Effects of Musical Storytelling on Pain Responses During Heel Lance for Blood Glucose Testing in Premature Infants: A Quasi-Experimental Study

Preawvanid Samart; Lawan Singhasai; Autchareeya Patoomwan

doi:10.60099/prijnr.2026.281666

Authors

Preawvanid Samart Graduate Student in the Master of Nursing Science Program (Pediatric Nursing), Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
Lawan Singhasai Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
Autchareeya Patoomwan Faculty of Nursing, Kasem Bundit University, Romklao Campus, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2026.281666

Keywords:

Blood glucose testing, Heel lance, Music, Nurses, Pain responses, premature infants, Storytelling

Abstract

Heel lance for blood glucose monitoring is a routine procedure for preterm infants in neonatal intensive care units. However, it is associated with acute pain that may adversely impact growth and neurodevelopment. This quasi-experimental, cross-over study—conducted at a tertiary hospital in Bangkok—aimed to evaluate the effects of musical storytelling on pain responses during heel lance procedures. Thirty-four preterm infants (gestational age: 34–36+6 weeks) were purposively recruited and randomly assigned to receive either the experimental condition (musical storytelling plus usual care) or the control condition (usual care only) f irst. Following the initial intervention, participants crossed over to the alternate condition. Pain responses were measured using the Neonatal Infant Pain Scale, heart rate, respiratory rate, and arterial oxygen saturation at three intervals: baseline, during the procedure, and post-procedure. Data were analyzed using two-way repeated measures ANOVA.
The results demonstrated that infants who received musical storytelling had signif icantly lower pain scores during the procedure and at 1-, 5-, and 10-minute post-heel-lance compared with the control group. Furthermore, those in the intervention group exhibited lower heart and respiratory rates, along with signif icantly higher arterial oxygen saturation levels at the 1-, 5-, and 10-minute intervals. These f indings suggest that musical storytelling is a benef icial and feasible non-pharmacological intervention for mitigating procedural pain. Integrating this practice into routine neonatal care can empower nurses to provide evidence-based pain management in the neonatal intensive care units. However, future research with larger, more diverse cohorts is necessary to compare various auditory stimuli and determine the optimal timing and duration for the intervention.

References

Cruz MD, Fernandes AM, Oliveira CR. Epidemiology of painful procedures performed in neonates: a systematic review of observational studies. Eur J Pain. 2016;20(4):489–98. doi:10.1002/ejp.757

Alidadian S, Naderifar M, Abbasi A, Navidian A, Mahmoodi N. Comparison of the effect of lullaby and kangaroo care on physiological criteria during heel lance in preterm neonates. Iran J Neonatol. 2021;12(4):40–7. doi:10.22038/ijn.2021.50687.1896

Relland LM, Gehred A, Maitre NL. Behavioral and physiological signs for pain assessment in preterm and term neonates: a systematic review. Pediatr Neurol. 2019;90:13-23. doi:10.1016/j.pediatrneurol.2018.10.001

Campbell-Yeo M, Eriksson M, Benoit B. Assessment and management of pain in preterm infants: a practice update. Children (Basel). 2022;9(2):244. doi:10.3390/children9020244

Williams MD, Lascelles BDX. Early neonatal pain: a review of clinical and experimental implications. Front Pediatr. 2020;8:30. doi:10.3389/fped.2020.00030

García-Valdivieso I, Yáñez-Araque B, Moncunill-Martínez E, Bocos-Reglero MJ, Gómez-Cantarino S. Effect of non-pharmacological methods in neonatal pain. Int J Environ Res Public Health. 2023;20(4):3226. doi:10.3390/ijerph20043226

Bağli E, Küçükoğlu S, Soylu H. The effect of lullabies and classical music on preterm neonates. Biol Res Nurs. 2024;26(2):181-91. doi:10.1177/10998004231202404

Nanou C, Lampropoulou C, Kirkou G, Metallinou D. Non-pharmacological methods to reduce pain in preterm infants. World J Adv Res Rev. 2024;22(2):1415-31. doi:10.30574/wjarr.2024.22.2.1556

Qiu J, Jiang YF, Li F, Tong QH, Rong H, Cheng R. Effect of combined music and touch intervention on pain response and beta-endorphin and cortisol concentrations in late preterm infants. BMC Pediatr. 2017;17(1):38. doi:10.1186/s12887-016-0755-y

Picciolini O, Porro M, Meazza A, Giannì ML, Rivoli C, Lucco G, et al. Early exposure to maternal voice: effects on preterm infants' development. Early Hum Dev. 2014;90(6):287-92. doi:10.1016/j.earlhumdev.2014.03.003

Mohan A, Gokulakrishnan G, El-Saie A, Brickley A, Hagan J, Pammi M. Music therapy for preterm neonates: a systematic review and meta-analysis. Acta Paediatr. 2021;110(12):3180-200. doi:10.1111/apa.16055

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-9. doi:10.1126/science.150.3699.971

Vinall J, Grunau RE. Impact of repeated procedural pain-related stress in infants born very preterm. Pediatr Res. 2014;75(5):584-7. doi:10.1038/pr.2014.16

Cavaiuolo C, Casani A, Di Manso G, Orfeo L. Effect of Mozart music on heel lance pain in preterm infants. J Pediatr Neonatal Individ Med. 2015;4(1):e040109. doi:10.7363/040109

Costa VS, Bündchen DC, Sousa H, Pires LB, Felipetti FA. Clinical benefits of music-based interventions for hospitalized children and adolescents: a systematic review. Acta Paediatr. 2022;111(3):478-89. doi:10.1111/apa.16222

Corrigan MJ, Keeler JR, Miller HD, Ben Khallouq BA, Fowler SB. Music therapy and retinopathy screening in premature infants. J Perinatol. 2020;40(12):1780-8. doi:10.1038/s41372-020-0719-9

Yu WC, Chiang MC, Lin KC, Chang CC, Lin KH, Chen CW. Effects of maternal voice on pain and mother-infant bonding in preterm infants during painful procedures. J Pediatr Nurs. 2022;63:e136-e142. doi:10.1016/j.pedn.2021.09.022

Lafferty MA, Mackley A, Green P, Ottenthal D, Locke R, Guillen U. Can Mozart improve weight gain in preterm infants? Am J Perinatol. 2023;40(7):793-8. doi:10.1055/s-0041-1731279

Glass GV. Primary, secondary, and meta-analysis of research. Educ Res. 1976;5(10):3-8.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988.

Lawrence J, Alcock D, McGrath PJ, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12(6):59-66.

Burns N, Grove SK. The practice of nursing research. 5th ed. St. Louis: Elsevier Saunders; 2005.

Korcharoenwat S. Mother loves you [Internet]. YouTube; [cited 2024 Aug 30]. Available from: https://www.youtube.com/watch?v=B7N9re3QKr8&t=135s

Balk SJ, Bochner RE, Ramdhanie MA, Reilly BK. Preventing excessive noise exposure in infants, children, and adolescents. Pediatrics. 2023;152(5):e2023063753. doi:10.1542/peds.2023-063753

Carvalhais C, Santos J, da Silva MV, Xavier A. Training of health care staff on noise reduction in neonatal intensive care units. J Toxicol Environ Health A. 2015;78(13-14):897-903. doi:10.1080/15287394.2015.1051204

Ding S, Wang Q, Fu X, Huang X, Liao L, Zhang Y. Effects of acoustic stimulation on painful procedures in preterm and full-term infants: a systematic review and network meta-analysis. Int J Nurs Stud. 2025;165:105031. doi:10.1016/j.ijnurstu.2025.105031

Lopes TCP, da Silva Vieira AG, Cordeiro SA, et al. Effectiveness of non-pharmacological interventions in reducing pain in preterm infants: a systematic review and network meta-analysis. Intensive Crit Care Nurs. 2024;84:103742. doi:10.1016/j.iccn.2024.103742

Ou Y, Chen L, Zhu X, Zhang T, Zhou Y, Zou L, et al. The effect of music on pain management in preterm infants during daily painful procedures: a systematic review and meta-analysis. Front Pediatr. 2024;12:1351401. doi:10.3389/fped.2024.1351401

Weng Y, Zhang J, Chen Z. Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials. BMC Pediatr. 2024;24:9. doi:10.1186/s12887-023-04488-y

Bergomi P, Chieppi M, Maini A, Mugnos T, Spotti D, Tzialla C, et al. Nonpharmacological techniques to reduce pain in preterm infants during routine procedures: a systematic review. Res Theory Nurs Pract. 2014;28(4):335-48. doi:10.1891/1541-6577.28.4.335

Chirico G, Cabano R, Villa G, Bigogno A, Ardesi M, Dioni E. Randomised study showed that recorded maternal voices reduced pain in preterm infants undergoing heel lance procedures in a neonatal intensive care unit. Acta Paediatr. 2017;106(10):1564-8. doi:10.1111/apa.13944

Kocaaslan Mutlu EN, Zafer Dinçkol R. Effectiveness of maternal voice and lullabies on pain and physiological parameters in preterm infants during aspiration: a randomized controlled study. Adv Neonatal Care. 2025;25(5):413-423. doi:10.1097/ANC.0000000000001295

Mohammed ES, Elmwafie SM, Mohamed FSA, Ismail SS. The effect of tactile versus auditory stimulation on reducing pain associated with invasive procedures among preterm neonates at NICUs. BMC Pediatr. 2025;25:623. doi:10.1186/s12887-025-05979-w

Otlu B, Esenay FI. Use of mothers milk odor and white noise on pain management in preterm infants: a randomized controlled trial. Adv Neonatal Care. 2025;25(1):28-36. doi:10.1097/ANC.0000000000001214

Özgürbüz N, Bahar A, Tuna A, Çopur E. The effect of lullaby played to preterm infants in neonatal intensive care units on physiological parameters and pain. J Pediatr Nurs. 2024;79:133-140. doi:10.1016/j.pedn.2024.08.019

Doğan P, Karakul A, Engür D, Öncel MY. The effectiveness of music on pain during heel blood collection in premature infants. Infant Behav Dev. 2025;81:102157. doi:10.1016/j.infbeh.2025.102157

Erdei C, Sunwoo J, Corriveau GC, Forde M, El-Dib M, Inder T. Effect of music-based interventions on physiologic stability of hospitalized preterm infants: a pilot study. J Perinatol. 2024;44(5):665-670. doi:10.1038/s41372-024-01907-5

Uematsu H, Sobue I. Effect of music and non-nutritive sucking on pain relief during heel lance in preterm infants. Paediatr Child Health. 2019;24(1):e33-e39. doi:10.1093/pch/pxy072

Kisilevsky BS, Hains SMJ, Brown CA, Lee CT, Cowperthwaite B, Stutzman SS, et al. Fetal sensitivity to properties of maternal speech and language. Infant Behav Dev. 2009;32(1):59–71. doi:10.1016/j.infbeh.2008.10.002