***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: Abstract Background : According to research findings , pain experience in neonatal period leads to short- and long-term complications that could be prevented by means of neonatal pain relief . Therefore , this study aim ed to investigate the effect of facilitated tucking position on  neonatal pain during heel prick blood sampling . Methods : This is a cross over clinical trial was done on 40 premature neonates . During blood sampling , neonates were put in either facilitated tucking or routine positions r and omly and Premature Infant Pain Profile ( PIPP ) was completed for each neonate . In the next sampling time , positions were changed and the process repeated . Data were analyzed using descriptive statistics , repeated measure ANOVA , and independent t-test . Results : Results showed that the mean pain intensity in each position was increased during sampling ( p = .0001 ) and after that was decreased significantly ( p = .001 ) , but before , during , and after sampling there was no significant difference between the two positions ( p > .05 ) . Conclusions : Overall findings showed that comparing neonates in the two positions ; there was no significant difference in their pain intensity . These results are almost in contrast with many research es findings in this area . It seems there is a need to further investigation regarding this subject OBJECTIVES : To test the comparative effectiveness of 2 nonpharmacologic pain-relieving interventions administered alone or in combination across time for repeated heel sticks in preterm infants . METHODS : A multicenter r and omized controlled trial in 3 NICUs in Switzerl and compared the effectiveness of oral sucrose , facilitated tucking ( FT ) , and a combination of both interventions in preterm infants between 24 and 32 weeks of gestation . Data were collected during the first 14 days of their NICU stay . Three phases ( baseline , heel stick , recovery ) of 5 heel stick procedures were videotaped for each infant . Four independent experienced nurses blinded to the heel stick phase rated 1055 video sequences presented in r and om order by using the Bernese Pain Scale for Neonates , a vali date d pain tool . RESULTS : Seventy-one infants were included in the study .  Interrater reliability was high for the total Bernese Pain Scale for Neonates score ( Cronbach ’s α : 0.90–0.95 ) . FT alone was significantly less effective in relieving repeated procedural pain ( P < .002 ) than sucrose ( 0.2 mL/kg ) . FT in combination with sucrose seemed to have added value in the recovery phase with lower pain scores ( P = .003 ) compared with both the single-treatment groups . There were no significant differences in pain responses across gestational ages . CONCLUSIONS : Sucrose with and without FT had pain-relieving effects even in preterm infants of < 32 weeks of gestation having repeated pain exposures . These interventions remained effective during repeated heel sticks across time . FT was not as effective and can not be recommended as a nonpharmacologic pain relief intervention for repeated pain exposure BACKGROUND Preterm infants manifest pain and stress by behavioural agitation and state change . Few studies have explored the effects of combining nonpharmacological interventions , i.e. non-nutritive sucking , oral sucrose , and facilitated tucking , on infants ' behaviours across painful procedures . OBJECTIVES To explore the effects of combined use of three nonpharmacological interventions ( non-nutritive sucking , oral sucrose , and facilitated tucking ) on infants ' pain- and stress-related behaviours during four assessment phases : baseline , intervention , heel stick , and recovery . DESIGN Prospect i ve , r and omised controlled trial . SETTING Level III neonatal intensive care unit in Taipei . METHOD A convenience sample of 110 infants ( gestational age 27 - 37 weeks ) needing heel sticks was r and omly assigned to five combinations of nonpharmacological treatments : ( 1 ) routine care , ( 2 ) non-nutritive sucking+facilitated tucking , ( 3 ) oral sucrose+facilitated tucking , ( 4 ) non-nutritive sucking+oral sucrose , and ( 5 ) non-nutritive sucking+oral sucrose+facilitated tucking . Outcomes were infants ' withdrawal or stress ( grimace , limb and trunk extension or squirming ) and approach or self-soothing ( sucking , sucking search , or mouthing ; h and holding or grasping ; and h and to mouth , face ) behaviours . RESULTS The frequency of infants ' withdrawal behaviours decreased significantly when they received combinations of nonpharmacological interventions before heel stick . Specifically , grimace frequency decreased by 32.2 % , 30.6 % , 19.7 % , and 13.8 % in infants receiving oral sucrose+non-nutritive sucking+facilitated tucking , non-nutritive sucking+oral sucrose , oral sucrose+facilitated tucking , and non-nutritive sucking+facilitated tucking , respectively , compared to those receiving routine care across assessment phases . Furthermore , infants ' frequency of limb and trunk extension or squirming decreased by 24.0 % when they received non-nutritive sucking+oral sucrose+facilitated tucking compared to those receiving routine care . Infants ' frequency of approach behaviours did not change significantly across all phases when they received non-nutritive sucking+oral sucrose+facilitated tucking , non-nutritive sucking+oral sucrose , and oral sucrose+facilitated tucking compared to those receiving routine care . CONCLUSIONS The combined use of nonpharmacological interventions ( non-nutritive sucking+oral sucrose+facilitated tucking ) effectively reduced the frequencies of infants ' withdrawal behaviours , i.e. grimace and limb and trunk extension or squirming . Our results provide evidence supporting clinicians ' incorporation of the combined use of facilitated tucking , oral sucrose , and non-nutritive sucking into clinical practice during painful procedures . Heel-stick procedures can be atraumatic when conducted while infants are stable and quiet , appropriately positioned , and stabilised and by offering facilitated tucking , oral sucrose , and non-nutritive sucking before gently sticking the heel and squeezing blood 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 PURPOSE To determine the effect of facilitated tucking ( FT ) on pain in preterm newborns during heel stick procedure done as a part of neonatal intensive care . METHODS This r and omized controlled cross-over pilot study included 20 preterm newborns of both sexes between gestational ages ( GA ) of 28 and 36 weeks based upon the eligibility criteria .  Pain was measured using Premature Infant Pain Profile ( PIPP ) following both heel stick with FT and without FT . RESULTS The newborns had a lower PIPP score at 30 seconds ( Mean , SD : 8.80 , 3.82 ) , 60 seconds ( Mean , SD : 7.55 , 3.28 ) , 90 seconds ( Mean , SD : 7.25 , 3.06 ) and 120 seconds ( Mean , SD : 6.65 , 3.05 ) when heel stick was done with FT compared to the same procedure done without FT at 30 seconds ( Mean , SD : 11.20 , 3.44 ) , 60 seconds ( Mean , SD : 10.75 , 3.24 ) , 90 seconds ( Mean , SD : 10.60 , 3.22 ) and 120 seconds ( Mean , SD : 10.50 , 3.15 ) . A ( 2 X 4 ) factorial ANOVA showed a statistically significant difference between these two procedures in all the time periods viz . , 30 seconds ( p=0.044 ) , 60 seconds ( p=0.004 ) , 90 seconds ( p=0.002 ) and 120 seconds ( p < 0.0001 ) at 0.05 level in PIPP score and favoring FT . CONCLUSION FT is an effective non-pharmacological pain management in preterm newborns during routine neonatal intensive care BACKGROUND Preterm infants ' repeated exposure to painful procedures may contribute to negative consequences . Thus , improving preterm infants ' neurodevelopmental outcomes requires prioritising their pain management . OBJECTIVES To compare the effectiveness of two non-pharmacological pain-relief strategies ( non-nutritive sucking and facilitated tucking ) with routine care on preterm infants ' pain , behavioural , and physiological responses before , during , and after heel-stick procedures . DESIGN Prospect i ve , r and omised controlled crossover trial . SETTING Level III Neonatal Intensive Care Unit in Taipei . METHOD Thirty-four preterm infants ( gestational age 29 - 37 weeks ) needing three procedural heel sticks were recruited by convenience sampling and r and omly assigned to a sequence of three treatments ( two pain-relief interventions and the control condition ) : ( 1 ) routine care , non-nutritive sucking , facilitated tucking , ( 2 ) non-nutritive sucking , facilitated tucking , routine care , and ( 3 ) facilitated tucking , routine care , non-nutritive sucking . Each treatment condition was performed on a different day to avoid any carry-over effect . Pain was measured by the Premature Infant Pain Profile ( PIPP ) , infant behaviour by a behavioural coding scheme , and physiological signals by electrocardiogram monitors . All data were collected 3 min without stimuli ( baseline ) , during heel-stick procedures , and recovery . RESULTS Infants  receiving non-nutritive sucking and facilitated tucking had significantly lower mean ( st and ard deviation ) pain scores during heel-stick procedures ( 6.39 [ 3.35 ] and 7.15 [ 3.88 ] , respectively ) than those receiving routine care ( 9.52 [ 4.95 ] ) . Infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios ( 0.39 , p=0.011 and 0.34 , p=0.005 , respectively ) for pain ( PIPP score≥6 ) than infants receiving routine care after adjusting for time , baseline pain scores , and infants ' characteristics . Similarly , infants receiving non-nutritive sucking and facilitated tucking had significantly lower odds ratios ( 0.23 , p<0.001 and 0.28 , p=0.03 , respectively ) for moderate-to-severe pain ( PIPP score≥12 ) than infants receiving routine care . Infants receiving facilitated tucking had lower frequency ratios for stress-related behaviours , abnormal heart rates , and decreased oxygen saturation than infants receiving routine care . CONCLUSIONS Both non-nutritive sucking and facilitated tucking effectively reduced pain scores more than routine care during heel-stick procedures . Non-nutritive sucking reduced PIPP pain scores more effectively than facilitated tucking . However , facilitated tucking showed broader effects not only on relieving pain , but also on enhancing infants ' physiological and behavioural stability during heel-stick procedures Background This study was conducted to evaluate the pain perceptions of newborns during the hepatitis B ( HBV ) vaccinations performed in the facilitated tucking position and the classical holding position , respectively . Methods The r and omized controlled experimental study was conducted between 1 September 2014 and 30 December 2014 at the neonatal intensive care unit of a Turkish university hospital . One group of infants was held in the facilitated tucking position ( the treatment group ; n = 30 ) during HBV vaccination ; infants in the other group were held in the classical holding position ( the control group ; n = 30 ) during HBV vaccination .  The Neonatal Infant Pain Scale ( NIPS ) scores of the infants in the treatment and control groups were compared during procedure . Also , the infants ’ physiological parameters were compared before , during , and after the procedure . Descriptive statistics , a chi-square test , and an independent sample s t-test were used to assess the data . Results The mean pain scores of infants vaccinated in the facilitated tucking position ( 2.83 ± 1.18 ) were significantly statistically lower than the scores of infants vaccinated in the classical holding position ( 6.47 ± 1.07 ) ( p < 0.05 ) . Conclusions The pain perceptions of newborns held in the facilitated tucking position during HBV vaccination were lower . The facilitated tucking position , a non-pharmacological method , is recommended as an effective and useful method for reducing pain during the procedure Background : Premature infants not only feel and underst and the pain , but also respond more intensively compared with term infants . Non-pharmacological methods of pain control are suitable to relieve pain in painful procedures . The facilitated tucking position is considered as a non-pharmacological method of pain control in infants ; however , its impact on frequent and repeated procedural pain such as endotracheal suctioning remains to be studied . Objectives : This paper is the report of a study that examined the impact of facilitated tucking position on behavioral pain during suctioning in premature neonates . Design : This was a clinical trial study with a crossover design . Setting s : The study was conducted in a level II Neonatal Intensive Care Unit , located in a teaching hospital , affiliated to Tehran University of Medical Sciences , Tehran , Iran . Participants : Thirty four infants were enrolled 
    Output:
    
Conclusion : Facilitated tucking position may improve the pain during painful procedures .
What is Known : • Exposure of premature babies to painful procedures is associated with changes in brain development , regardless of other factors . •
Facilitated tucking reduces the expression of pain in premature infants .
What is New : • Facilitated tucking position was efficient in pain management of preterm infants when compared to routine care .
• Facilitated tucking compared to opioid or oral glucose did not achieve a significant reduction in pain intensity .
What is Known : • Exposure of premature babies to painful procedures is associated with changes in brain development , regardless of other factors . •
Facilitated tucking reduces the expression of pain in premature infants .
What is New : • Facilitated tucking position was efficient in pain management of preterm infants when compared to routine care .
• Facilitated tucking compared to opioid or oral glucose did not achieve a significant reduction in pain intensity