***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: OBJECTIVE To test the efficacy of maternal skin-to-skin contact , or kangaroo care ( KC ) , on diminishing the pain response of preterm neonates to heel lancing . DESIGN A crossover design was used , in which the neonates served as their own controls . Subjects Preterm neonates ( n = 74 ) , between 32 and 36 weeks ' postmenstrual age and within 10 days of birth , who were breathing without assistance and who were not receiving sedatives or analgesics in 3 level II to III neonatal intensive care units in Canada . INTERVENTIONS In the experimental condition , the neonate was held in KC for 30 minutes before the heel-lancing procedure and remained in KC for the duration of the procedure . In the control condition , the neonate was in the prone position in the isolette . The ordering of conditions was r and om . MAIN OUTCOME MEASURES The primary outcome was the Premature Infant Pain Profile , which is composed of 3 facial actions , maximum heart rate , and minimum oxygen saturation changes from baseline in 30-second blocks . Videotapes , taken with the camera positioned on the neonate 's face so that an observer could not tell whether the neonate was being held or was in the isolette , were coded by research assistants who were naïve to the purpose of the study . Heart rate and oxygen levels were continuously monitored into a computer for later analysis . A repeated- measures analysis of covariance was used , with order of condition and site as factors and severity of illness as a covariate . RESULTS Premature Infant Pain Profile scores across the first 90 seconds from the heel-lancing procedure were significantly ( .002<P<.04 ) lower by 2 points in the KC condition . CONCLUSIONS For preterm neonates who are 32 weeks ' postmenstrual age or older , KC seems to effectively decrease pain from heel lancing . Further study is needed to determine if younger neonates or those requiring assistance in breathing , or older infants or toddlers , would benefit from KC , or if it would remain effective over several procedures . Given its effectiveness , and that parents of neonates in critical care units want to participate more in comforting their children , KC is a potentially beneficial strategy for promoting family health OBJECTIVE : To determine the sound environment of preterm infants cared for in the NICU and to test the hypothesis that infants exposed to more adult language will make more vocalizations . METHODS : This was a prospect i ve cohort study of 36 infants who had a birth weight of ≤1250 g. Sixteen-hour recordings of the infant sound environment were made in the NICU from a digital language processor at 32 and 36 weeks ' postmenstrual age . Adult word counts , infant vocalizations , and conversational turns were analyzed . RESULTS : Infant vocalizations are present as early as 32 weeks . Both adult word counts per hour and infant vocalizations per hour increase significantly between 32 and 36 weeks . Infant exposure to language as a percentage of time was small but increased significantly . When a parent was present , infants had significantly more conversational turns per hour than when a parent was not present at both 32 and 36 weeks ( P < .0001 ) . CONCLUSIONS : Preterm infants begin to make vocalizations at least 8 weeks before their projected due date and significantly increase their number of vocalizations over time . Although infant exposure to language increased over time , adult language accounted for only a small percentage of the sounds to which an infant is exposed in the NICU . Exposure to parental talk was a significantly stronger predictor of infant vocalizations at 32 weeks and conversational turns at 32 and 36 weeks than language from other adults . These findings highlight the powerful impact that parent talk has on the appearance and increment of vocalizations in preterm infants in the NICU To study the effects of live maternal speaking and singing on physiological parameters of preterm infants in the NICU and to test the hypothesis that vocal stimulation can have differential effects on preterm infants at a behavioural level OBJECTIVE : The goal of this study was to test the association of mean adult word counts at 32 and 36 weeks ’ postmenstrual age in the NICU  with Bayley Scales of Infant and Toddler Development , 3rd Edition ( Bayley-III ) , cognitive and language scores . It was hypothesized that preterm infants exposed to higher word counts would have higher cognitive and language scores at 7 and 18 months ’ corrected age . METHODS : This prospect i ve cohort study included 36 preterm infants with a birth weight ≤1250 g.  Sixteen-hour recordings were made in the NICU by using a digital language processor at 32 and 36 weeks ’ postmenstrual age . Regression analyses were performed on adult word count per hour , with Bayley-III measures correcting for birth weight . RESULTS : Adult word counts in the NICU were positively correlated with 7- and 18-month Bayley-III scores . For the 32-week recording , in regression analyses adjusting for birth weight , adult word count per hour independently accounted for 12 % of the variance in language composite scores ( P = .04 ) and 20 % of the variance in expressive communication scores at 18 months ( P = .008 ) . For the 36-week recording , adult word count per hour independently accounted for 26 % of the variance in cognitive composite scores at 7 months ( P = .0049 ) . CONCLUSIONS : Increased amount of parent talk with preterm infants in the NICU was associated with higher 7- and 18-month corrected age Bayley-III language and cognitive scores . These findings offer an opportunity for language intervention starting in the NICU PURPOSE To determine if a recording of a mother 's voice talking soothingly to her baby is useful in diminishing pain in newborns born between 32 and 36 weeks ' gestational age ( GA ) during routine painful procedures . BACKGROUND While maternal skin-to-skin contact has been proven efficacious for diminishing procedural pain in both full-term and preterm neonates , it is often not possible for mothers to be present during a painful procedure . Because auditory development occurs before the third trimester of gestation , it was hypothesized that maternal voice could substitute for maternal presence and be effective in diminishing pain response . SUBJECTSPreterm infants between 32 and 36 weeks ' GA ( n = 20 ) in the first 10 days of life admitted to 2 urban university-affiliated neonatal intensive care units . DESIGN AND METHODS Crossover design with r and om ordering of condition . Following informed consent , an audio recording of the mother talking soothingly to her baby was filtered to simulate the mother 's voice traveling through amniotic fluid . A final 10-minute recording of repetition of mothers ' talking was recorded with maximum peaks of 70 decibels ( dB ) and played at levels ranging between 60 and 70 ambient decibels ( dbA ) , selected above recommendations of the American Academy of Pediatrics in order to be heard over high ambient noise in the setting s. This was played to her infant by a portable cassette tape player 3 times daily during a 48-hour period after feedings ( gavage , bottle , or breast ) . At the end of 48 hours when blood work was required for clinical purpose s , using a crossover design , the infant underwent the heel lancing with or without the recording being played . The order of condition was r and omized , and the second condition was within 10 days . The Premature Infant Pain Profile ( PIPP ) was used as primary outcome . This is a composite measure using heart rate , oxygen saturation , 3 facial actions , behavioral state , and gestational age . This measure has demonstrated reliability and validity indexes . RESULTS There were no significant differences between groups on the PIPP or any of the individual components of the PIPP except a lower oxygen saturation level in the voice condition following the procedure . The second condition , regardless of whether it was voice or control , had higher heart rate scores and lower oxygen saturation scores even in the prelance baseline and warming phases . Order did not affect PIPP scores or facial actions . CONCLUSIONS Different modalities of maternal presence would appear to be necessary to blunt pain response in infants , and recorded maternal voice alone is not sufficient . The loudness of the recording may have obliterated the infant 's ability to discern the mother 's voice and may even have been aversive , reflected in decreased oxygen saturation levels in the voice condition . Preterm neonates of 32 to 36 weeks ' gestation may become sensitized to painful experiences and show anticipatory physiological response Aversive environment auditory stimuli is a common concern in neonatal intensive care . Recently , interest has developed regarding the use of music applications to mask such stimuli and to reduce the high risk for complications or failure to thrive . In this study of 20 oxygenated , low birth weight infants in a Newborn Intensive Care Unit of a regional medical center in the Southeastern United States , 10 infants listened to lullabies and 10 infants to recordings of their mother 's voice through earphones for 20 minutes across three consecutive days . Oxygen saturation levels and frequency of oximeter alarms were recorded . Results indicated a differential response to the two auditory stimuli as listening time progressed . On Day 1 , the infants listening to music had significantly higher oxygen saturation levels , but these effects disappeared by Days 2 and 3 . On Days 2 and 3 , however , the babies hearing music had significantly depressed oxygen saturation levels during the posttest intervals after the music was terminated . Infants hearing music had significantly fewer occurrences of Oximeter alarms during auditory stimuli than did those listening to the mothers ' voice . Implication s for the therapeutic use of auditory stimuli in the Newborn Intensive Care Unit are discussed BACKGROUND Preterm infants complete their development in Neonatal Intensive Care Unit being exposed to environmental stimuli that lead to the early maturation of the sensory systems . It is known that the fetus perceives sounds and reacts to them with movements since the 26th-28th week of gestational age . Maternal voice represents a source of sensory stimulation for the fetus . AIMS To investigate the effect of the exposure to maternal voice , administered by bone conduction , on preterm infants autonomic and neurobehavioral development . STUDY DESIGN Longitudinal , explorative , case control study . SUBJECTS 71 preterm infants with birth weight < 1500 g , born adequate for gestational age OUTCOME MEASURES vital and neurobehavioral parameters at term , neurofunctional assessment at 3 and 6months of corrected age . RESULTS Infants in the treatment group had lower heart rate values and a higher proportion of stable skin color at each study point as compared to the control group . The scores in the visual attention performance and in the quality of the general movements at term were better in the treatment group than in the control one . Neurofunctional assessment score at 3months of corrected age was higher in the treatment group whereas no difference between the two groups was detected at 6months of corrected age . CONCLUSIONS Early exposure to maternal voice exerts a beneficial effect on preterm infants autonomic and neurobehavioral development OBJECTIVES : We conducted a r and omized trial to test the hypothesis that mother ’s voice played through a pacifier-activated music player ( PAM ) during nonnutritive sucking would improve the development of sucking ability and promote more effective oral feeding in preterm infants . METHODS : Preterm infants between 34 0/7 and 35 6/7 weeks ’ postmenstrual age , including those with brain injury , who were taking at least half their feedings enterally and less than half orally , were r and omly assigned to receive 5 daily 15-minute sessions of either PAM with mother ’s recorded voice or no PAM , along with routine nonnutritive sucking and maternal care in both groups . Assignment was masked to the clinical team . RESULTS : Ninety-four infants ( 46 and 48 in the PAM intervention and control groups , respectively ) completed the study . The intervention group had significantly increased oral feeding rate ( 2.0 vs 0.9 mL/min , P < .001 ) , oral volume intake ( 91.1 vs 48.1 mL/kg/d , P = .001 ) , oral feeds/day ( 6.5 vs 4.0 , P < .001 ) , and faster time-to-full oral feedings ( 31 vs 38 d , P = .04 ) compared with controls . Weight gain and cortisol levels during the 5-day protocol were not different between groups . Average hospital stays were 20 % shorter in the PAM group , but the difference was not significant ( P = .07 ) . CONCLUSIONS : A PAM using mother ’s voice improves oral feeding skills in preterm infants without adverse effects on hormonal stress or growth Objective : To investigate the effects of  parental presence and infant holding in the neonatal intensive care unit ( NICU ) on neurobehavior at term equivalent . Study Design : Prospect i ve cohort enrolled 81 infants born ⩽30 weeks gestation . Nurses tracked parent visitation , holding and skin-to-skin care throughout the NICU hospitalization . At term , the NICU Network Neurobehavioral Scale was administered . Associations between visitation , holding and early neurobehavior were determined using linear and logistic regression . Result : The mean hours per week of parent visitation was 21.33±20.88 ( median=13.90 ; interquartile range 10.10 to 23.60 ) . Infants were held an average of 2.29±1.47 days per week ( median=2.00 ; interquartile range 1.20 to 3.10 ) . Over the hospital stay , visitation hours decreased ( P=0.01 ) , while holding frequencies increased ( P<0.001 ) . More visitation was associated with better quality of movement ( P=0.02 ) , less arousal ( P=0.01 ) , less excit 
    Output:
    
Robust effects emerged for feeding , cognitive and neurobehavioral development .
Wide differences emerged in infants ’ characteristics and maternal voice exposure methods .
Inconsistency emerged for physiological outcomes ( e.g. , heart rate variability , oxygen saturation , number of critical alarm events ) , whereas a robust pattern of findings emerged for feeding behaviors , as well as cognitive and neurobehavioral development .
Maternal voice appears to be a non‐noxious intervention , which is consistent with developmental care and which can be embedded in developmental care strategies