Premature neonates in the neonatal intensive care unit (NICU) frequently require painful, invasive procedures as part of life-sustaining care. Nonpharmacologic, developmental-supportive interventions are commonly explored to reduce procedural stress in this population. This pilot evidence-based practice initiative evaluated a pacifier activated lullaby (PAL) device as a therapeutic music intervention, facilitated by a neonatal music therapist (NICU-MT) working collaboratively with bedside nurses, for neonates undergoing retinopathy of prematurity (ROP) examinations.
The stated purpose was to examine the impact of the PAL device intervention on physiologic and pain outcomes for neonates following ROP exams in the NICU.
The project enrolled neonates (N = 25) who underwent ROP examinations in the NICU. A NICU-MT facilitated the PAL device intervention in collaboration with bedside nursing staff. The intervention consisted of providing the PAL device to the infant following the ROP exam; the device is activated by nonnutritive sucking on a pacifier and delivers a lullaby contingent on the infant’s suck behavior.
The initiative was described as an evidence-based practice pilot rather than a randomized controlled trial; details in the abstract indicate an interprofessional implementation with the NICU-MT and nurses providing procedural support via the device.
Data were collected at multiple intervals to assess infant pain and physiologic stress. Measurements were obtained before the ROP procedure (preprocedure baseline), at the end of the procedure (end of exam), and during PAL device use at 1, 3, and 5 minutes after the procedure.
Outcome measures included:
These measures were used to assess changes from baseline through the immediate postprocedure period and during the PAL intervention.
End-of-procedure averages reflected physiologic stress associated with the ROP exam: increased heart rate, decreased arterial oxygen saturation (SaO2), and elevated N-PASS pain scores. Following initiation of the PAL device, serial measurements at 1, 3, and 5 minutes showed progressive improvement in both vital signs and pain scores.
By the five-minute PAL intervention interval, mean values for heart rate, respiratory rate, SaO2, and N-PASS pain scores had improved and approximated preprocedure baseline averages. The authors interpret these findings to suggest the PAL device may encourage return toward baseline physiologic and behavioral states after the stress of an ROP exam.
The abstract does not report specific p values, confidence intervals, or effect sizes. It reports trends and group-level mean trajectories across project intervals rather than providing detailed inferential statistics in the abstract text.
The PAL device used in the initiative is a pacifier-based system that delivers contingent lullaby music when the infant generates nonnutritive sucking. The article includes photographic documentation of the device and graphical figures illustrating mean trajectories for heart rate, SaO2, respiratory rate, and N-PASS scores across the project intervals (preprocedure, end of procedure, and 1, 3, 5 minutes of PAL use).
Figure legends and images in the full text demonstrate the device and summarize the group mean changes over time, supporting the narrative that physiologic metrics and pain scores trended back toward baseline by five minutes of PAL use.
The pilot findings indicate that a PAL device, delivered by a NICU-MT in partnership with bedside nurses, may provide procedural support that helps neonates return toward preprocedure baseline physiologic and pain measures after invasive, painful procedures such as ROP examinations.
Authors conclude that music therapists and nurses can collaboratively implement therapeutic music interventions like the PAL device as part of procedural support in the NICU. The intervention is positioned as a nonpharmacologic adjunct to reduce short-term physiologic and behavioral signs of pain and stress after a procedure.
This report is a pilot evidence-based practice initiative; the abstract does not present detailed statistical analyses, effect sizes, or long-term follow-up data. Sample size is reported as N = 25. The abstract does not provide detailed inclusion/exclusion criteria, randomization, control conditions, or information on potential confounders.
Future work to strengthen the evidence base would require reporting of full statistical results, larger and possibly randomized designs, detailed methodology for device application, and assessment of reproducibility and generalizability. The abstract notes improvement toward baseline by five minutes of PAL use but does not report sustained outcomes beyond the five-minute postprocedure interval.
The authors and setting are clearly specified: Cassi Crouse (lead music therapist) with Margaret Gettis and Regena Spratling (nurse scientists) at Children’s Healthcare of Atlanta. The initiative is published in the American Journal of Nursing and the full text is available through PubMed Central (PMCID: PMC13387686).