Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Music for pain relief of minor procedures in term neonates

A Correction to this article was published on 29 September 2023

This article has been updated



Music for neonatal pain has not been exclusively studied in term neonates in a well-designed trial compared to the standard of care. This study aims to assess the effectiveness of music intervention as an adjuvant in relieving acute pain in term newborns undergoing minor painful procedures.


This randomized, controlled, blinded trial included any term neonate undergoing heel prick. Both control and intervention groups received oral sucrose 2 min before heel prick. Intervention group was exposed to ‘Bedtime Mozart’ lullaby recorded music via bedside speakers. Pain was measured using Neonatal Infant Pain Scale (NIPS) at 1-min intervals. Investigators were blinded using noise-canceling headphones that played random music.


A total of 100 neonates were enrolled. Mean gestational age was 39.2 weeks, and mean duration of the procedure was 113 s. Music group was found to have significantly lower pain scores [OR = 0.42 (0.31, 0.56), p < 0.001]. Baseline NIPS scores were similar across groups and there was no interaction effect between groups and time. When NIPS were categorized as pain and no pain, there continued to be statistically significant lower NIPS scores in the music group (p < 0.001).


Recorded music, in addition to sucrose, is efficacious in reducing pain, encouraging its use in term neonates.


  • Recorded music effectively reduces pain induced by minor procedures in term neonates.

  • Clinical studies have shown that live and recorded music induces changes in vital signs and pain scores in the NICU’s predominantly preterm population.

  • Most of these studies were also conducted in the white ethnic population.

  • Our study objectively proves reduction in pain scores by using recorded music in a randomized, controlled, blinded study of predominantly non-white, term neonates.

  • Recorded music is effective in reducing acute pain in term neonates and can be widely used even in low-resource nurseries.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow diagram of patient allocation as per CONSORT guidelines.
Fig. 2: Mean NIPS scores measured across time and compared between groups.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Change history


  1. Perry, M. et al. Neonatal pain. Crit. Care Nurs. Clin. North Am. 30, 549–561 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Tobias, J. K. & Deshpande, J. K. Pediatric Pain Management for Primary Care (American Academy of Pediatrics, 2005).

  3. Olsson, E. et al. The use and reporting of Neonatal Pain Scales: a systematic review of randomized trials. Pain 162, 353–360 (2021).

    Article  PubMed  Google Scholar 

  4. Stevens, B., Yamada, J., Ohlsson, A., Haliburton, S. & Shorkey, A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst. Rev. 7, CD001069 (2016).

    PubMed  Google Scholar 

  5. Wade, C. et al. Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis. Lancet Child Adolesc. Health 4, 750–760 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Benoit, B., Martin-Misener, R., Latimer, M. & Campbell-Yeo, M. Breast-feeding analgesia in infants: an update on the current state of evidence. J. Perinat. Neonatal Nurs. 31, 145–159 (2017).

    Article  PubMed  Google Scholar 

  7. Johnston, C. et al. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst. Rev. 2, CD008435 (2017).

    PubMed  Google Scholar 

  8. Ranger, M., Albert, A., MacLean, K. & Holsti, L. Cerebral hemodynamic response to a therapeutic bed for procedural pain management in preterm infants in the NICU: a randomized controlled trial. Pain. Rep. 6, e890 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Johnston, C. C., Filion, F. & Nuyt, A. M. Recorded maternal voice for preterm neonates undergoing heel lance. Adv. Neonatal Care 7, 258–266 (2007).

    Article  PubMed  Google Scholar 

  10. Rossi, A. et al. Music reduces pain perception in healthy newborns: a comparison between different music tracks and recoded heartbeat. Early Hum. Dev. 124, 7–10 (2018).

    Article  PubMed  Google Scholar 

  11. Standley, J. Music therapy research in the NICU: an updated meta-analysis. Neonatal Netw. 31, 311–316 (2012).

    Article  PubMed  Google Scholar 

  12. Ghetti, C. et al. Longitudinal Study of music Therapy’s Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an international randomised trial. BMJ Open 9, e025062 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Standley, J. M. A meta-analysis of the efficacy of music therapy for premature infants. J. Pediatr. Nurs. 17, 107–113 (2002).

    Article  PubMed  Google Scholar 

  14. Cevasco, A. M. & Grant, R. E. Effects of the pacifier activated lullaby on weight gain of premature infants. J. Music Ther. 42, 123–139 (2005).

    Article  PubMed  Google Scholar 

  15. Cavaiuolo, C., Casani, A., Di Manso, G. & Orfeo, L. Effect of Mozart music on heel prick pain in preterm infants: a pilot randomized controlled trial. J. Pediatr. Neonatal Individual. Med. 4, e040109 (2015).

    Google Scholar 

  16. Butt, M. L. & Kisilevsky, B. S. Music modulates behaviour of premature infants following heel lance. Can. J. Nurs. Res. 31, 17–39 (2000).

    CAS  PubMed  Google Scholar 

  17. Hartling, L. et al. Music for medical indications in the neonatal period: a systematic review of randomised controlled trials. Arch. Dis. Child Fetal Neonatal Ed. 94, F349–F354 (2009).

    Article  CAS  PubMed  Google Scholar 

  18. Bieleninik, L., Ghetti, C. & Gold, C. Music therapy for preterm infants and their parents: a meta-analysis. Pediatrics 138, e20160971 (2016).

    Article  PubMed  Google Scholar 

  19. Yurkovich, J., Burns, D. S. & Harrison, T. The effect of music therapy entrainment on physiologic measures of infants in the cardiac intensive care unit: single case withdrawal pilot study. J. Music Ther. 55, 62–82 (2018).

    Article  PubMed  Google Scholar 

  20. Shah, S. R., Kadage, S. & Sinn, J. Trial of music, sucrose, and combination therapy for pain relief during heel prick procedures in neonates. J. Pediatr. 190, 153–158.e152 (2017).

    Article  PubMed  Google Scholar 

  21. Committee on Environmental Health. Noise: a hazard for the fetus and newborn. Pediatrics 100, 724–727 (1997).

    Article  Google Scholar 

  22. Dhand, N. K. & Khatkar, M. S. Statulator: An Online Statistical Calculator. Sample Size Calculator for Comparing Two Independent Means; (2014).

  23. Zhu, J. et al. Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in china: a randomized controlled trial. Midwifery 31, 365–372 (2015).

    Article  PubMed  Google Scholar 

  24. Nelder, J. A. & Wedderburn, R. W. M. Generalized linear models. J. R. Stat. Soc. Ser. A (Gen.) 135, 370–384 (1972).

    Article  Google Scholar 

  25. Liang, K.-Y. & Zeger, S. L. Longitudinal data analysis using generalized linear models. Biometrika 73, 13–22 (1986).

    Article  Google Scholar 

  26. Bellieni, C. V. et al. Effect of multisensory stimulation on analgesia in term neonates: a randomized controlled trial. Pediatr. Res. 51, 460–463 (2002).

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank the families of the patients for their support and the nurses, nursery staff members, patient care technician Wendy Contreras, resident physician Dr Samantha Arevalo-Marcano, and pediatric program director Dr Magda Mendez from Lincoln Medical & Mental Health Center for helping with the data collection process. We also would like to thank Wendi Xiao from A.I. DuPont Children’s Hospital, DE, for her initial help with biostatistics.


Statistical analysis work was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54‑GM104941 (PI: Hicks).

Author information

Authors and Affiliations



These authors contributed equally: J.H.V. and S.A. J.H.V., S.A., and D.S.G. conceptualized, designed the study and the data collection instruments, collected data, performed the initial data analysis, drafted, reviewed, and revised the manuscript. D.N. and S.D. designed the data collection instruments, helped register the trial, collected data, and reviewed and revised the manuscript. P.A. conceptualized and designed the study, coordinated, and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Saminathan Anbalagan.

Ethics declarations

Competing interests

The authors declare no competing interests.

Consent to participate

Written informed consent was obtained from participants’ parents or legal guardians to participate in the study.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: the music used for this study is from an album called ‘Bedtime Mozart’ and not necessarily music composed by Mozart. Any references to Mozart music have been corrected accordingly.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anbalagan, S., Velasquez, J.H., Staufert Gutierrez, D. et al. Music for pain relief of minor procedures in term neonates. Pediatr Res (2023).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


Quick links