy for premature neonates in NICUs. No Patient or Public Contribution.

Effect of White Noise Intervention Combined with Multi-dimensional Nursing Mode on Sleep Quality and Incidence of Nosocomial Infection in Patients Undergoing Hip Replacement

Objective

To investigate the clinical effects of white noise intervention combined with multi-dimensional nursing mode in patients receiving hip replacement (HR).

Methods

The study selected the clinical data of 161 patients who underwent HR in our hospital from February 2020 to February 2022 for retrospective analysis. According to patients' willingness, they were divided into the study group (n = 77, receiving white noise intervention combined with multi-dimensional nursing mode) and the control group (n = 84, receiving routine nursing). Pittsburgh sleep quality index (PSQI) scale was used to evaluate patients' sleep quality in the two groups, and the incidence of nosocomial infection in the both groups was counted.

Results

Before nursing and white noise intervention, the PSQI scores of patients' sleep quality in the two groups were all lower, with no obvious difference (P > 0.05). After nursing and white noise intervention, the sleep quality of the two groups was all improved, and the study group had overtly lower PSQI score and score of psychological status than the control group (P < 0.05). After nursing and white noise intervention, the study group had remarkably lower incidence of nosocomial infection than the control group (p < 0.05).

Conclusion

White noise intervention combined with multi-dimensional nursing mode can effectively improve the sleep quality of patients undergoing HR and reduce the incidence of nosocomial infection, which is of positive significance for promoting the recovery of postoperative limb function.

Musical and vocal interventions to improve neurodevelopmental outcomes for preterm infants

BACKGROUND

Preterm birth interferes with brain maturation, and subsequent clinical events and interventions may have additional deleterious effects. Music as therapy is offered increasingly in neonatal intensive care units aiming to improve health outcomes and quality of life for both preterm infants and the well-being of their parents. Systematic reviews of mixed methodological quality have demonstrated ambiguous results for the efficacy of various types of auditory stimulation of preterm infants. A more comprehensive and rigorous systematic review is needed to address controversies arising from apparently conflicting studies and reviews.

OBJECTIVES

We assessed the overall efficacy of music and vocal interventions for physiological and neurodevelopmental outcomes in preterm infants (< 37 weeks' gestation) compared to standard care. In addition, we aimed to determine specific effects of various interventions for physiological, anthropometric, social-emotional, neurodevelopmental short- and long-term outcomes in the infants, parental well-being, and bonding.

SEARCH METHODS

We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, RILM Abstracts, and ERIC in November 2021; and Proquest Dissertations in February 2019. We searched the reference lists of related systematic reviews, and of studies selected for inclusion and clinical trial registries.

SELECTION CRITERIA

We included parallel, and cluster-randomised controlled trials with preterm infants < 37 weeks` gestation during hospitalisation, and parents when they were involved in the intervention. Interventions were any music or vocal stimulation provided live or via a recording by a music therapist, a parent, or a healthcare professional compared to standard care. The intervention duration was greater than five minutes and needed to occur more than three times.

DATA COLLECTION AND ANALYSIS

Three review authors independently extracted data. We analysed the treatment effects of the individual trials using RevMan Web using a fixed-effects model to combine the data. Where possible, we presented results in meta-analyses using mean differences with 95% CI. We performed heterogeneity tests. When the I2 statistic was higher than 50%, we assessed the source of the heterogeneity by sensitivity and subgroup analyses. We used GRADE to assess the certainty of the evidence.

MAIN RESULTS

We included 25 trials recruiting 1532 infants and 691 parents (21 parallel-group RCTs, four cross-over RCTs). The infants gestational age at birth varied from 23 to 36 weeks, taking place in NICUs (level 1 to 3) around the world. Within the trials, the intervention varied widely in type, delivery, frequency, and duration. Music and voice were mainly characterised by calm, soft, musical parameters in lullaby style, often integrating the sung mother's voice live or recorded, defined as music therapy or music medicine. The general risk of bias in the included studies varied from low to high risk of bias. Music and vocal interventions compared to standard care Music/vocal interventions do not increase oxygen saturation in the infants during the intervention (mean difference (MD) 0.13, 95% CI -0.33 to 0.59; P = 0.59; 958 infants, 10 studies; high-certainty evidence). Music and voice probably do not increase oxygen saturation post-intervention either (MD 0.63, 95% CI -0.01 to 1.26; P = 0.05; 800 infants, 7 studies; moderate-certainty evidence). The intervention may not increase infant development (Bayley Scales of Infant and Toddler Development (BSID)) with the cognitive composition score (MD 0.35, 95% CI -4.85 to 5.55; P = 0.90; 69 infants, 2 studies; low-certainty evidence); the motor composition score (MD -0.17, 95% CI -5.45 to 5.11; P = 0.95; 69 infants, 2 studies; low-certainty evidence); and the language composition score (MD 0.38, 95% CI -5.45 to 6.21; P = 0.90; 69 infants, 2 studies; low-certainty evidence). Music therapy may not reduce parental state-trait anxiety (MD -1.12, 95% CI -3.20 to 0.96; P = 0.29; 97 parents, 4 studies; low-certainty evidence). The intervention probably does not reduce respiratory rate during the intervention (MD 0.42, 95% CI -1.05 to 1.90; P = 0.57; 750 infants; 7 studies; moderate-certainty evidence) and post-intervention (MD 0.51, 95% CI -1.57 to 2.58; P = 0.63; 636 infants, 5 studies; moderate-certainty evidence). However, music/vocal interventions probably reduce heart rates in preterm infants during the intervention (MD -1.38, 95% CI -2.63 to -0.12; P = 0.03; 1014 infants; 11 studies; moderate-certainty evidence). This beneficial effect was even stronger after the intervention. Music/vocal interventions reduce heart rate post-intervention (MD -3.80, 95% CI -5.05 to -2.55; P < 0.00001; 903 infants, 9 studies; high-certainty evidence) with wide CIs ranging from medium to large beneficial effects. Music therapy may not reduce postnatal depression (MD 0.50, 95% CI -1.80 to 2.81; P = 0.67; 67 participants; 2 studies; low-certainty evidence). The evidence is very uncertain about the effect of music therapy on parental state anxiety (MD -0.15, 95% CI -2.72 to 2.41; P = 0.91; 87 parents, 3 studies; very low-certainty evidence). We are uncertain about any further effects regarding all other secondary short- and long-term outcomes on the infants, parental well-being, and bonding/attachment. Two studies evaluated adverse effects as an explicit outcome of interest and reported no adverse effects from music and voice.

AUTHORS' CONCLUSIONS

Music/vocal interventions do not increase oxygen saturation during and probably not after the intervention compared to standard care. The evidence suggests that music and voice do not increase infant development (BSID) or reduce parental state-trait anxiety. The intervention probably does not reduce respiratory rate in preterm infants. However, music/vocal interventions probably reduce heart rates in preterm infants during the intervention, and this beneficial effect is even stronger after the intervention, demonstrating that music/vocal interventions reduce heart rates in preterm infants post-intervention. We found no reports of adverse effects from music and voice. Due to low-certainty evidence for all other outcomes, we could not draw any further conclusions regarding overall efficacy nor the possible impact of different intervention types, frequencies, or durations. Further research with more power, fewer risks of bias, and more sensitive and clinically relevant outcomes are needed.

Effects of recorded maternal voice on anthropometric parameters and heart rate in premature infants: A pilot randomised controlled trial

PURPOSE

To explore the benefits of a recorded maternal voice intervention on weight, recumbent length, head circumference, and heart rate of preterm infants in the neonatal intensive care unit.

METHODS

A pilot randomised controlled trial was conducted in this study. Preterm infants in the neonatal intensive care unit (N = 109) were recruited and randomly assigned to an intervention or control group. Both groups received routine nursing care, while preterm infants in the intervention group received a recorded maternal voice program of 20 min, twice daily for 21 days. Preterm infants' daily weight, recumbent length, head circumference, and heart rate were collected during the 21-day intervention. Participants' heart rate in the intervention group was also recorded once a day pre-during-after the recorded maternal voice program.

RESULTS

Preterm infants in the intervention group showed a significant increase in weight (-75.94, 95% CI -108.04, -43.85, P < 0.001), recumbent length (-0.54, 95% CI -0.76, -0.32, P < 0.001), and head circumference (-0.37, 95%CI -0.56, -0.18, P < 0.001) compared with the control group. Preterm infants in the intervention group also showed significant changes in heart rate pre-during-after the recorded maternal voice program. However, no significant differences were found in the heart rate scores between the two groups.

DISCUSSION

The changes in heart rate pre-during-after the intervention may help explain participants' more significant increase in weight, recumbent length, and head circumference.

PRACTICE IMPLICATIONS

The recorded maternal voice intervention could be incorporated into clinical practice to promote growth and development in preterm infants in the neonatal intensive care unit.

STUDY REGISTRATION

Australian New Zealand Clinical Trials Register, https://www.anzctr.org.au/; (registration number: ACTRN12622000019707).

The effect of using maternal voice, white noise, and holding combination interventions on the heel stick sampling

BACKGROUND

Heel stick sampling, a common procedure in newborns, causes acute pain.

AIMS

This study aims to measure the outcome of five various non-pharmacologic pain relief groups; maternal voice, white noise, holding, maternal voice+holding, and white noise+holding.

METHODS

The study is an open label, randomized controlled trial. A total of 178 newborns were included in this study. Newborns were randomly allocated to each group; white noise (n = 31), maternal voice (n = 31), holding (n = 30), white noise+holding (n = 29), maternal voice+holding (n = 28), and control (n = 29) interventions. Newborns' pain responses were evaluated using the Neonatal Infant Pain Scale (NIPS), and the Premature Infant Pain Profile (PIPP). The primary measured outcomes were the newborns' pain levels, while the secondary outcomes were the heart rate and changes in oxygen saturation. The mean values of pain in neonates between groups were evaluated one minute before (Phase1), during (Phase2), and one minute after (Phase3) the procedure.

RESULTS

The research results are given with comparisons in three time periods (Phase1, Phase2 and Phase3). White noise and white noise+holding were found to have the lowest mean NIPS and PIPP score (p < 0.001). The mean heart rate was found to be the lowest in the white noise+holding group (p < 0.001). There was no significant difference between the groups in terms of oxygen saturation score (p = 0.453).

CONCLUSION

The white noise+holding applied to newborns during heel stick sampling were effective in pain reduction. Nurses and midwives can use white noise+holding method.

IMPLICATIONS TO PRACTICE

These results contribute to the pain management of newborns.

Effects of white noise on procedural pain-related cortical response and pain score in neonates: A randomized controlled trial

Objectives

To evaluate the effects of white noise on pain-related cortical response, pain score, and behavioral and physiological parameters in neonates with procedural pain.

Methods

A double-blind, randomized controlled trial was conducted. Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB (experimental group) or 0 dB (control group) 2 min before radial artery blood sampling and continued until 5 min after needle withdrawal. Pain-related cortical response was measured by regional cerebral oxygen saturation (rScO₂) monitored with near-infrared spectroscopy, and facial expressions and physiological parameters were recorded by two video cameras. Two assessors scored the Premature Infant Pain Profile-Revised (PIPP-R) independently when viewing the videos. Primary outcomes were pain score and rScO₂ during arterial puncture and 5 min after needle withdrawal. Secondary outcomes were pulse oximetric oxygen saturation (SpO₂) and heart rate (HR) during arterial puncture, and duration of painful expressions. The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200055571).

Results

Sixty neonates (experimental group, n = 29; control group, n = 31) were included in the final analysis. The maximum PIPP-R score in the experimental and control groups was 12.00 (9.50, 13.00), 12.50 (10.50, 13.75), respectively (median difference −0.5, 95% CI −2.0 to 0.5), and minimum rScO₂ was (61.22 ± 3.07)%, (61.32 ± 2.79)%, respectively (mean difference −0.325, 95% CI −1.382 to 0.732), without significant differences. During arterial puncture, the mean rScO₂, HR, and SpO₂ did not differ between groups. After needle withdrawal, the trends for rScO₂, PIPP-R score, and facial expression returning to baseline were different between the two groups without statistical significance.

Conclusion

The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score, behavioral and physiological parameters in neonates with procedural pain.

Effect of non-pharmacological interventions on sleep in preterm infants in the neonatal intensive care unit: A protocol for systematic review and network meta-analysis

BACKGROUND

Premature infants are prone to suffer multisystem complications after birth due to the incomplete development of organ tissues and low immunity, and they require a longer period of supervised treatment in the neonatal intensive care unit (NICU). However, due to the specificity of medical care in the NICU, the sleep of preterm infants is highly susceptible that has an impact on the prognosis of preterm infants. Recently, various non-pharmacological interventions have been applied to the sleep of preterm infants in the NICU, which have shown positive outcomes. However, the efficacy and safety of them are unclear. This study aims to evaluate the effects of non-pharmacological interventions on sleep in preterm infants in the NICU through a network meta-analysis.

METHODS

Randomized controlled trials of non-pharmacological interventions on sleep in preterm infants in the NICU published before September 2021 will be searched in online databases, including the Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science. Two researchers will be independently responsible for screening and selecting eligible literatures, extracting data and evaluating the risk of bias in the included studies. Stata 14.0 software will be used for data analysis.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will provide comprehensive and reliable evidence-based references for the efficacy and safety in different non-pharmacological interventions on sleep in preterm infants in the NICU.

Newborn Incubators Do Not Protect from High Noise Levels in the Neonatal Intensive Care Unit and Are Relevant Noise Sources by Themselves

BACKGROUND

While meaningful sound exposure has been shown to be important for newborn development, an excess of noise can delay the proper development of the auditory cortex.

AIM

The aim of this study was to assess the acoustic environment of a preterm baby in an incubator on a newborn intensive care unit (NICU).

METHODS

An empty but running incubator (Giraffe Omnibed, GE Healthcare) was used to evaluate the incubator frequency response with 60 measurements. In addition, a full day and night period outside and inside the incubator at the NICU of the University Hospital Zurich was acoustically analyzed.

RESULTS

The fan construction inside the incubator generates noise in the frequency range of 1.3-1.5 kHz with a weighted sound pressure level (SPL) of 40.5 dB(A). The construction of the incubator narrows the transmitted frequency spectrum of sound entering the incubator to lower frequencies, but it does not attenuate transient noises such as alarms or opening and closing of cabinet doors substantially. Alarms, as generated by the monitors, the incubator, and additional devices, still pass to the newborn.

CONCLUSIONS

The incubator does protect only insufficiently from noise coming from the NICUThe transmitted frequency spectrum is changed, limiting the impact of NICU noise on the neonate, but also limiting the neonate's perception of voices. The incubator, in particular its fan, as well as alarms from patient monitors are major sources of noise. Further optimizations with regard to the sound exposure in the NICU, as well as studies on the role of the incubator as a source and modulator, are needed to meet the preterm infants' multi-sensory needs.