***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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    ***EXAMPLES*** 
    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 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 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 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 12 minutes before , during , and 15 minutes after two heelsticks , one with and one without facilitated tucking . HYPOTHESIS Premature neonates will have less variation in heart rate and hemoglobin oxygen saturation , shorter crying and sleep disruption times , and less fluctuation in sleep states in response to the painful stimulus of a heelstick with facilitated tucking than without . RESULTS Neonates demonstrated a lower mean heart rate 6 - 10 minutes post-stick ( p < 0.04 ) , shorter mean crying time ( p < 0.001 ) , shorter mean sleep disruption time ( p < 0.001 ) , and fewer sleep-state changes ( p = 0.003 ) after heelstick with facilitated tucking than without . CONCLUSION Facilitated tucking is an effective comfort measure in attenuating premature neonates ' psychologic and behavioral responses to minor pain BACKGROUND Physiologic and behavioral responses to procedural pain are influenced by gestational age ( GA ) . Compared with term neonates , hospitalized preterm neonates are subjected to more painful procedures aim ed at improving their clinical outcome . Although several trials to determine the efficacy of sucrose for managing procedural pain have been conducted , none have examined the influence of GA . OBJECTIVES To examine the influence of GA on the efficacy and short-term safety of oral sucrose for relieving procedural pain associated with heel lances . To explore GA differences in behavioral and physiologic indicators of pain . METHODS As part of a larger r and omized controlled trial ( RCT ) to examine the efficacy and safety of sucrose during heel lance , 190 neonates were stratified by GA : ( a ) 27 to 31 6/7 weeks ( group 1 ; n = 63 ) , ( b ) 32 to 35 6/7 weeks ( group 2 ; n = 63 ) , and ( c ) > 36 weeks ( group 3 ; n = 64 ) . They were then r and omized to receive ( a ) oral sucrose and non-nutritive sucking ( NNS ) , ( b ) sucrose alone , or ( c ) sterile water and NNS ( control ) for a heel lance . The influence of GA was determined by examining the short-term safety , as defined by the number of associated adverse events ( choking , coughing or vomiting , sustained tachycardia , sustained tachypnea or dyspnea , or sustained oxygen desaturation ) . The efficacy was measured by changes in a vali date d pain measure , scored during each phase of the intervention and analyzed according to GA groups . RESULTS Significant differences in pain response existed in each GA group , with the lowest mean pain scores in the sucrose and NNS group . Significant GA differences in behavioral and physiologic responses were found , with the most mature neonates demonstrating the greatest magnitude of pain response . The greatest number of short-term adverse effects to treatment occurred in the lowest GA group . CONCLUSIONS In a secondary analysis of a larger RCT , sucrose and NNS was the most efficacious intervention for single heel lances in each of 3 GA groups . However , infants of lower GA experienced more adverse events . Research on the efficacy and safety of repeated doses of oral sucrose , tested in infants from a wide range of GA , is required Abstract Objectives : To investigate whether breast feeding is effective for pain relief during  venepuncture in term neonates and compare any effect with that of oral glucose combined with a pacifier . Design : R and omised controlled trial . Participants : 180 term newborn infants undergoing venepuncture ; 45 in each group . Interventions : During venepuncture infants were either breast fed ( group 1 ) , held in their mother 's arms without breast feeding ( group 2 ) , given 1 ml of sterile water as placebo ( group 3 ) , or given 1 ml of 30 % glucose followed by pacifier ( group 4 ) . Video recordings of the procedure were assessed by two observers blinded to the purpose of the study . Main outcome measures : Pain related behaviours evaluated with two acute pain rating scales : the Douleur Aiguë Nouveau-né scale ( range 0 
    Output:
    
The breastfeeding group had significantly less increase in the heart rate , reduced proportion of crying time and reduced duration of crying compared to the swaddled or pacifier group .
Premature Infant Pain Profile scores were lower in the breastfeeding group when compared to the placebo and the group positioned in mother 's arms , but were not different compared to the no-treatment and the glucose groups .
Neonates in the supplemental breastmilk group had a significantly less increase in the heart rate and Neonatal Facial Coding Score but no significant difference in the duration of crying time and oxygen saturation change compared to the placebo .
CONCLUSIONS If available , breastfeeding or breastmilk should be used to alleviate pain in neonates undergoing painful procedure compared to placebo , positioning , or no intervention .
Administration of glucose/sucrose had a similar effectiveness as breastfeeding for reducing pain .