Abstract
This study examined the effects of music-reinforced nonnutritive sucking (NNS) for premature infants experiencing heelstick. Subjects for this one-trial study were 60 preterm, low birthweight (LBW) infants in a neonatal intensive care unit, aged 32 to 37 weeks post conceptional age, who were randomly assigned to one of three treatment groups, evenly divided for gender: PAL experimental (n = 20), pacifier-only control (n = 20), and no-contact control (n = 20). For experimental infants, intervention began approximately 3 minutes prior to the heelstick and continued throughout and approximately 3 minutes following the blood collection procedure. Infants were provided the Sondrex® PAL System® which played 10-second lullaby music contingent on sucking. Procedures were the same for infants in the pacifier-only control group, except that they did not receive music reinforcement for sucking. Standard care and pain management procedures (e.g., swaddling, cuddling, and sucrose) were not limited for any infants. Stress level and behavior state were assessed continuously and physiologic measures of heart rate, respiratory rate, and oxygen saturation (SaO2) were recorded at 15-second intervals for all infants.
Although no significant differences were revealed between the PAL and pacifier-only groups, more and greater differences were evident between the PAL and no-contact groups than between the pacifier-only and no-contact control groups. Not only were behavior state and stress level means lower for all intervals and increases smaller during the painful stimulus for the PAL group than for the other two treatment groups, but the patterns of behavior state and stress level were more stable across time for the PAL group than for the other groups. Also, the pattern of changes in SaO2 and in behavior state and stress level indicate that music-reinforced NNS may facilitate return to homeostasis following the completion of the heelstick procedure. No meaningful gender differences were observed for physiologic measures, but standard deviations for behavior state and stress level were smaller for females than for males across time, indicating greater stability in responses. Based on results of this study, music-reinforced NNS seems to be effective in attenuating behavior state and stress level increases for preterm, LBW infants experiencing heelstick.
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