The effectiveness of music on pain among preterm infants in the NICU: a systematic review

Abstract

Background Preterm infants are exposed to a variety of painful procedures in a neonatal intensive care unit (NICU) and repeated and untreated pain can cause adverse consequences. Music is one of the non-pharmacological interventions that has been used increasingly in this vulnerable patient group. Objectives The objective was to systematically search, appraise and synthesize the best available evidence related to the effectiveness of music on pain among preterm infants for painful procedures in the NICU. Inclusion criteria Preterm infants born in or before 37 weeks of gestational age treated in the NICU were chosen as the population. The intervention included any type of music, which was implemented for infants by a music therapist or any health care providers during painful procedures for the purposes of research. The comparison group received no music intervention. Outcomes included level of pain measured by pain scores and physiological, behavioral and hormonal pain indicators. The review considered only experimental study designs including randomized controlled trials (RCTs) for inclusion. Search strategy Searches were conducted of 10 electronic databases of published studies and five sources of unpublished studies, in collaboration with a librarian covering January 2000−April/May 2013. The search did not impose any language restrictions. A total of 702 potentially relevant papers were identified. Six hundred forty-eight were excluded based on the evaluation of titles and abstracts, thus 54 papers remained. After excluding duplicates, 13 papers were retrieved for detailed examination. Eleven papers were excluded after review of the full text papers. Finally, two papers, which were experimental with cross-over design, were included. Methodological quality The methodological quality of eligible studies was assessed by two independent reviewers using a standardized critical appraisal tool for experimental studies (MAStARI) from the Joanna Briggs Institute. Data collection and synthesis Data were extracted from the studies that met the criteria for methodological quality. Two reviewers independently extracted the details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. The data were synthesized using a narrative review, because heterogeneity in population, music interventions used and outcome measurements limited the possibility to pool data. The results concerning the effectiveness of music were reported using p-values and 95% CIs if appropriate. Results The effect of recorded music was examined in both studies relating to heel stick as a painful procedure. Music seemed to have a positive effect on physiological (heart rate and oxygenation) and behavioral pain indicators, as well as the pain scores (NIPS, NFCS) when considering the preterm infants’ pain in the neonatal intensive care unit. Hormonal pain indicators were not reported in the included studies. Conclusions Music may be effective in relieving preterm infants’ pain related to painful procedures in the NICU. However, the results cannot be generalized due to the fact that these studies employed sample size and their wide heterogeneity by population, outcome measurements and interventions.