***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The aim of this study was to examine the effect of breastfeeding on pain relief in full-term neonates during injection of hepatitis B vaccine . Methods This was a r and omized clinical trial . A sample of full-term neonates was r and omly allocated into two groups : the experimental group and the control group . Neonates in the experimental group were breastfed two minutes before , during , and after the hepatitis B immunization and the control group were held in mothers ’ arms but not fed .  Pain was assessed using the Douleur Aiguë du Nouveau-né ( DAN ) scale measuring facial expressions , limb movements and vocal expressions . The assessment s were carried out after hepatitis B immunization . Results One hundred thirty healthy full-term neonates were studied ( 65 in the experimental group and 65 in the control group ) . Gestational age , birth weight , Apgar score and gender did not differ between the two groups . The mean total pain score as measured by the DAN scale was 3.52 ( SD = 1.37 ) for the experimental group and it was 6.78 ( SD = 1.69 ) for the controls indicating a significant lower pain score for the experimental group ( P<0.001 ) . Also , there were significant differences for the three measures of DAN scale that are facial expressions , limb movements and vocal expression , between the two study groups ( P<0.001 ) . Conclusion The findings confirm that breastfeeding reduces pain and is effective way for pain relief during hepatitis B vaccine injection . Trial registration I RCT 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 investigate interventions that affect pain reduction during vaccination in infants and children attending a well-child unit . STUDY DESIGN A consecutive sample of 243 children between age 0 and 48 months receiving their routine vaccinations was r and omly assigned to 1 of the study groups . A total of 158 infants under age 6 months were r and omly assigned to breast-feeding or no breast-feeding during immunization , and 85 children age 6 to 48 months were r and omly assigned to receive 12 % sucrose solution , lidocaine-prilocaine cream , or no intervention . All children were evaluated for crying time and pain score by a pediatrician using the Neonatal Infant Pain Scale ( NIPS ) for those under age 12 months and the Children 's Hospital of Eastern Ontario Pain Scale ( CHEOPS ) for those over age 12 months . RESULTS Breast-feeding in infants under age 6 months and use of sucrose or lidocaine-prilocaine in children age 6 to 48 months significantly reduced crying time and pain scores compared with controls . No difference in outcome was seen between the sucrose and lidocaine-prilocaine treatment groups . CONCLUSIONS Here we exp and on previous findings by demonstrating that breast-feeding may have an analgesic effect up to age 6 months and that in older children , both sucrose and lidocaine-prilocaine reduce vaccination pain Objective To compare analgesic effect of direct breast feeding , 25 % dextrose solution and placebo as we give 1st intramuscular whole cell DPT injection to 6week — 3month old infants . Design R and omized , placebo controlled trial . Setting Immunization clinic of Department of Pediatrics , LLRM Medical College . Participants Infants coming for their 1st DPT vaccination were r and omized in to three groups of 40 each . Outcome measures The primary outcome variable was the duration of cry after vaccination . Secondary outcome variables were Modified Facial Coding Score ( MFCS ) and latency of onset of cry . Results 120 babies were equally enrolled in breast feed group , 25 % dextrose fed group and distilled water fed group .  Median ( interquartile range ) of duration of cry was significantly lower in breast fed ( 33.5 ( 17–54 ) seconds ) and 25 % dextrose fed babies ( 47.5 ( 31–67.5 ) seconds ) as compared to babies given distilled water ( 80.5 ( 33.5–119.5 ) seconds ) ( P<0.001 ) . MFCS at 1 min and 3 min was significantly lower in direct breast fed and dextrose fed babies . Conclusions Direct breastfeeding and 25 % dextrose act as analgesic in young infants undergoing DPT vaccination in young infants less than 3 month of age 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 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The primary objective was to evaluate the analgesic effect of a eutectic mixture of local anesthetics ( EMLA ) during whole cell DPT vaccination . The secondary objective was to evaluate if the analgesic effect of EMLA was synergistic to breastfeeding . A r and omized , placebo-controlled trial was done to include infants of up to 3 months of age who came for their first DPT vaccination . The outcome variables were duration of cry , latency of onset of cry , and Modified Facial Coding Score .  Thirty babies were enrolled in each of three groups . The groups did not differ significantly in baseline characteristics . Median ( interquartile range ) of duration of cry was least [ 34.6 ( 24.1–72.2 ) s ] in babies receiving EMLA cream with breastfeeding ( EB group ) , followed by 94.2 ( 46.1–180 ) s in babies receiving EMLA cream with oral distilled water ( EW group ) , as compared to 180.0 ( 180–180 ) s in babies receiving placebo cream with oral distilled water ( PCW group ) ( p < 0.05 ) . Mean ( SD ) of latency of cry was significantly greater in EB group [ 2.4 ( 1.14 ) s ] and EW group [ 1.9 ( 0.62 ) s ] as compared to babies in PCW group [ 1.5 ( 0.47 ) s ] ( p < 0.05 ) , but the difference between EB and EW groups was not significant . Modified Facial Coding Score was significantly lower in EB group as compared to the other groups ( p < 0.05 ) . Conclusions : Topical EMLA is effective in reducing pain and has a synergistic effect in analgesia when combined with breastfeeding during vaccination in infants Background : Vaccination is one of the most common painful procedures in infants . Despite the irreparable consequences and complications of acute pain in infants , and existence of pharmacological and non-pharmacological methods for pain control , pain control in infants has received less attention . Therefore , this research aim ed to compare the vaccination-related pain in infants younger than 6 months who receive vapocoolant spray and breastfeeding during injection , in order to suggest a strategy to provide emotional , mental , and physical health for infants . Material s and Methods : This is a r and omized clinical trial study on 144 infants less than 6 months of age , referred to Ibn Sina Health Care Center in 2009 , who were selected by convenience sampling . Forty-eight infants were allocated through systematic r and om sampling to each study group ( i.e. , breastfeeding , vapocoolant spray , and control group ) . Inclusion criteria were : Fully conscious infants , lack of any disease ( sensory , motor abnormalities , cold , etc . ) , taking no medication , exclusive breastfeeding , vaccination for hepatitis B and DTP , regular visits to health care center , infants with Iranian nationality , and quiet infants who did not cry . The infant was excluded if he/she was crying and it was impossible to make him/her quiet before injection . Data were gathered by a question naire ( six questions ) and checklist [ neonatal infant pain scale ( NIPS ) ] . Data were analyzed by descriptive and inferential statistical methods through SPSS . Results : The findings suggest that breastfeeding during vaccination has a more analgesic effect on vaccination pain , compared to application of vapocoolant spray before vaccination . In 64.6 % of the infants , breastfeeding during vaccination caused analgesia , while 25 % of the infants who received vapocoolant spray experienced analgesic effect . There was a significant difference in pain between the infants who received vapocoolant spray and those on breastfeeding during injection ( P < 0.001 ) . Conclusion : It seems that breastfeeding during vaccination in infants under 6 months of age is an effective , natural , safe , accessible , and inexpensive method without side effects to reduce vaccination-related pain BACKGROUND AND AIM Despite the clinical importance of pain , many neonates are subjected to numerous painful invasive procedures and their complications as part of their care . This study has been design ed to investigate the effect of swaddling and breastfeeding , and their combined effect on the pain induced by BCG vaccination in healthy term infants . METHOD This r and omized double-blind intervention study was performed on 131 healthy term neonates in Motahari Hospital of Jahrom . The sample s were r and omly assigned into three intervention groups and a control group . The infants in the swaddled group were swaddled 2 minutes before and 2 minutes after vaccination . The infants in the breastfed group were breastfed within 45 minutes before vaccination . The infants in the combination group were both breast fed before and swaddled within vaccination but the infants in the control group were vaccinated without any intervention . Heart rate and oxygen saturation level of neonates were recorded in the 3 phases of : baseline , injection and 2 minutes after injection . Furthermore , the neonates ' faces were recorded using a video camera . Then pain intensity was measured by Neonatal Facial Coding System ( NFCS ) . Mean Score of pain intensity and physiological responses of subjects were statistically analyzed using non parametrical Kruskal-Wallis test and Mann-Whitney . RESULTS The mean of pain intensity ( NFCS ) and changes in the heart rate at injection time to the baseline in the three intervention groups in comparison with the control group showed statistically significant difference ( p=0.003 and p=0.002 respectively ) . However changes in blood oxygen saturation level , were not statistically significant difference between four groups . CONCLUSION Regarding to the significant impact of both breastfeeding and swaddling on the pain reduction of vaccination , it is recommended to take benefit 
    Output:
    
Our primary outcome was pain .
Breastfeeding did not consistently reduce changes in physiological indicators , such as heart rate .
Breastfeeding was more effective in reducing crying duration or pain scores during vaccination compared to : 25 % dextrose and topical anaesthetic cream ( EMLA ) , vapocoolant , maternal cuddling , and massage .
AUTHORS ' CONCLUSIONS We conclude , based on the 10 studies included in this review , that breastfeeding may help reduce pain during vaccination for infants beyond the neonatal period .
Breastfeeding consistently reduced behavioural responses of cry duration and composite pain scores during and following vaccinations .
However , there was no evidence that breastfeeding had an effect on physiological responses .