Maternal Speech Decreases Pain Scores and Increases Oxytocin Levels in Preterm Infants During Painful Procedures
Condition: Preterm Birth; Pain, Procedural
MeSH terms: Premature Birth; Pain, Procedural
Study type: Interventional

Summary: 
      Preterm infants undergo early separation from parents and are exposed to frequent painful
      clinical procedures, with resultant short- and long-term effects on their neurodevelopment.
      We aimed to establish whether the mother's voice could provide an effective and safe
      analgesia for preterm infants and whether endogenous oxytocin (OXT) could be linked to pain
      modulation. Twenty preterm infants were exposed to three conditions-mother's live voice
      (speaking or singing) and standard care-in random order during a painful procedure. OXT
      levels (pg/mL) in saliva and plasma cortisol levels were quantified, and the Premature Infant
      Pain Profile (PIPP) was blindly coded by trained psychologists.
    

Detailed description: 
      Preterm birth rates are continuously increasing in almost all countries, with 15 million
      premature infants being born every year worldwide1. Despite rapid advances in technology, the
      number of preterm-born children who show short- and long-term sequelae of prematurity, even
      before reaching school age, remains high. Around 40% of low birth weight preterm infants
      experience a complex spectrum of unfavourable neurodevelopmental outcomes when compared with
      their pairs at term. Thus, prematurity is of great concern for health policies in both low-
      and high-income countries. The impaired development of preterm infants is not only associated
      with medical factors, but it is also at least partly a consequence of the atypical early-life
      environment of these infants, including exposure to pain and separation from the primary
      caregivers.

      The aim of the present work was first, to assess whether early closeness with parents during
      essential but painful clinical procedures could have a positive role in pain modulation in
      preterm infants, thus contributing to the universal right to pain relief. Second, we aimed to
      investigate the possible role of the oxytocinergic system in this putative pain modulation
      through maternal vocal contact.

      In the present protocol, we introduce the effects of separation and early pain exposure as
      two environmental factors that are even more deleterious when concomitant, inducing short-
      and long-term problems in the preterm infant's development. We then suggest that there are
      protective effects of early closeness between parents and preterm infants in early care and,
      more specifically, of early vocal contact between parents and preterm infants during
      hospitalisation. Lastly, we discuss the role of oxytocin (OXT) as a crucial biomarker for
      attachment processes and in relation to brain inflammation due to stressful procedures for
      preterm infants in the neonatal intensive care unit (NICU).
    

Intervention name(s): Maternal speech; Maternal singing; Standard care
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): In both intervention conditions, speaking and singing, the mothers were asked not to touch the baby but to pay close attention to his/her reactions and to modulate the voice accordingly. A nurse was present during all procedures.; In both intervention conditions, speaking and singing, the mothers were asked not to touch the baby but to pay close attention to his/her reactions and to modulate the voice accordingly. A nurse was present during all procedures.; the newborn was placed by the nurse in the incubator in the standard care conditions recommended for painful procedures (supine position, wrapped and contained by the nest).
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Crossover clinical trial with a repeated measures design. Each patient is assigned to a sequence of three treatments (maternal speech, maternal singing, and standard treatment).
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Oxytocin; Maternal voice; Neonatal Intensive Care Unit