Efficacy and safety of Maternal voice for Preterm Neonatal Pain: a Systematic Literature Review

DOI: https://doi.org/10.25077/jom.8.2.1-14.2023


Ni Luh Putu Herli Mastuti (Univeritas Brawijaya)


Purpose: Pain in neonates, especially in preterm neonates has short effects and long effects. A mother’s voice can stabilize the physiological state, support feeding, reduce pain, and promote growth and development. aimed to analyze the effect and safety of maternal voice for preterm neonatal pain, to provide scientific evidence.

Design : The research design used in this study is the systematic literature review. The identification of the study uses a PRISMA flow diagram, and quality assessment uses critical appraisal tools from the Centre for Evidence-Based Medicine. The analyzed data related to the population, intervention, and outcomes (PIO components).

Findings: Ten studies were included in this study, ranging from 2018 to 2023. Seven studies showed the significant efficacy of maternal voice in reducing preterm neonatal pain, and three studies no significance. Five studies show maternal voice can reduce pain significantly more than routine care, and two studies use a combination of maternal voice and other non-pharmacological management, including breast milk, taste, Non-nutritive sucking, heartbeat sounds mother voice, and mother touch therapy. Pain parameters use the Pain Scale and serum and salivary cortisol level.

Implications: Maternal voice; both live or recorded, voice or heartbeat, was effective and safe in reducing pain sensation in preterm neonates.



Preterm Neonatal, Pain, Cortisol level, Maternal voice, recorded maternal voice, maternal heartbeat

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Alemdar, D. K. (2018) ‘Effect of recorded maternal voice, breast milk odor, and incubator cover on pain and comfort during peripheral cannulation in preterm infants’, Applied Nursing Research, 40, pp. 1–6.

Almadhoob, A. and Ohlsson, A. (2020) ‘Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants’, Cochrane Database of Systematic Reviews.

Apaydin Cirik, V. et al. (2023) ‘The effect of using maternal voice, white noise, and holding combination interventions on the heel stick sampling’, Journal of Pediatric Nursing, 70, pp. 1–11.

Arnon, S. et al. (2014) ‘Maternal singing during kangaroo care led to autonomic stability in preterm infants and reduced maternal anxiety’, Acta Paediatrica, International Journal of Paediatrics, 103(10), pp. 1039–1044.

Asmarani, R. I. et al. (2020) ‘Effect of massage on salivary cortisol level in preterm neonates’, Iranian Journal of Neonatology, 11(1), pp. 12–16

Bieleninik, Ł., Ghetti, C. and Gold, C. (2016) ‘Music therapy for preterm infants and their parents: A meta-analysis’, Pediatrics, 138(3).

Brummelte, S. et al. (2012) ‘Procedural pain and brain development in premature newborns’, Annals of Neurology, 71(3), pp. 385–396.

Chen, Y. et al. (2021) ‘The Effect of Maternal Voice on Venipuncture Induced Pain in Neonates: A Randomized Study’, Pain Management Nursing, 22(5), pp. 668–673.

Chen, Y. S., Tan, Y. J. and Zhou, L. S. (2019) ‘Clinical effect of maternal voice stimulation in alleviating procedural pain in hospitalized neonates’, Chinese Journal of Contemporary Pediatrics, 21(1), pp. 58–63.

Chirico, G. et al. (2017) ‘Randomized study showed that recorded maternal voices reduced pain in preterm infants undergoing heel lance procedure in a neonatal intensive care unit’, Acta Paediatr, 106, pp. 1564–68.

Cong, X. et al. (2017) ‘The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU’, Early Human Development, 108, pp. 9–16.

Dorn, F. et al. (2014) ‘Influence of acoustic stimulation on the circadian and ultradian rhythm of premature infants’, Chronobiology International, 31(9), pp. 1062–1074.

Efendi, D. et al. (2021) ‘Comparison of mother’s therapeutic touch and voice stimulus in reduce pain in premature infants undergoing invasive procedures’, Pediatria Medica e Chirurgica, 43.

Febriani, A. D. B. (2021) ‘Nyeri pada Neonatus’, in Wandita, S. et al. (eds) Buku Ajar Neonatologi Anak. kedua. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia, pp. 260–267.

Filippa, M. et al. (2021) ‘Maternal speech decreases pain scores and increases oxytocin levels in preterm infants during painful procedures’, Scientific Reports, 11(1), pp. 1–10.

García-Valdivieso, I. et al. (2023) ‘Effect of Non-Pharmacological Methods in the Reduction of Neonatal Pain: Systematic Review and Meta-Analysis’, International Journal of Environmental Research and Public Health, 20(4).

Gomella, T. L., Eyal, F. G. and Bany-Mohammed, F. (eds) (2020)

Gomella’s Neonatology : Management, Procedures, On-call Problems, Diseases, and Drugs. Eight. McGraw-Hill Education.

Graven, S. N. and Browne, J. V. (2008) ‘Auditory Development in the Fetus and Infant’, Newborn and Infant Nursing Reviews, 8(4), pp. 187–193.

Haksari, E. L. (2019) ‘Historical Perspective : Low Birthweight and Preterm Infant in Indonesia’, Neoreviews, 20(10), pp. e548–e560.

Ivars, K. et al. (2015) ‘Development of salivary cortisol circadian rhythm and reference intervals in full-term infants’, PLoS ONE, 10(6), pp. 1–13.

Ivars, K. et al. (2017) ‘Development of salivary cortisol circadian rhythm in preterm infants’, PLoS ONE, 12(8), pp. 1–15.

Jin, L. et al. (2023) ‘Maternal voice reduces procedural pain in neonates’, Medicine, 102(12).

Jones, C. and Gwenin, C. (2021) ‘Cortisol level dysregulation and its prevalence—Is it nature’s alarm clock?’, Physiological Reports, 8(24), pp. 1–9.

Kawaljeet., J. A. (2012) ‘Pain Management in Newborns’, Bone, 23(1), pp. 1–7.

Kim, J. H. et al. (2020) ‘Comparison of salivary and serum cortisol levels in mechanically ventilated patients and non-critically ill patients’, Acute and Critical Care, 35(3), pp. 149–155.

Küçük Alemdar, D. and Güdücü Tüfekcİ, F. (2018) ‘Effects of maternal heart sounds on pain and comfort during aspiration in preterm infants’, Japan Journal of Nursing Science, 15(4), pp. 330–339..

Liao, J. et al. (2021) ‘International Journal of Nursing Studies Mothers ’ voices and white noise on premature infants ’ physiological reactions in a neonatal intensive care unit : A multi-arm randomized controlled trial’, International Journal of Nursing Studies, 119, p. 103934.

McCormick, M. C. et al. (2011) ‘Prematurity: An overview and public health implications’, Annual Review of Public Health, 32, pp. 367–379.

Mörelius, E., He, H. G. and Shorey, S. (2016) ‘Salivary cortisol reactivity in preterm infants in neonatal intensive care: An integrative Review’, International Journal of Environmental Research and Public Health, 13(3), pp. 1–14.

Newnham, C. A., Inder, T. E. and Milgrom, J. (2009) ‘Measuring preterm cumulative stressors within the NICU: The neonatal infant stressor scale’, Early Human Development, 85(9), pp. 549–555.

Page, M. J. et al. (2021) ‘The PRISMA 2020 statement: An updated guideline for reporting systematic reviews’, The BMJ, 372.

Partanen, E. et al. (2013) ‘Learning-induced neural plasticity of speech processing before birth’, Proceedings of the National Academy of Sciences of the United States of America, 110(37), pp. 15145–15150.

Pourkaviani, S. et al. (2020) ‘Clinical Validation of the Neonatal Infant Stress Scale with preterm infant salivary cortisol’, Peditr Res, 87(7), pp. 1237–1243.

Rad, Z. A. et al. (2021) ‘The effect of inhaling mother’s breast milk odor on the behavioral responses to pain caused by hepatitis B vaccine in preterm infants: a randomized clinical trial’, BMC Pediatrics, 21(1), pp. 1–6.

Rand, K. and Lahav, A. (2014) ‘Maternal sounds elicit lower heart rate in preterm newborns in the first month of life’, Early Hum Dev, 90(10), pp. 679–683.

Rohsiswanto, R. (2021) ‘Epidemiologi Pelayanan Perinatal dan neonatal di Indonesia’, in Wandita, S. et al. (eds) Buku Ajar Neonatologi Anak. kedua. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia, pp. 1–7.

Sackett, D. L. and Haynes, R. B. (2016) Clinical Epidemiology (Practice and Method), International Encyclopedia of Public Health.

Shen, Q. et al. (2022) ‘Efficacy and safety of non-pharmacological interventions for neonatal pain: an overview of systematic reviews’, BMJ Open, 12(9), pp. 1–8.

Stoye, D. Q. et al. (2022) ‘Saliva cortisol diurnal variation and stress responses in term and preterm infants’, Archives of Disease in Childhood - Fetal and Neonatal Edition, 107(5), pp. 558–564.

Tasci, B. and Kuzlu Ayyildiz, T. (2020) ‘The Calming Effect of Maternal Breast Milk Odor on Term Infant: A Randomized Controlled Trial’, Breastfeeding Medicine, 15(11), pp. 724–730.

Tennant, F. (2013) ‘The Physiologic Effects of Pain on the Endocrine System’, Pain and Therapy, 2(2), pp. 75–86.

Tsikouras, P. et al. (2021) ‘Premature Birth, Management, Complication’, in Wang, Z. (ed.) Global Women’s Health.

Ullsten, A., Eriksson, M. and Kla, M. (2018) ‘Singing , sharing , soothing – biopsychosocial rationales for parental infant-directed singing in neonatal pain management : A theoretical approach’, 1, pp. 1–13.

Vinall, J. and Grunau, R. E. (2014) ‘Impact of repeated procedural pain-related stress in infants born very preterm’, Pediatric Research, 75(5), pp. 584–587.

Williams, M. D. and Lascelles, B. D. X. (2020) ‘Early Neonatal Pain—A Review of Clinical and Experimental Implications on Painful Conditions Later in Life’, Frontiers in Pediatrics, 8(February).

Williamson, S. and McGrath, J. M. (2019) ‘What Are the Effects of the Maternal Voice on Preterm Infants in the NICU?’, Advances in Neonatal Care, 19(4), pp. 294–310.

Wu, H. P., Yang, L., et al. (2020) ‘Effects of Combined Use of Mother’s Breast Milk, Heartbeat Sounds, and Non-Nutritive Sucking on Preterm Infants’ Behavioral Stress During Venipuncture: A Randomized Controlled Trial’, Journal of Nursing Scholarship, 52(5), pp. 467–475.

Wu, H. P., Yin, T., et al. (2020) ‘Integration of Different Sensory Interventions From Mother’s Breast Milk for Preterm Infant Pain During Peripheral Venipuncture Procedures: A Prospective Randomized Controlled Trial’, Journal of Nursing Scholarship, 52(1), pp. 75–84.

Yu, W. C. et al. (2022) ‘Effects of maternal voice on pain and mother–Infant bonding in premature infants in Taiwan: A randomized controlled trial’, Journal of Pediatric Nursing, 63, pp. e136–e142.

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