***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objectives To evaluate the ability of the Behavioral Indicators of Infant Pain ( BIIP ) scale to discriminate between skin-breaking and nonskin breaking procedures , and to identify sensitized pain responses in preterm infants in the neonatal intensive care unit ( NICU ) . Methods Sixty-nine infants born between 24 and 32 weeks gestational age were assessed at 32 weeks postconceptional age during blood collection on one day ( procedure A ) , and then on another day during blood collection preceded by a diaper change ( procedure B ) . Procedure order was r and omized . Outcome measures were changes in BIIP coded from continuous bedside video recordings and changes in heart rate ( HR ) . Results During blood collection ( procedure A ) , BIIP scores ( P<0.0001 ) and mean HR ( P<0.0001 ) were higher than during the diaper change and higher when the infants had had a preceding diaper change ( procedure B vs. procedure A ) ( P<0.03 ) . HR changed from baseline to the stressors for each procedure . No differences in mean HR were observed during Lance phase between the procedure A and the B blood collection ; however , HR remained elevated significantly during the Recovery phase when blood collection was preceded by the diaper change ( P<0.03 ) . Discussion The BIIP scale is reliable , accurate , and valid assessment for measuring acute pain in preterm infants in the NICU . This assessment combines the relatively most specific , anatomically based , theoretically derived indicators ; and it allows evaluation of behavioral and physiologic pain responses separately OBJECTIVES To examine the construct validity , inter-rater reliability , and feasibility of the Premature Infant Pain Profile-Revised in infants of varying gestational ages , diagnoses , and procedures . METHODS A prospect i ve cross-over study with infants in three gestational age groups ( 26 - 31 , 32 - 36 , and ≥37 weeks ) at three university-affiliated Neonatal Intensive Care Units in Canada . One hundred and ninety five bedside nurses and expert raters rated 202 hospitalized infants ' pain during scheduled procedures using the measure . An expert rater and a nurse independently assessed infants ' pain scores , using the  Premature Infant Pain Profile-Revised  , during 246 scheduled pairs of painful and non-painful procedures in the 202 infants . Nurses also completed a feasibility survey on using the measure in a clinical setting . To establish construct validity , pain scores were computed during painful and non-painful procedures . Inter-rater reliability between pain experts and nurses was calculated . A 5-point Likert scale was used to measure feasibility in terms of clarity , ease of use , and time to complete . RESULTS Irrespective of gestational age , Premature Infant Pain Profile-Revised scores were significantly higher during painful procedures ( mean 6.7 [ SD 3.0 ] ) compared to non-painful procedures ( mean 4.8 [ SD 2.9 ] ) . There was a high degree of correlation between nurses ' and experts ' ratings for painful ( all R(2)=0.92 , p<0.001 ) and non-painful ( all R(2)=0.87 , p<0.001 ) procedures . Mean scores on all feasibility indicators were equal to or higher than 3.8 . DISCUSSION The Premature Infant Pain Profile Revised has beginning construct validation , inter-rater reliability , and is considered feasible by clinicians . Concurrent validation studies should be considered CONTEXT Effective strategies to improve pain management in neonates require a clear underst and ing of the epidemiology and management of procedural pain . OBJECTIVE To report epidemiological data on neonatal pain collected from a geographically defined region , based on direct bedside observation of neonates . DESIGN , SETTING , AND PATIENTS Between September 2005 and January 2006 , data on all painful and stressful procedures and corresponding analgesic therapy from the first 14 days of admission were prospect ively collected within a 6-week period from 430 neonates admitted to tertiary care centers in the Paris region of France ( 11.3 millions inhabitants ) for the Epidemiology of Procedural Pain in Neonates ( EPIPPAIN ) study . MAIN OUTCOME MEASURE Number of procedures considered painful or stressful by health personnel and  corresponding analgesic therapy . RESULTS The mean ( SD ) gestational age and intensive care unit stay were 33.0 ( 4.6 ) weeks and 8.4 ( 4.6 ) calendar days , respectively . Neonates experienced 60,969 first-attempt procedures , with 42,413 ( 69.6 % ) painful and 18,556 ( 30.4 % ) stressful procedures ; 11,546 supplemental attempts were performed during procedures including 10,366 ( 89.8 % ) for painful and 1180 ( 10.2 % ) for stressful procedures . Each neonate experienced a median of 115 ( range , 4 - 613 ) procedures during the study period and 16 ( range , 0 - 62 ) procedures per day of hospitalization . Of these , each neonate experienced a median of 75 ( range , 3 - 364 ) painful procedures during the study period and 10 ( range , 0 - 51 ) painful procedures per day of hospitalization . Of the 42,413 painful procedures , 2.1 % were performed with pharmacological-only therapy ; 18.2 % with nonpharmacological-only interventions , 20.8 % with pharmacological , nonpharmacological , or both types of therapy ; and 79.2 % without specific analgesia , and 34.2 % were performed while the neonate was receiving concurrent analgesic or anesthetic infusions for other reasons . Prematurity , category of procedure , parental presence , surgery , daytime , and day of procedure after the first day of admission were associated with greater use of specific preprocedural analgesia , whereas mechanical ventilation , noninvasive ventilation and administration of nonspecific concurrent analgesia were associated with lower use of specific preprocedural analgesia . CONCLUSION During neonatal intensive care in the Paris region , large numbers of painful and stressful procedures were performed , the majority of which were not accompanied by analgesia BACKGROUND Spinal anesthesia ( SA ) remains the ' gold st and ard ' in neonatal anesthesia for inguinal herniorrhaphy but its short duration impedes its usefulness . We previously demonstrated that clonidine prolongs neonatal SA without immediate side effects . METHODS We conducted a prospect i ve observational study of 124 infants undergoing herniorrhaphy under SA with bupivacaine and clonidine . Two cohorts , term ( n = 57 ) and former preterm ( n = 67 ) infants , were evaluated and compared with regard to episodes of apnea , desaturation , and bradycardia within 24 h of SA . RESULTS In both groups , postoperative desaturation episodes were unchanged after SA , compared with the 12 preoperative hours , despite significantly increased apnea ( P < 0.003 and < 0.011 respectively ) . Transient bradycardias occurred in former preterm infants ( P < 0.014 ) : they spontaneously resolved in all cases . Mean arterial pressure did not vary during the study . Upper sensory level of SA , sedation on entering the postanesthesia care unit ( PACU ) and duration of stay in the PACU were similar in both groups . CONCLUSIONS The clinical significance of short apneas , recovering spontaneously without desaturation , remains debatable . It is concluded that addition of clonidine to neonatal SA results in acceptable side effects . Side effects must be compared with the potential advantages before future recommendations Objectives : To assess the influence of an infusion of clonidine 1 & mgr;g/kg/hr on fentanyl and midazolam requirement in ventilated newborns and infants . Design : Prospect i ve , double-blind , r and omized controlled multicenter trial . Controlled trials.com/IS RCT N77772144 . Setting : Twenty-eight level 3 German PICUs/neonatal ICUs . Patients : Ventilated newborns and infants : stratum I ( 1–28 d ) , stratum II , ( 29–120 d ) , and stratum III ( 121 d to 2 yr ) . Interventions : Patients received clonidine 1 & mgr;g/kg/hr or placebo on day 4 after intubation . Fentanyl and midazolam were adjusted to achieve a defined level of analgesia and sedation according to Hartwig score . Measurements and Main Results : Two hundred nineteen infants were r and omized ; 212 received study medication , 69.7 % were ventilated in the postoperative care and 30.3 % for other reasons . Primary endpoint : consumption of fentanyl and midazolam in the 72 hours following the onset of study medication ( main observation period ) in the overall study population . The confirmatory analysis of the overall population showed no difference in the consumption of fentanyl and midazolam . Explorative age-stratified analysis demonstrated that in stratum I ( n = 112 ) the clonidine group had a significantly lower consumption of fentanyl ( clonidine : 2.1 ± 1.8 & mgr;g/kg/hr , placebo : 3.2 ± 3.1 & mgr;g/kg/hr ; p = 0.032 ) and midazolam ( clonidine : 113.0 ± 100.1 & mgr;g/kg/hr , placebo : 180.2 ± 204.0 & mgr;g/kg/hr ; p = 0.030 ) . Strata II ( n = 43 ) and III ( n = 46 ) showed no statistical difference . Sedation and withdrawal-scores were significantly lower in the clonidine group of stratum I ( p < 0.001 ) . Frequency of severe adverse events did not differ between groups . Conclusions : Clonidine 1 & mgr;g/kg/hr in ventilated newborns reduced fentanyl and midazolam dem and with deeper levels of analgesia and sedation without substantial side effects . This was not demonstrated in older infants , possibly due to lower clonidine serum levels OBJECTIVE Inadequate assessment of  pain in premature infants is a persistent clinical problem . The objective of this research was to develop and vali date a measure for assessing pain in premature infants that could be used by both clinicians and research ers . DESIGN The  Premature Infant Pain Profile ( PIPP ) was developed and vali date d using a prospect i ve and retrospective design . Indicators of pain were identified from clinical experts and the literature . Indicators were retrospectively tested using four existing data sets . PATIENTS AND SETTING S Infants of varying gestational ages undergoing different painful procedures from three different setting s were utilized to develop and vali date the measure . METHODS AND RESULTS The largest data set ( n = 124 ) was used to develop the PIPP . The development process included determining the factor structure of the data , developing indicators and indicator scales and establishing internal consistency . The remaining three data sets were utilized to establish beginning construct validity . CONCLUSIONS The PIPP is a newly developed pain assessment measure for premature infants with beginning content and construct validity . The practicality and feasibility for using the PIPP in clinical practice will be determined in prospect i ve research in the clinical setting Objective The objectives of this study were to : ( 1 ) evaluate the validity of the Neonatal Facial Coding System ( NFCS ) for assessment of postoperative pain and ( 2 ) explore whether the number of NFCS facial actions could be reduced for assessing postoperative pain . Design Prospect i ve , observational study . Patients Thirty-seven children ( 0–18 months old ) undergoing major abdominal or thoracic surgery .  Outcome Measures The outcome measures were the NFCS , COMFORT “ behavior ” scale , and a Visual Analog Scale ( VAS ) , as well as heart rate , blood pressure , and catecholamine and morphine plasma concentrations . At 3-hour intervals during the first 24 hours after surgery , nurses recorded the children 's heart rates and blood pressures and assigned COMFORT “ behavior ” and VAS scores . Simultaneously we videotaped the children 's faces for NFCS coding .  Plasma concentrations of catecholamine , morphine , and its metabolite M6 G were determined just after surgery , and at 6 , 12 , and 24 hours postoperatively . Results All 10 NFCS items were combined into a single index of pain . This index was significantly associated with COMFORT “ behavior ” and VAS scores , and with heart rate and blood pressure , but not with catecholamine , morphine , or M6 G plasma concentrations . Multidimensional scaling revealed that brow bulge , eye squeeze , nasolabial furrow , horizontal mouth stretch , and taut tongue could be combined into a reduced measure of pain . The remaining items were not interrelated . This reduced NFCS measure was also significantly associated with COMFORT “ behavior ” and VAS scores , and with heart rate and blood pressure , but not with the catecholamine , morphine , or M6 G plasma concentrations . Conclusion This study demonstrates that the NFCS is a reliable , feasible , and valid tool for assessing postoperative pain . The reduction of the NFCS to 5 items increases the specificity for pain assessment without reducing the sensitivity and validity for detecting changes in pain IMPORTANCE Continuous morphine infusion as st and ard postoperative analgesic therapy in young infants is associated with unwanted adverse effects such as respiratory depression . OBJECTIVE To determine whether intravenous paracetamol ( acetaminophen ) 
    Output:
    
We did not find any studies that met our inclusion criteria and hence there is no evidence to recommend or refute the use of clonidine for the prevention or treatment of procedural or postoperative pain , or pain associated with clinical conditions in neonates