Multisensory Stimulation and Soft Tissue Therapy on Pain and Neurodevelopment Among Preterm Neonates

Maternal voice reduces procedural pain in neonates: A meta-analysis of randomized controlled trials

BACKGROUND

Procedural pain management is a very important part in the clinical care of neonates. We aimed to conduct a meta-analysis to evaluate the effects of maternal voice on neonatal procedural pain, to provide insights to the clinical pain care of neonates.

METHODS

Two researchers independently searched PubMed, EMBASE, The Cochrane Library, CINAHL, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang and Weipu Database for randomized controlled trials (RCTs) involving the effects of maternal voice on the procedural pain of neonates up to October 25, 2022. Two investigators screened the literature based on the inclusion and exclusion criteria and evaluated the methodological quality of the inclusion study. RevMan 5.3 software was used for the meta-analysis.

RESULTS

A total of 8 RCTs with a total of 584 neonates were included. Our meta-analysis indicated that maternal voice reduces the pain score (SMD = -0.60, 95% CI: -0.81 to -0.39) and heart rate (SMD = -0.81, 95% CI: -1.44 to -0.18) and increases the comfort level (SMD = -0.47, 95% CI: -0.83 to -0.11) and blood oxygen saturation (SMD = 0.70, 95% CI: 0.03-1.38) during procedure (all P < .05). Moreover, maternal voice reduces the pain score (SMD = -0.58, 95% CI: -0.88 to -0.28) and heart rate (SMD = -0.44, 95% CI: -0.75 to -0.12) and increases the blood oxygen saturation (SMD = 0.41, 95% CI: 0.00 to -0.82) after procedure (all P < .05). No publication biases were detected by the funnel plots and Egger tests (all P > .05).

CONCLUSION

Maternal voice is beneficial to reduce procedural pain and improve the physiological indicators in neonates. It is still necessary to conduct high-quality, large sample studies in the future to further elucidate the effect of maternal voice on neonatal pain care.

Manual and alternative therapies as non-pharmacological interventions for pain and stress control in newborns: a systematic review

BACKGROUND

Supporting therapies that provide stress and pain control of preterm and term newborns infants contribute positively to the neuropsychomotor development. Non-pharmacological interventions that involve manual techniques are described, considering protocols that can be reproduced by physical therapists, with positive and negative outcomes reports.

DATA SOURCES

Systematic review follows PRISMA 2020 statements guidelines. Primary and specific health sciences databases (Science Direct, Pubmed, Scielo, Embase and Scopus) were consulted between October 2021 and May 2022. Articles considered were clinical trials, randomized or not, that included descriptions of the type of intervention as non-pharmacological and that studied the following outcomes: "pain" and "stress".

RESULTS

Fifteen articles were selected for analysis, reaching a methodological quality of at least 3 on the Jadad Scale for the Quality of Researched Sources. The non-pharmacological therapies most applied in isolation were massage, swaddling or wrapping, gentle touch and kinesthetic stimulation, and the combined therapies were non-nutritive sucking and swaddling, oral sucrose and swaddling, sensory stimulation and familiar odors, and sensory saturation. The outcomes found were relaxation, pain, and stress reduction after the application of painful procedures. The behavioral changes included crying, grimacing, yawning, sneezing, jerky arm or leg movements, startles, and finger flaring. The vital signs included heart rate, blood oxygen saturation level, and pulse respiration.

CONCLUSIONS

Combined techniques lead to better results in controlling neonatal pain when compared to isolated techniques. They can be applied both in preterm and term infants in a safe way and are reproducible in any health unit in a simple and economical way.