Comparison of the effect of listening to the white noise, lullaby, and nature sounds on pain during intravenous line insertion in premature neonates in the neonatal intensive care unit

Background & objectives: Intravenous (IV) line insertion in neonates has always been a painful and disturbing experience for the neonate as well as the operator. Various methods have been described by the researchers to keep the neonates comfortable during this procedure. This study was conducted to compare the effect of listening to white noise, lullabies, and nature sounds on pain during IV line insertion in the premature infants hospitalized in the Neonatal Intensive Care Unit (NICU). Methodology: In this clinical trial study, 110 premature infants admitted to the NICU were selected by the convenience sampling method and were placed into four groups: e.g., lullaby, nature sound, white noise, and control groups, with 4 blocks. Interventions: the pain of each infant was measured at three steps: before, during the insertion of the intravenous line, and 5 minutes after it. The Neonatal Infant Pain Scale (NIPS) was used to measure pain. The findings were analyzed with SPSS version 23 software. Non-parametric tests such as the Kruskal-Wallis test, Chi-square test, and the Bonferroni post-hoc test were employed. A statistical significance level of P < 0.05 was considered for all tests. Results: The results showed that the pain during IV-line insertion in the white noise group was significantly less than in the other groups, and significantly more in the control group than in the other groups. The pain in the nature sound group was significantly lower than in the lullaby sound group. After 5 minutes of IV-line insertion in premature infants, the pain level was the lowest in all groups. Pain in the control group was 4.34 times (P < 0.001), and in the lullaby group was 0.87 times higher than white noise (P < 0.001); the nature sound was different from white noise. It had no meaning. The results showed that the pain estimation of the four groups during the intervention was lower than before. Also, the pain before the intervention was 0.75 times higher than 10 min after the intervention (P = 0.003). Conclusion: Listening to white noise and the sounds of nature as one of the bio-behavioral solutions has an effect on pain reduction during intravenous line insertion in neonates hospitalized in the NICU, and the application of these simple and effective methods by the nurses working in the NICUs is recommended. Abbreviations: NICU: Neonatal Intensive Care Unit, NIDCAP: Newborn Individualized Developmental Care and Assessment Program, NIPS: Neonatal Infant Pain Scale, IV: Intravenous Keywords: Critical care; Intravenous; Nature sound; Neonate; NIPS; Non-pharmacological; Pain; Premature infants; Sound; White noise Citation: Nickchehre S, Rasuli M, Shoghi M. Comparison of the effect of listening to white noise, lullaby, and nature sounds on pain during intravenous line insertion in premature neonates in the neonatal intensive care unit. Anaesth. pain intensive care 2025;29(6):607-615. DOI: 10.35975/apic.v29i6.2927 Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025