***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: There is evidence that newborn babies feel pain even at the lowest gestational ages when they can survive . Because sweet solutions such as sucrose , given orally , may relieve pain in neonates , we decided to compare the effects of two concentrations of glucose ( normally used for intravenous infusions ) and of breast milk in a r and omized controlled trial in 120 babies requiring heel‐prick tests .  Glucose solutions and breast milk are readily available in the neonatal department . No other treatment was given . Our results strongly suggest that 1 ml of a 30 % glucose solution given orally alleviates mild pain significantly and can be used for this purpose in newborns . Breast milk and 10 % glucose did not have a similar effect OBJECTIVE To determine whether milk and its components reduce  crying  in newborns during and after blood collection for phenylketonuria evaluation . METHODOLOGY Seventy-two normal newborns ingested 2 mL of milk ( Similac ) , Ross Special Formula , fat , protein , lactose , sucrose , or water for the 2 minutes preceding blood collection via heel lance . Crying duration during and for the 3 minutes after the procedure was determined by scorers who were blind to the ingestive substance . RESULTS Sucrose and Similac each reduced crying during the blood collection procedure . Sucrose , fat , protein , and Ross Special Formula were effective during the 3-minute recovery period . Neither water nor lactose were effective during or after blood collection . CONCLUSION Milk and some of its components are antinociceptive in human newborns . Based on previous studies , reduced crying during and after painful stimulation may be mediated through endogenous opioids . These findings are of potential clinical significance : natural protective mechanisms , normally engaged during suckling , may safely and noninvasively be activated to reduce  newborn crying to painful stimulation OBJECTIVE To determine the efficacy of sucrose analgesia for procedural pain during the first week of life in preterm neonates in neonatal intensive care units on enhancing later clinical outcomes . METHODS A total of 107 preterm neonates who were born at < 31 weeks ' postconceptional age ( PCA ) entered this double-blind , r and omized , controlled trial within 48 hours of birth at 3 level III university-affiliated neonatal intensive care units in Canada , and 103 completed the study .  Sucrose ( 0.1 mL of 24 % ) or sterile water was administered orally up to 3 times , 2 minutes apart , for every invasive procedure during a 7-day period . Motor development and vigor , and alertness and orientation components of the Neurobehavioral Assessment of the Preterm Infant were measured at 32 , 36 , and 40 weeks ' PCA ; Score for Neonatal Acute Physiology was measured on the last day of intervention ; and Neuro-Biological Risk Score ( NBRS ) was measured at 2 weeks of age and at discharge . Primary analyses of covariance were applied for each outcome to compare group differences followed by secondary analyses using st and ard linear regression within each group to determine predictors of outcomes . RESULTS Although there were no differences between the groups on any outcomes , there were significant dose-related effects within each group . In the sucrose group only , higher number of doses of sucrose predicted lower scores on motor development and vigor , and alertness and orientation at 36 weeks ' , lower motor development and vigor at 40 weeks ' , and higher NBRS at 2 weeks ' postnatal age . Higher number of invasive procedures was predictive of higher NBRS both times in the water group . CONCLUSIONS Repeated use of sucrose analgesia in infants < 31 weeks ' PCA may put infants at risk for poorer neurobehavioral development and physiologic outcomes . Additional study is needed to determine the most appropriate age and duration of sucrose analgesia in preterm infants A r and omized study was done to compare non pharmacological methods to reduce the pain of heel pricks in 104 stable term neonates .  Non-nutritive sucking ( NNS ) , rocking , massage , sucrose ( 20 percent ) , distilled water ( DW ) and expressed breast milk ( EBM ) were used as pain reducing agents . Duration of cry and Douleur Aiguë du Nouveau né ( DAN ) score were used to assess pain . Physiological parameters were also recorded before and after the stimulus . At 30 seconds after the stimulus , the pain scores were lowest in the sucrose group but this was not sustained at 1 , 2 and 4 minutes . At 2 and 4 minutes pain scores were lowest in the NNS and rocking groups as compared to sucrose , distilled water , expressed breast milk and massage . The total duration of crying was also lowest in the NNS and rocking groups . Physiological parameters were comparable in all groups . Babies who were in Prechtl State 1 and 2 ( sleeping ) at the time of stimulus showed significantly lesser response to pain compared to babies who were awake . This was seen in all the intervention groups . In conclusion , our study suggests that rocking or giving a baby a pacifier are more effective non-pharmacological analgesics than EBM , DW , sucrose or massage for the pain of heel pricks in neonates . A calm or sleeping state before a painful procedure also appears to decrease crying and pain scores CONTEXT This study identifies a behavioral and nonpharmacologic means of preventing newborn pain . OBJECTIVE To determine whether breastfeeding is analgesic in newborn infants undergoing heel lance-a routine , painful , hospital procedure . DESIGN A prospect i ve , r and omized , controlled trial . SETTING Hospital maternity services at Boston Medical Center , Boston , Massachusetts , and Beverly Hospital , Beverly , Massachusetts . PARTICIPANTS A r and om sample of 30 full-term , breastfed infants . INTERVENTIONS Infants in the intervention group were held and breastfed by their mothers during heel lance and blood collection procedures for the Newborn Screening Program Blood Test . Infants in the control group experienced the same blood test while receiving the st and ard hospital care of being swaddled in their bassinets . OUTCOMES MEASURES Crying , grimacing , and heart rate differences were analyzed between the breastfeeding and the control infants before , during , and after blood collection . RESULTS Crying and grimacing were reduced by 91 % and 84 % , respectively , from control infant levels during the blood collection . Heart rate was also substantially reduced by breastfeeding . CONCLUSIONS Breastfeeding is a potent analgesic intervention in newborns during a st and ard blood collection Aim : To assess the effectiveness of expressed breast milk ( EBM ) in reducing pain due to venepuncture , in term neonates , as measured by behavioural and physiological observations . Methods : This r and omized , placebo‐controlled , double‐blind trial involved 81 full‐term neonates , up to 4wk of postnatal age , who needed venepuncture for blood investigations . Two minutes before the venepuncture , in the intervention arm , 40 babies received 5 ml of EBM , while 41 babies in control group received 5 ml of distilled water ( DW ) as placebo . Two observers who were blinded to the intervention recorded the physiological ( heart rate and oxygen saturation ) and behavioural parameters [ duration of crying and modified Neonatal Facial Coding Scores ( NFCS ) ] after the venepuncture . Results : There was no difference in the baseline characteristics of the neonates in the two groups . The duration of crying was significantly shorter in babies fed EBM [ median 38.5 s , interquartile range ( IQR ) 9.5–57.5 s ] than in those fed DW ( median 90 s , IQR 28–210 s ) . The mean duration of crying in EBM group was shorter by 70.7 ( 95 % confidence interval 36.6–104.9 ) s. The modified NFCS at 0 , 1 and 3 min was significantly lower ( p > 0.01 ) in the EBM than in the DW group . The change in heart rate and oxygen saturation was significantly lower in the EBM group and returned to baseline values sooner than in the DW group The objective of this study was to examine the pain-relieving effect of breast-feeding during immunization injections in healthy neonates . Sixty-six healthy infants returning to a clinic for their second- , third- , or fourth-month immunization with intramuscular diphtheria , tetanus , and pertussis  were r and omized to be breast-fed before , during , and after the injection or to be given the injection according to routine clinic procedure ( no breast-feeding ) . To assess the pain responses of the neonates during and after immunization , we noted their heart rates , oxygen saturation levels , and length of crying . The crying time was shorter in the experimental ( breast-feeding ) group ( M + /- SD duration , 35.85 + /- 40.11 seconds ) than in the control group ( M + /- SD duration , 76.24 + /- 49.61 seconds ; p = .001 ) . The heart rate and oxygen saturation levels were almost the same in both groups . We concluded that breast-feeding , maternal holding , and skin-to-skin contact significantly reduced crying in infants receiving an immunization injection for diphtheria , tetanus , and pertussis 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 Breastfeeding may be useful for relieving procedural pain experienced by neonates . Research ers have compared breastfeeding against other pain relieving approaches in several studies , presenting marked method ologic heterogeneity . Objective : To investigate the effectiveness of breastfeeding in reducing pain in newborns undergoing blood collection for newborn screening . Method : The sample of this r and omized clinical trial study consisted of 60 full-term newborns : 31 in the experimental group and 29 in the control group . The experimental group was breastfed 5 minutes before , during , and for 5 minutes after the blood collection procedure . Neonates in the control group were held in mothers ' arms but not fed or given a soother . The duration of breastfeeding was prolonged in comparison to previous studies . Results : The primary outcomes were Neonatal Facial Actions ( Neonatal Facial Activity Coding System-upper face ) , sleep-wake state . Heart rate was considered as an index of arousal . Sucking frequency was only evaluated in the experimental group . Compared with the control group , the experimental group had significantly lower , Neonatal Facial Activity Coding System and sleep-wake state scores and heart rates changes . In the experimental group sucking frequency was highest during the first 5 minutes of breastfeeding before the procedure . Discussion : This study innovates from earlier studies in 4 respects : the different phases of the procedure were evaluated separately ; the breastfeeding intervention covered the period from 5 minutes before the blood collection until the end of recovery ; sleep-wake state was fully assessed ( not merely crying ) and the sucking frequency in the experimental group was assessed during the procedure . The conclusion was that breastfeeding was effective in reducing pain caused by blood collection for newborn screening This study evaluates the effects of colostrum , delivered via syringe or on a pacifier , on the pain and heart rate reactions of newborns undergoing routine heel-lance . This was achieved by following a quasi-r and omized , controlled trial in which 60 newborn infants at Boston Medical Center , Boston , MA , were r and omly assigned to receive colostrum , sucrose , or water , by syringe or on a pacifier , for a total of 6 groups ( n = 10 per group ) . The effectiveness of an intervention was determined by comparing crying , grimacing , and heart rate differences among groups during and following blood collection . We report that colostrum , delivered by syringe or on a pacifier , did not reduce crying or grimacing relative to control infants who received water . As has been previously reported , sucrose markedly reduced both crying and grimacing , and attenuated the rise in heart rate that normally accompanies blood collection ( p < .002 ) . Water , via syringe or on a pacifier , did not prevent the increase in heart rate , nor did colostrum via syringe . In contrast , colostrum delivered on a pacifier prevented the increase in heart rate despite pain reactivity and extreme crying . The implication s of this dissociation are discussed OBJECTIVE To identify the effectiveness of " facilitated tucking , " a nonpharmacologic nursing intervention , as a comfort measure in modulating preterm neonates ' physiologic and behavioral responses to minor pain . DESIGN Prospect i ve , repeated measure , r and om sequencing , and experimental . SETTING Level III neonatal intensive-care unit of a tertiary care university pediatric hospital . PARTICIPANTS Thirty preterm neonates , 25 - 35 weeks gestation . INTERVENTIONS Heart rate , oxygen saturation , and sleep state were recorded 1 
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However , there was no statistically significant difference in PIPP scores when compared to no intervention .
Douleur Aigue Nouveau-ne scores ( DAN ) were significantly lower in the breastfeeding group compared to the placebo group and the group held in mother 's arms , but not when compared to the glucose group .
Neonatal Infant Pain Scale ( NIPS ) was significantly lower in the breastfeeding group compared to the no intervention group , but there was no difference when compared to the oral sucrose group .
The Neonatal Facial Coding System ( NFCS ) was significantly lower in the breastfeeding group when compared to oral glucose , pacifier use , holding by mother and no intervention , but no difference was found when compared to formula feeding .
Supplemental breast milk yielded variable results .
Neonates in the supplemental breast milk group had a significantly lower increase in heart rate , a reduction in duration of crying and a lower NFCS compared to the placebo group .
Neonates in the supplemental breast milk group had a significantly higher increase in heart rate changes when compared to the sucrose group .
Sucrose ( in any concentration , i.e. 12.5 % , 20 % , 25 % ) was found to reduce the duration of cry when compared to breast milk , as did glycine , pacifier use , rocking , or no intervention .
Breast milk was found not to be effective in reducing vali date d and non-vali date d pain scores such as NIPS , NFCS , and DAN ; only being significantly better when compared to placebo ( water ) or massage .
Administration of glucose/sucrose had similar effectiveness as breastfeeding for reducing pain .