# Effect of combined skin-to-skin contact, breastfeeding, and parents’ live lullaby singing on relieving acute procedural pain in neonates (SWEpap): a multicenter randomized controlled trial in Sweden

## TL;DR

This study tested if combining skin-to-skin contact, breastfeeding, and live lullaby singing by parents can help reduce pain in newborns during medical procedures.

## Contribution

This is the first study to investigate the combined use of skin-to-skin contact, breastfeeding, and live parental lullaby singing for neonatal pain relief.

## Key findings

- Infants receiving oral glucose had significantly lower pain scores compared to those receiving combined parent-delivered interventions.
- Parents reported a strong sense of meaningfulness and stress relief from participating in the combined interventions.
- Pain scores remained in the mild to moderate range across all groups, indicating the interventions were safe and feasible.

## Abstract

Engaging parents in parent-delivered pain relief in routine postnatal care is aligned with evidence-informed infant pain care and should be encouraged. This is part two of the mixed-methods SWEpap research project investigating combined parent-delivered pain management. Skin-to-skin contact (SSC) and breastfeeding are among the most studied parental pain-relieving interventions and are often combined for better effects. Live parental lullaby singing has not previously been investigated in combination with SSC and breastfeeding during painful procedures. This study investigated the efficacy of combined parent-delivered pain management versus standard care with oral glucose in healthy newborn infants during routine venipuncture.

This was a multicenter randomized controlled trial with three parallel groups. Parent–infant dyads (n= 225) were recruited from three healthcare regions in Sweden and randomized to one of the following three groups during routine venipuncture: 1) standard care with glucose; 2) SSC with parent; and 3) combination of SSC, breastfeeding (if applicable), and parents’ live singing. The primary outcome was pain expression assessed using Premature Infant Pain Profile—Revised (PIPP-R); the secondary outcomes were galvanic skin response (GSR) and parents’ evaluations of pain, stress, and meaningfulness using a visual analogue scale (VAS).

The median PIPP-R was 5 (IQR 3–6) for group 1, 7 (5–9) for group 2, and 7 (5–10) for group 3 (p< 0.001). There were no significant differences in GSR. Parents’ VAS-assessment of infant pain ranged from a median of 9.5 to 17 mm, significantly higher in groups 2 and 3 (p= 0.017). The parents rated their own stress 4.5 - 6.5 (n.s.) and meaningfulness 93 - 96 (n.s.).

Pain scores remained within the mild to moderate range across all groups, with the infants receiving oral glucose having significantly lower pain scores. This was the first study combining SSC, breastfeeding, and parents’ live lullaby singing, and more research is needed to optimize parent-delivered pain management. Parent-delivered pain management combining SSC, breastfeeding, and parents’ live lullaby singing is a feasible and safe intervention with potential pain alleviating properties offering the parents a strong sense of meaningfulness and stress relief.

Clinical trial number: NCT04341194 Trial registration date: 10-04-2020 Trial start date: 01-03-2021

The online version contains supplementary material available at 10.1186/s12887-025-06393-y.