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  • 1.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre For Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Klässbo, Maria
    Centre For Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Family-centred music therapy during painful procedures in neonatal care2018Conference paper (Refereed)
    Abstract [en]

    Background: During the most vulnerable period in a child’s life, preterm and sick newborns are exposed to a high number of painful procedures, sometimes without the comfort of their parents. Repeated pain and frequent use of opioids can have consequences for the neurological and behaviour-oriented development of the infant.It is vital to identify a repertoire of effective non-pharmacological interventions.

    Method: Preterm and term infants (n=38) were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live by a music  therapy student. Standard care (facilitated tucking and oral glucose) was provided for all neonates. Behavioural and physiological pain responses were assessed.

    Results: Live singing with newborn infants is a social communicative interaction. If the vocal performance is predictable and regular from start, it may optimize homeostasis during painful procedures. However, 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. There were non-significant indications of fewer and shorter skin punctures with lullaby singing.

    Conclusion: The additive effect of live lullaby singing has not been shown to alleviate infants’ behavioural pain responses during venepuncture; nor has it been shown to be stressful. Pain involves the interaction of biopsychosocial and situational factors,  therefore more research is needed to explore the potential benefits of music therapy including the role of the parents.

  • 2.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Live music therapy with lullaby singing as affective support during painful procedures: a case study with microanalysis2017In: Nordic Journal of Music Therapy, ISSN 0809-8131, Vol. 26, no 2, p. 142-166Article in journal (Refereed)
    Abstract [en]

    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.

  • 3.
    Ullsten, Alexandra
    et al.
    Örebro University, School of Music, Theatre and Art.
    Volgsten, Ulrik
    Örebro University, School of Music, Theatre and Art.
    Klässbo, Maria
    Region Värmland, Karlstad, Sweden.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Live lullaby singing during painful procedures in preterm and term infants2019Conference paper (Refereed)
    Abstract [en]

    Introduction: Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Infant-directed singing is a multisensory biopsychosocial communication that also applies to ill and vulnerable hospitalised infants. The first Nordic implementation process of family-centred neonatal music therapy started in Sweden at the Central Hospital in Karlstad by the first author in March 2010 (Fig. 1). Live lullaby singing during painful procedures is the first clinical trial to measure the pain-relieving effects of live lullaby singing during venepuncture in preterm and term neonates.

    Method: 38 infants were subjected to venepuncture with and without live lullaby singing, in a randomised order with a cross over design. Parent-preferred lullabies were performed live by a music therapy student and standard care (facilitated tucking and oral glucose) was provided for all infants. Behavioural and physiological pain responses were assessed. The data from the RCT was analysed with qualitative and quantitative methods.

    Results: During the lullaby procedures the physiological patterns were more stable and regular. Lullaby singing significantly calmed the infants’ respiration before venepuncture (Fig. 2). There were nonsignificant indications of fewer and shorter skin punctures with lullaby singing. The behavioural pain responses did not show any significant differences between the live lullaby singing and standard care procedures, however, nor did they indicate that live lullaby singing was harmful or stressful.

    Conclusion: Live singing with infants is a biopsychosocial communicative interaction. A music therapist specialised in family-centred neonatal music therapy methods can mentor parents how to use live lullaby singing in connection to painful procedures. More research is needed to explore the potential benefits of family-centred music therapy as procedural support including the voice of the parents.

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