Effects of three auditory stimuli on neonatal pain during heel lance: A randomized controlled trial

JOURNAL OF NEONATAL NURSING, cilt.32, ss.2-8, 2026 (Scopus)

Background: Neonatal procedural pain is frequent in intensive care settings, and effective non-pharmacological

interventions are needed. Evidence comparing different auditory stimuli is limited.

Objective: To compare the effects of three auditory stimuli on neonatal pain during heel lance.

Methods: This assessor-blinded randomized controlled trial included eligible neonates born between 28 and 42

weeks of gestation who were randomly assigned to one of four groups: maternal prenatal music, white noise,

heartbeat sound, or control.

Results: A total of 84 neonates were enrolled in the study. The enrolled neonates had a mean gestational age of

33.92 ± 3.41 weeks; 53.6% were male and 46.4% were female. During heel lance, the mean NIAPAS pain score

was significantly lower in the white noise group than in the control group (8.81 ± 3.57 vs. 12.45 ± 2.45;

p = 0.007). One minute after the procedure, mean pain scores were 2.48 ± 1.85 in the music group, 4.19 ± 2.53

in the heartbeat group, 3.07 ± 2.18 in the white noise group, and 7.26 ± 3.03 in the control group, with

significantly lower scores in all intervention groups than in the control group (music: p < 0.001; heartbeat:

p = 0.030; white noise: p = 0.011). Mean crying duration was 18.95 ± 9.11 s in the music group, 18.43 ± 11.43 s

in the heartbeat group, 20.86 ± 11.49 s in the white noise group, and 27.14 ± 12.04 s in the control group.

Crying duration was significantly shorter in the music (p = 0.010) and heartbeat (p = 0.025) groups than in the

control group.

Conclusion: White noise reduced procedural pain, whereas maternal prenatal music and heartbeat sounds were

effective in reducing post-procedural pain and crying. These findings suggest that simple auditory interventions

may be incorporated into routine neonatal care as safe, inexpensive, and easily applicable non-pharmacological

strategies for procedural pain management. Further studies are warranted to confirm these findings across

different neonatal populations and clinical settings.