Objective: During the most vulnerable period in a child’s life, preterm and sick newborns are exposed to a high number of painful procedures, sometimes without the comfort and affection of their parents. Since repeated pain and frequent use of opioids can have consequences for the neurological and behaviour-oriented development of the infant, it is vital to identify effective non-pharmacological interventions with regard to procedural pain. Methods: Preterm and ill term neonates (n=38) were subjected to venepuncture with and without live infant-directed lullaby singing, in a randomised order with a cross over design. Physiological data were collected and the procedures were videotaped. Parents (n=11) and staff (n=11) were interviewed about live singing as affective support. From this larger study two premature infants were selected for a case study. Their behavioural and physiological responses as well as the liveperformed lullaby, were analysed in-depth with microanalysis. Results: Transcriptions of the lullaby-performances identified signs of “amodal perception” and “time in movement” by which the infants transposed the vocalization of the live-singing into their behaviour synchronizing in dance-like body gestures with the variations in intensity, shape and temporal structures of the vocal performance. Live singing with premature infants is a social communicative interaction which may optimize homeostasis during painful procedures if the lullaby singing is predictable and regular from start. Conclusion: Since emotional regulation is a central feature of music therapy this case study brings important clinical implications for how the affective interaction between the music therapist or the parent and the infant should be composed during painful procedures. Pain involves the interaction of biopsychosocial and situational factors, therefore more research is needed to explore the potential benefits of music therapy including the role of the parents
