***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: We previously demonstrated that local massage for one minute can enhance immunogenicity of diphtheria , tetanus , and whole-cell pertussis ( DTPw ) vaccination . This study further analyzes the effects of more intense local manipulation on infants after DTPw and DTPa ( diphtheria , tetanus , and acellular pertussis ) vaccination .  A total of 808 infants aged two months were recruited to be vaccinated with either DTPw or DTPa .  Vaccinees in both groups were further divided into two groups ; those receiving local manipulation ( massage and hot packing after vaccinations ) and those receiving only vaccinations . Results showed that safety profiles were largely similar between those who had local manipulation following vaccination and those without . The only significant difference was more frequent local reactions including pain and swelling following the first two doses in both the DTPa and DTPw groups receiving manipulation compared with the groups not receiving manipulation . Serologic tests revealed that local manipulation had no significant effect on antibody response to pertussis toxin and filamentous hemagglutinin , and diphtheria and tetanus toxins . The effect of local massage on DTPw was related to the intensity of local massage . Too vigorous a local manipulation caused adverse local reactions and no beneficial effect on antibody response . As for the infants receiving DTPa and local massages for two minutes with hot packing , no significant effect on either the reactogenicity or immunogenicity was found AIMS This study examined the effectiveness of non-nutritive sucking on  preterm infant pain , changes in infant behaviour and frequency of abnormal physiological signals during heel stick procedures in Taiwan . BACKGROUND Preterm infants ' repetitive exposure to painful procedures may result in changes to brain organisation . Pain management should be a priority in neonatal care . DESIGN R and omised control trial . METHODS Preterm infants ( gestational age 28.9 - 37 weeks ) were r and omised to two groups : those receiving ( experimental , n = 52 ) or not receiving non-nutritive sucking ( control , n = 52 ) during heel stick procedures .  Pain was measured before ( for three minutes ) , during and after ( during 10-minute recovery ) heel stick procedures by the Premature Infant Pain Profile , changes in infant behaviour and abnormal physiological parameters . Results . Infants in both groups had similar odds ratios for pain and moderate-to-severe pain ( 0.57 and 0.58 , respectively ) , after adjusting for time effects , postconceptional age , heel stick duration , painful experiences and baseline Premature Infant Pain Profile score . The pain scores of infants with non-nutritive sucking were significantly lower than those of non-nutritive sucking infants at all eight phases of the heel stick procedures . Infants undergoing heel stick procedures in the experimental group had lower rates ratios for ' grimace ' and ' h and to mouth or face ' behaviours than control infants ( 0.73 and 0.78 , respectively ) . CONCLUSION Non-nutritive sucking effectively reduced pain , particularly mild to moderate pain and behavioural responses to pain in infants receiving heel stick procedures , suggesting that nurses can offer this intervention to relieve pain in preterm infants undergoing invasive procedures . RELEVANCE TO CLINICAL PRACTICE Infants should be given an appropriate-sized pacifier for comfort during painful procedures . Nurses need to be informed about the effectiveness of non-nutritive sucking , its analgesic mechanisms and how to use and incorporate it into practice 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 This experiment had three goals : 1 . To identify the basis of sucking-induced analgesia in healthy , term , newborn humans undergoing the painful , routine , procedure of heel lance and blood collection . 2 . To evaluate how taste-induced and sucking-induced analgesias combine to combat pain . 3 . To determine whether facial grimacing was an accurate index of diminished pain , or whether it was linked to tissue trauma . We report that : 1 . Sucking an unflavored pacifier was analgesic when and only when suck rate exceeded 30 sucks/min . 2 . The combination of sucrose and nonnutritive sucking was remarkably analgesic ; we saw no behavioral indication in nine of the ten infants that the heel lance had even occurred . 3 . Grimacing was reduced to almost naught by procedures that essentially eliminated crying and markedly reduced heart rate during the blood harvesting procedure Background Co-bedding , a developmental care strategy , is the practice of caring for diaper clad twins in one incubator ( versus separating and caring for each infant in separate incubators ) , thus creating the opportunity for skin-to-skin contact and touch between the twins . In studies of mothers and their infants , maternal skin-to-skin contact has been shown to decrease procedural pain response according to both behavioral and physiological indicators in very preterm neonates . It is uncertain if this comfort is derived solely from maternal presence or from stabilization of regulatory processes from direct skin contact . The intent of this study is to compare the comfort effect of co-bedding ( between twin infants who are co-bedding and those who are not ) on infant pain response and physiologic stability during a tissue breaking procedure ( heelstick ) . Methods / Design Medically stable preterm twin infants admitted to the Neonatal Intensive Care Unit will be r and omly assigned to a co-bedding group or a st and ard care group .  Pain response will be measured by physiological and videotaped facial reaction using the Premature Infant Pain Profile scale ( PIPP ) . Recovery from the tissue breaking procedure will be determined by the length of time for heart rate and oxygen saturation to return to baseline . Sixty four sets of twins ( n = 128 ) will be recruited into the study . Analysis and inference will be based on the intention-to-treat principle . Discussion If twin contact while co-bedding is determined to have a comforting effect for painful procedures , then changes in current neonatal care practice s to include co-bedding may be an inexpensive , non invasive method to help maintain physiologic stability and decrease the long term psychological impact of procedural pain in this high risk population . Knowledge obtained from this study will also add to existing theoretical models with respect to the exact mechanism of comfort through touch . Trial registration OBJECTIVE . The role of laparoscopic surgery in pediatric inguinal hernia repair is unclear . We aim ed to compare day-case laparoscopic hernia repair with open repair . METHODS . A prospect i ve , single-blinded r and omized study in children aged 4 months to 16 years with unilateral inguinal hernia was performed . The primary outcome measure was the time to normal daily activities after surgery . Secondary outcome measures included postoperative pain , time in the operation room , results , and complications . RESULTS . Eighty-nine patients were enrolled ( laparoscopic hernia repair : 47 , open repair : 42 ) . The mean number of days to normal activity after laparoscopic hernia repair and open repair was 2.4 and 2.5 , respectively . Thirty-seven ( 79 % ) patients with laparoscopic hernia repair and 20 ( 42 % ) with open repair required rescue analgesia postoperatively . The median pain score in the second postoperative morning was significantly higher after laparoscopic hernia repair . The median times in the operation room for laparoscopic hernia repair and open repair were 63 and 38 minutes , respectively . Surgical and cosmetic results were similar at up to 2 years ' follow-up . CONCLUSIONS . Recovery and outcome were similar after open repair and laparoscopic hernia repair in children .  Laparoscopic hernia repair was associated with increased theater time and postoperative pain BACKGROUND : Suprapubic aspiration ( SPA ) and urine catheterization ( UC ) are performed frequently in preterm neonates to rule out urinary tract infection ; however , a comparison of the pain caused by both procedures has not been made previously . OBJECTIVE : To compare pain responses in preterm infants who are undergoing urine collection by using SPA versus UC .  METHODS : Prospect i ve , single-blind , r and omized clinical trial was conducted in 2 NICUs . Preterm infants who required urine sample s for microbiologic analysis were r and omly assigned to undergo either SPA or UC . The infants ' facial and physiologic responses were videotaped during the procedure and later scored by a research assistant who was blind to the method of urine collection . The primary outcome measure was facial-grimacing during the procedure , which was assessed by measuring the percentage of time the infants displayed brow-bulging . Secondary outcomes included changes in heart rate ( beats per minute ) , oxygen saturation ( % ) , and procedural success rate . RESULTS : Forty-eight preterm infants participated . Characteristics did not differ ( P > .05 ) between groups . The mean ( SD ) percent brow-bulging score was higher in the SPA group than in the UC group ( 67 % [ 34 ] vs 42 % [ 38 ] ; P = .02 ) . Heart rate and oxygen saturation did not differ ( P = .50 and .74 , respectively ) . The procedure-success rate , although lower in the SPA group , was not statistically different ( 60 % vs 78 % ; P = .17 ) . CONCLUSIONS : SPA was more painful than UC , as assessed by brow-bulging , and had a tendency to be associated with a higher rate of procedure failure . These findings should be taken into consideration when choosing between these 2 procedures for preterm infants who undergo urine sampling OBJECTIVES : Cobedding of preterm twin infants  provides tactile , olfactory , and auditory stimulation and may affect pain reactivity . We carried out a r and omized trial to assess the effect of cobedding on pain reactivity and recovery in preterm twin neonates . METHODS : Stable preterm twins ( n = 67 sets ) between 28 and 36 weeks of gestational age were r and omly assigned to a cobedding group ( cared for in the same incubator or crib ) or a st and ard care group ( cared for in separate incubators or cribs ) . Pain response ( determined by the Premature Infant Pain Profile [ PIPP ] ) and time to return to physiologic baseline parameters were compared between groups with adjustment for the nonindependence of twin infants . RESULTS : Maternal and infant characteristics were not significantly different between twin infants in the cobedding and st and ard care groups except for 5-minute Apgar < 7 and postnatal age and corrected gestational age on the day of the heel lance . Mean PIPP scores were not different between groups at 30 , 60 , or 120 seconds . At 90 seconds , mean PIPP scores were higher in the cobedding group ( 6.0 vs 5.0 , P = .04 ) . Recovery time was shorter in the cobedding group compared with the st and ard care group , ( mean = 75.6 seconds versus 142.1 seconds , P = .001 ) . No significant adverse events were associated with cobedding . Adjustment for nonindependence between twins and differences in baseline characteristics did not change the results . CONCLUSIONS : Cobedding enhanced the physiologic recovery of preterm twins undergoing heel lance , but did not lead to lower pain scores The objective of this study was to compare the effects of containment and swaddling on premature infants '  heart rates ( HR ) , oxygen saturation ( SpO(2 ) , and the Premature Infant Pain Profile ( PIPP ) scores after heelstick . The study used a cross-over experimental design , 32 premature infants with gestational age < 3 
    Output:
    
There is evidence that different non-pharmacological interventions can be used with preterms , neonates , and older infants to significantly manage pain behaviors associated with acutely painful procedures .
The most established evidence was for non-nutritive sucking , swaddling/facilitated tucking , and rocking/holding .
There are significant gaps in the existing literature on non-pharmacological management of acute pain in infancy