human
***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: OBJECTIVES : Recorded music risks overstimulation in NICUs . The live elements of music such as rhythm , breath , and parent-preferred lullabies may affect physiologic function ( eg , heart and respiratory rates , O2 saturation levels , and activity levels ) and developmental function ( eg , sleep , feeding behavior , and weight gain ) in premature infants . METHODS : A r and omized clinical multisite trial of 272 premature infants aged ≥32 weeks with respiratory distress syndrome , clinical sepsis , and /or SGA ( small for gestational age ) served as their own controls in 11 NICUs . Infants received 3 interventions per week within a 2-week period , when data of physiologic and developmental domains were collected before , during , and after the interventions or no interventions and daily during a 2-week period . RESULTS : Three live music interventions showed changes in heart rate interactive with time . Lower heart rates occurred during the lullaby ( P < .001 ) and rhythm intervention ( P = .04 ) . Sucking behavior showed differences with rhythm sound interventions ( P = .03 ) . Entrained breath sounds rendered lower heart rates after the intervention ( P = .04 ) and differences in sleep patterns ( P < .001 ) . Caloric intake ( P = .01 ) and sucking behavior ( P = .02 ) were higher with parent-preferred lullabies . Music decreased parental stress perception ( P < .001 ) . CONCLUSIONS : The informed , intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function . Entrained with a premature infant ’s observed vital signs , sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet – alert states . Parent-preferred lullabies , sung live , can enhance bonding , thus decreasing the stress parents associate with premature infant care Objective : The objective of this study was to investigate the effects of recorded lullabies and taped maternal voice in premature infants . Study design : Sixty-two preterm infants in a stable condition with 30<37 weeks of gestation and < 10 days of postnatal age were r and omly assigned to hear ( A ) recorded lullabies or ( B ) taped maternal voice for 30 min each evening during 14 consecutive days or ( C ) receive no st and ardized acoustic stimulation ( control group ) . Heart rate and respiratory rate were recorded daily before , during and after the intervention ( A and B ) or a comparable period with no intervention ( C ) , whereas activity was measured on days 1 , 7 and 14 of the intervention using accelerometers . Results : Both interventions led to a significant decrease in heart rate and respiratory rate during and after the stimulation when compared with the control group . The changes were more pronounced in infants with higher gestational ages ( P=0.001 ) . Lower activity was measured during the intervention when compared with the control group ( P<0.01 ) . Conclusions : St and ardized acoustic stimulation with recorded lullabies and taped maternal voice led to a decrease in heart rate and respiratory rate , and was associated with lower activity . Whether this indicates a reduced stress reaction needs to be investigated in further studies BACKGROUND Music therapy has been recommended as an adjuvant therapy for both preterm infants and mothers during their stay in the neonatal intensive care unit ( NICU ) , and has been shown to have beneficial effects . OBJECTIVES To study the usefulness of combining live harp music therapy and kangaroo care ( KC ) on short-term physiological and behavioral parameters of preterm infants and their mothers in the NICU setting . METHODS Included in this study were stable infants born between 32 and 37 weeks of gestation , with normal hearing . Mother-infant dyads were r and omly assigned to KC and live harp music therapy or to KC alone . Using repeated measures , neonatal and maternal heart rate , oxygen saturation and respiratory rate were recorded along with neonatal behavioral state and maternal anxiety state . Maternal age , ethnicity , education , and love of music were documented . RESULTS Fifty-two mother-infant dyads were tested . Compared with KC alone , KC and live harp music therapy had a significantly beneficial effect on maternal anxiety score ( 46.8 + /- 10 vs. 27.7 + /- 7.1 , respectively , P < 0.01 ) . Infants ' physiological responses and behavior did not differ significantly . No correlation was found between mothers ' age , ethnicity , years of education and affinity for music , and anxiety scores ( P = 0.2 to 0.5 for all four variables ) . CONCLUSIONS KC combined with live harp music therapy is more beneficial in reducing maternal anxiety than KC alone . This combined therapy had no apparent effect on the tested infants ' physiological responses or behavioral state OBJECTIVE : The rate of weight gain in preterm infants who are exposed to music seems to improve . A potential mechanism could be increased metabolic efficiency ; therefore , we conducted this study to test the hypothesis that music by Mozart reduces resting energy expenditure ( REE ) in growing healthy preterm infants . DESIGN . A prospect i ve , r and omized clinical trial with crossover was conducted in 20 healthy , appropriate-weight-for-gestational-age , gavage-fed preterm infants . Infants were r and omly assigned to be exposed to a 30-minute period of Mozart music or no music on 2 consecutive days . Metabolic measurements were performed by indirect calorimetry . RESULTS : REE was similar during the first 10-minute period of both r and omization groups . During the next 10-minute period , infants who were exposed to music had a significantly lower REE than when not exposed to music ( P = .028 ) . This was also true during the third 10-minute period ( P = .03 ) . Thus , on average , the effect size of music on REE is a reduction of ∼10 % to 13 % from baseline , an effect obtained within 10 to 30 minutes . CONCLUSIONS : Exposure to Mozart music significantly lowers REE in healthy preterm infants . We speculate that this effect of music on REE might explain , in part , the improved weight gain that results from this “ Mozart effect . BACKGROUND Music stimulation has been shown to provide significant benefits to preterm infants . We hypothesized that live music therapy was more beneficial than recorded music and might improve physiological and behavioral parameters of stable preterm infants in the neonatal intensive care unit . METHODS Thirty-one stable infants r and omly received  live music , recorded music , and no music therapy over 3 consecutive days . A control of the environment noise level was imposed . Each therapy was delivered for 30 minutes . Inclusion criteria were postconceptional age > or = 32 weeks , weight > or = 1,500 g , hearing confirmed by distortion product otoacoustic emissions ( DPOAEs ) , and no active illness or documentation of hyperresponsiveness to the music .  Heart rate , respiratory rate , oxygen saturation , and a behavioral assessment were recorded , every 5 minutes , before , during , and after therapy , allowing 30 minutes for each interval . The infant 's state was given a numerical score as follows : 1 , deep sleep ; 2 , light sleep ; 3 , drowsy ; 4 , quiet awake or alert ; 5 , actively awake and aroused ; 6 , highly aroused , upset , or crying ; and 7 , prolonged respiratory pause > 8 seconds . The volume range of both music therapies was from 55 to 70 dB. Parents and medical personnel completed a brief question naire indicating the effect of the three therapies . RESULTS Live music therapy had no significant effect on physiological and behavioral parameters during the 30-minute therapy ; however , at the 30-minute interval after the therapy ended , it significantly reduced heart rate ( 150 + /- 3.3 beats/min before therapy vs 127 + /- 6.5 beats/min after therapy ) and improved the behavioral score ( 3.1 + /- 0.8 before therapy vs 1.3 + /- 0.6 after therapy , p < 0.001 ) . Recorded music and no music therapies had no significant effect on any of the tested parameters during all intervals . Both medical personnel and parents preferred live music therapy to recorded music and no music therapies ; however , parents considered live music therapy significantly more effective than the other therapies . CONCLUSIONS Compared with recorded music or no music therapy , live music therapy is associated with a reduced heart rate and a deeper sleep at 30 minutes after therapy in stable preterm infants . Both recorded and no music therapies had no significant effect on the tested physiological and behavioral parameters INTRODUCTION The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics ( EMLA ) on pain responses of neonates undergoing circumcision . METHOD A r and omized , double-blind experimental design was used with 23 neonates .  Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate , respiratory rate , oxygen saturation levels , salivary cortisol levels , and length of cry . Each infant 's state was examined for a potential contribution to the pain response . FINDINGS Infant state , salivary cortisol levels , and respiratory rates were not significant . Pain ratings had considerable variability for all treatment conditions , but both single treatment groups had less pain by the end of the procedure . The heart rate was significantly lower for the EMLA group and remained stable for the music group . Oxygen saturation differences were statistically significant for the music group ( P = .02 ) and approached significance for the EMLA group . DISCUSSION Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision . Further study is warranted . Neonates deserve interventions that will provide them with a less painful start in life Objective . To test the effect of nonnutritive sucking ( NNS ) , music therapy ( MT ) , and combined NNS and MT ( NNS + MT ) , versus no intervention , on heart rate , transcutaneous oxygen ( TcPao 2 ) levels , and pain behavior of neonates in intensive care units having blood taken by a heel-stick procedure . Methodology . A within-subjects , counter-balancing , repeated- measures design conducted in a government-funded hospital in Hong Kong , comparing TcPao 2 levels , heart rate , and pain behavior outcomes in 27 neonates . Results . Repeated- measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions ( Wilk 's λ = .142 ; F[3,27 ] = 31.82 ; η2 = .47 ) . One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonates ' heart rate ( Wilk 's λ = .647 ; F[2,27 ] = 18.93 ; η2 = .35 ) , improved their TcPao 2 levels ( Wilk 's λ = .481;F [ 2,27 ] = 37.42 ; η2 = .51 ) , and reduced their pain behavior ( Wilk 's λ = .312 ; F [ 2,27 ] = 76.42 ; η2 = .68 ) . Posthoc scheffe tests revealed that NNS + MT had the strongest effect on neonates ' TcPao 2 levels and pain behavior ; MT alone had the strongest effect on neonates ' heart rate . Conclusions . Health professionals using NNS + MT when doing heel-sticks can improve the TcPao 2 levels of neonates and reduce their pain . Using MT alone can improve the heart rate of neonates 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 Introduction : Music stimulation has been shown to provide significant benefits to preterm infants . Thus the aim of this study was determine the effect of recorded mum 's lullaby and Brahm ’s lullaby on oxygen saturation in preterm infants . Methods : This double-blind r and omized controlled trial was carried out on 66 premature newborns with 
    Output:
    
agent
***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: OBJECTIVES : Recorded music risks overstimulation in NICUs . The live elements of music such as rhythm , breath , and parent-preferred lullabies may affect physiologic function ( eg , heart and respiratory rates , O2 saturation levels , and activity levels ) and developmental function ( eg , sleep , feeding behavior , and weight gain ) in premature infants . METHODS : A r and omized clinical multisite trial of 272 premature infants aged ≥32 weeks with respiratory distress syndrome , clinical sepsis , and /or SGA ( small for gestational age ) served as their own controls in 11 NICUs . Infants received 3 interventions per week within a 2-week period , when data of physiologic and developmental domains were collected before , during , and after the interventions or no interventions and daily during a 2-week period . RESULTS : Three live music interventions showed changes in heart rate interactive with time . Lower heart rates occurred during the lullaby ( P < .001 ) and rhythm intervention ( P = .04 ) . Sucking behavior showed differences with rhythm sound interventions ( P = .03 ) . Entrained breath sounds rendered lower heart rates after the intervention ( P = .04 ) and differences in sleep patterns ( P < .001 ) . Caloric intake ( P = .01 ) and sucking behavior ( P = .02 ) were higher with parent-preferred lullabies . Music decreased parental stress perception ( P < .001 ) . CONCLUSIONS : The informed , intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function . Entrained with a premature infant ’s observed vital signs , sound and lullaby may improve feeding behaviors and sucking patterns and may increase prolonged periods of quiet – alert states . Parent-preferred lullabies , sung live , can enhance bonding , thus decreasing the stress parents associate with premature infant care Objective : The objective of this study was to investigate the effects of recorded lullabies and taped maternal voice in premature infants . Study design : Sixty-two preterm infants in a stable condition with 30<37 weeks of gestation and < 10 days of postnatal age were r and omly assigned to hear ( A ) recorded lullabies or ( B ) taped maternal voice for 30 min each evening during 14 consecutive days or ( C ) receive no st and ardized acoustic stimulation ( control group ) . Heart rate and respiratory rate were recorded daily before , during and after the intervention ( A and B ) or a comparable period with no intervention ( C ) , whereas activity was measured on days 1 , 7 and 14 of the intervention using accelerometers . Results : Both interventions led to a significant decrease in heart rate and respiratory rate during and after the stimulation when compared with the control group . The changes were more pronounced in infants with higher gestational ages ( P=0.001 ) . Lower activity was measured during the intervention when compared with the control group ( P<0.01 ) . Conclusions : St and ardized acoustic stimulation with recorded lullabies and taped maternal voice led to a decrease in heart rate and respiratory rate , and was associated with lower activity . Whether this indicates a reduced stress reaction needs to be investigated in further studies BACKGROUND Music therapy has been recommended as an adjuvant therapy for both preterm infants and mothers during their stay in the neonatal intensive care unit ( NICU ) , and has been shown to have beneficial effects . OBJECTIVES To study the usefulness of combining live harp music therapy and kangaroo care ( KC ) on short-term physiological and behavioral parameters of preterm infants and their mothers in the NICU setting . METHODS Included in this study were stable infants born between 32 and 37 weeks of gestation , with normal hearing . Mother-infant dyads were r and omly assigned to KC and live harp music therapy or to KC alone . Using repeated measures , neonatal and maternal heart rate , oxygen saturation and respiratory rate were recorded along with neonatal behavioral state and maternal anxiety state . Maternal age , ethnicity , education , and love of music were documented . RESULTS Fifty-two mother-infant dyads were tested . Compared with KC alone , KC and live harp music therapy had a significantly beneficial effect on maternal anxiety score ( 46.8 + /- 10 vs. 27.7 + /- 7.1 , respectively , P < 0.01 ) . Infants ' physiological responses and behavior did not differ significantly . No correlation was found between mothers ' age , ethnicity , years of education and affinity for music , and anxiety scores ( P = 0.2 to 0.5 for all four variables ) . CONCLUSIONS KC combined with live harp music therapy is more beneficial in reducing maternal anxiety than KC alone . This combined therapy had no apparent effect on the tested infants ' physiological responses or behavioral state OBJECTIVE : The rate of weight gain in preterm infants who are exposed to music seems to improve . A potential mechanism could be increased metabolic efficiency ; therefore , we conducted this study to test the hypothesis that music by Mozart reduces resting energy expenditure ( REE ) in growing healthy preterm infants . DESIGN . A prospect i ve , r and omized clinical trial with crossover was conducted in 20 healthy , appropriate-weight-for-gestational-age , gavage-fed preterm infants . Infants were r and omly assigned to be exposed to a 30-minute period of Mozart music or no music on 2 consecutive days . Metabolic measurements were performed by indirect calorimetry . RESULTS : REE was similar during the first 10-minute period of both r and omization groups . During the next 10-minute period , infants who were exposed to music had a significantly lower REE than when not exposed to music ( P = .028 ) . This was also true during the third 10-minute period ( P = .03 ) . Thus , on average , the effect size of music on REE is a reduction of ∼10 % to 13 % from baseline , an effect obtained within 10 to 30 minutes . CONCLUSIONS : Exposure to Mozart music significantly lowers REE in healthy preterm infants . We speculate that this effect of music on REE might explain , in part , the improved weight gain that results from this “ Mozart effect . BACKGROUND Music stimulation has been shown to provide significant benefits to preterm infants . We hypothesized that live music therapy was more beneficial than recorded music and might improve physiological and behavioral parameters of stable preterm infants in the neonatal intensive care unit . METHODS Thirty-one stable infants r and omly received  live music , recorded music , and no music therapy over 3 consecutive days . A control of the environment noise level was imposed . Each therapy was delivered for 30 minutes . Inclusion criteria were postconceptional age > or = 32 weeks , weight > or = 1,500 g , hearing confirmed by distortion product otoacoustic emissions ( DPOAEs ) , and no active illness or documentation of hyperresponsiveness to the music .  Heart rate , respiratory rate , oxygen saturation , and a behavioral assessment were recorded , every 5 minutes , before , during , and after therapy , allowing 30 minutes for each interval . The infant 's state was given a numerical score as follows : 1 , deep sleep ; 2 , light sleep ; 3 , drowsy ; 4 , quiet awake or alert ; 5 , actively awake and aroused ; 6 , highly aroused , upset , or crying ; and 7 , prolonged respiratory pause > 8 seconds . The volume range of both music therapies was from 55 to 70 dB. Parents and medical personnel completed a brief question naire indicating the effect of the three therapies . RESULTS Live music therapy had no significant effect on physiological and behavioral parameters during the 30-minute therapy ; however , at the 30-minute interval after the therapy ended , it significantly reduced heart rate ( 150 + /- 3.3 beats/min before therapy vs 127 + /- 6.5 beats/min after therapy ) and improved the behavioral score ( 3.1 + /- 0.8 before therapy vs 1.3 + /- 0.6 after therapy , p < 0.001 ) . Recorded music and no music therapies had no significant effect on any of the tested parameters during all intervals . Both medical personnel and parents preferred live music therapy to recorded music and no music therapies ; however , parents considered live music therapy significantly more effective than the other therapies . CONCLUSIONS Compared with recorded music or no music therapy , live music therapy is associated with a reduced heart rate and a deeper sleep at 30 minutes after therapy in stable preterm infants . Both recorded and no music therapies had no significant effect on the tested physiological and behavioral parameters INTRODUCTION The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics ( EMLA ) on pain responses of neonates undergoing circumcision . METHOD A r and omized , double-blind experimental design was used with 23 neonates .  Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate , respiratory rate , oxygen saturation levels , salivary cortisol levels , and length of cry . Each infant 's state was examined for a potential contribution to the pain response . FINDINGS Infant state , salivary cortisol levels , and respiratory rates were not significant . Pain ratings had considerable variability for all treatment conditions , but both single treatment groups had less pain by the end of the procedure . The heart rate was significantly lower for the EMLA group and remained stable for the music group . Oxygen saturation differences were statistically significant for the music group ( P = .02 ) and approached significance for the EMLA group . DISCUSSION Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision . Further study is warranted . Neonates deserve interventions that will provide them with a less painful start in life Objective . To test the effect of nonnutritive sucking ( NNS ) , music therapy ( MT ) , and combined NNS and MT ( NNS + MT ) , versus no intervention , on heart rate , transcutaneous oxygen ( TcPao 2 ) levels , and pain behavior of neonates in intensive care units having blood taken by a heel-stick procedure . Methodology . A within-subjects , counter-balancing , repeated- measures design conducted in a government-funded hospital in Hong Kong , comparing TcPao 2 levels , heart rate , and pain behavior outcomes in 27 neonates . Results . Repeated- measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions ( Wilk 's λ = .142 ; F[3,27 ] = 31.82 ; η2 = .47 ) . One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonates ' heart rate ( Wilk 's λ = .647 ; F[2,27 ] = 18.93 ; η2 = .35 ) , improved their TcPao 2 levels ( Wilk 's λ = .481;F [ 2,27 ] = 37.42 ; η2 = .51 ) , and reduced their pain behavior ( Wilk 's λ = .312 ; F [ 2,27 ] = 76.42 ; η2 = .68 ) . Posthoc scheffe tests revealed that NNS + MT had the strongest effect on neonates ' TcPao 2 levels and pain behavior ; MT alone had the strongest effect on neonates ' heart rate . Conclusions . Health professionals using NNS + MT when doing heel-sticks can improve the TcPao 2 levels of neonates and reduce their pain . Using MT alone can improve the heart rate of neonates 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 Introduction : Music stimulation has been shown to provide significant benefits to preterm infants . Thus the aim of this study was determine the effect of recorded mum 's lullaby and Brahm ’s lullaby on oxygen saturation in preterm infants . Methods : This double-blind r and omized controlled trial was carried out on 66 premature newborns with 
    Output:
    