***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: Two hundred well hydrated babies of 6 weeks to 12 months of age who had been fed on formula feeds and who were admitted with acute gastroenteritis were r and omly allocated to receive either a st and ard return to full milk feeds , or immediate full strength feeds with one of three milk formulas , HN25 , SMA Gold Cap , or Formula S. There were significant differences in weight change among the four treatment groups at two and five days , with initial weight loss recorded only for the group of babies who were receiving the grade d return to full feeding . There was no difference in the duration of diarrhoea after admission , nor in the time to discharge . Eighteen babies were classified as failures of treatment . None had long term complications .  Well hydrated infants with acute gastroenteritis may resume full milk feeding immediately Early feeding is generally recommended for children with acute diarrhea .  The concentration at which the milk should be given to children weaned at an early age remains a matter of debate . The aim of the study was therefore to evaluate the role of milk dilution in the first 24 hours on the outcome of diarrhea .  Sixty-nine well nourished and weaned children , aged 1 to 9 months and with moderate watery acute diarrhea were included after oral rehydration therapy ( ORT )  in a r and omised controlled study to receive either half-strength ( diluted group ) or full strength ( undiluted group ) milk . Both groups displayed the same clinical characteristics except for the weight . The outcome of the diarrhea until cessation was the same in the 2 groups . No failure requiring a specific treatment was observed . The duration of diarrhea and the total stool output were not statistically different in the 2 groups , i.e. 39 + /- 7 hrs in diluted vs 47 + /- 8 in undiluted , and 883 + /- 205 g in diluted vs 924 + /- 161 g in undiluted . These results are strengthened by the lack of significant differences in the weight gain , the number and volume of vomiting , the volume of ORT and milk intake . However , the energy intake was significantly higher in the group receiving full strength milk . These results suggest that there is no immediate clinical advantage to dilute the milk in the first 24 hours of feeding well nourished children with moderate acute watery diarrhea , if early feeding is associated with the ORT recommended by the WHO Sixty two babies under the age of 6 months who were admitted with gastroenteritis completed a study of gradual refeeding compared with abrupt refeeding after a period of rehydration . There was no difference in the incidence of recurrence of diarrhoea due to lactose intolerance , effect on weight , or duration of hospital stay . Twenty six babies ( 42 % ) had recurrence of diarrhoea after refeeding , all of whom settled with the introduction of a lactose free soya based formula .  Well nourished babies under 6 months of age with mild to moderately severe gastroenteritis can be fed immediately with full strength milk feeds after rehydration . The introduction of a lactose free soya based preparation may provide an alternative to repeated attempts at regrading with cows ' milk feeds in those patients with lactose intolerance There is concern that feeding full-strength animal milk to infants aged less than 6 months with diarrhoea may have adverse consequences . We assessed the effects on clinical course of two feeding regimens in 159 Guatemalan and Brazilian infants aged 2 weeks to 6 months who had had acute diarrhoea for 120 h or less , showed signs of mild to moderate dehydration , and had no complications . After correction of dehydration , infants were assigned r and omly to receive continued full-strength milk feeding or initial feeding with diluted milk with regrading to full-strength milk over 48 h. There were no significant differences between feeding groups in rate of treatment failures ( -1 % , 95 % Cl -14 to 12 % ) or mean ( SD ) total stool output ( full-strength milk 335 [ 268 ] g/kg , diluted milk 338 [ 354 ] g/kg ) and duration of diarrhoea ( 92 [ 50 ] vs 92 [ 44 ] h ) . A significant association was found between presence of reducing substances in stools and treatment failure ( OR 4.3 , 95 % CI 1.1 to 16.8 ) , but reducing substances in stools were common both in treatment successes ( 61 % ) and in failures ( 87 % ) . Our study supports the conclusion that , for infants under 6 months of age with diarrhoea whose only food is animal milk or formula , the milk or formula normally given should be provided in full strength as soon as dehydration has been corrected To assess the best possible method of reintroducing milk in children suffering from acute gastroenteritis , 150 children ( 76 males and 74 females ) admitted with acute gastroenteritis were allocated to one of three regimens : a. clear fluids initially , followed by increasing strengths of milk , in quarter strength steps ; b. clear fluids initially and then reintroducing full strength milk ; c. regimen of continuing full strength milk . There was no difference between the three groups in the outcome or in the length of stay in the hospital , but those who were continued on full strength milk gained more weight . The weight gain did not attain statistical significance ; it is our impression on clinical grounds that this weight gain may be important in the malnourished infant who is more prone to enteritis We determined the efficacy of a soy‐based formula compared with a cow 's milk formula in infant re‐feeding after acute diarrhea in a r and omized controlled double‐blind clinical trial . Infants 2–12 months of age with diarrhea of less than one week 's duration and mild or moderate dehydration admitted to a pediatric hospital or in the practice of a participating primary care pediatrician were investigated . Seventy‐six patients were enrolled and 73 completed the study ; 39 infants received a soy‐based formula ( Isomil ) and 34 received a cow 's milk formula ( SMA ) .  Hospitalized patients were rehydrated with an oral glucose‐electrolyte solution or an iv dextrose‐sodium solution . Out patients received oral glucose‐electrolyte solution . In all patients , the study formula was commenced ad libitum during the first 24 h as determined by the attending pediatrician . The primary outcome measure was duration of diarrhea , defined as time to first normal stool , when subsequent stools were normal for a 24‐h period . In addition , a predetermined secondary outcome was proportion of treatment failures , defined as the need to reinstitute clear fluids because of emesis , refusal to accept study formula , need for iv fluids due to negative fluid balance or diarrhea persisting beyond 7 days after enrollment . Total duration of diarrhea was significantly longer ( p= 0.03 ) in those receiving cow 's milk ( mean±SD 6.6 ± 4.2 days ) than in those receiving soy‐based formula ( 4.5 ± 3.6 days ) . Volume of formula intake and weight gain at 14 days were not different in the two groups . There were 18 treatment failures in the cow 's milk formula recipients and 13 failures in the soy formula recipients ( p= 0.08 ) . Soy‐based formula significantly shortened the duaration of acute diarrhea in well nourished infants compared with cow 's milk formula To compare the efficacy of a low-lactose hydrolyzed milk formula , a lactose-free corn syrup-based milk formula , and a st and ard lactose-containing formula during refeeding after rehydration in infants with gastroenteritis , 135 patients older than 2 years were studied by r and omized trial . Clearly demonstrated disadvantages in terms of early weight loss and longer duration of diarrhea were observed with the lactose-based formula compared with early weight gains on both the low-lactose formulae , and thus the lactose-containing formula was discontinued after 91 patients . The early weight loss with the lactose-containing formula was statistically significantly related to the degree of relative ( rehydrated ) underweight . The two low-lactose formulae were further compared in the remaining 44 patients . Early weight gain ( 48 h ) was significantly greater with the lactose-hydrolyzed formula compared with the corn syrup-based formula , but no statistically significant differences were observed in duration of diarrhea , energy intake , treatment failures , or late weight gain . We conclude that the routine use of a low-lactose formula during refeeding after rehydration in infants with gastroenteritis may have some advantages in underweight infants and toddlers in whom it is important to prevent further weight loss BACKGROUND St and ard treatment of infants who are dehydrated as a result of acute gastroenteritis is to administer oral rehydration therapy ( ORT ) . Traditionally , food has been withdrawn for 24 - 48 h , but there is no conclusive evidence that this is of any real benefit to the patient . Immediate modified feeding , in which an infant on ORT is not starved but administered a limited diet , may have benefits in the treatment of gastroenteritis , especially in children who are nutritionally compromised before they develop the illness . AIM A pilot study was carried out to investigate the effects of giving infants suffering from acute gastroenteritis a limited modified diet in conjunction with ORT . METHOD Infants recruited into the study by their general practitioner or by a research doctor in the hospital casualty unit of Bristol Children 's Hospital were r and omly allocated to receive ORT with or without immediate modified feeding . The duration of diarrhoea , weight change , and incidence of vomiting and lactose intolerance were measured in both treatment groups , and the results were compared . RESULTS Of the infants studied , 27 received ORT and immediate modified feeding , and 32 ORT alone . The duration of diarrhoea , and incidence of vomiting or lactose intolerance were no greater in the group receiving immediate modified feeding . Patients who received ORT and immediate modified feeding appeared to gain more weight than the infants who were starved for 24 - 48 h , but this difference was not statistically significant . CONCLUSION Immediate modified feeding is safe and effective , and may have nutritional advantages over traditional ORT with starvation . A similar but multicentre study using unmodified diet , i.e. child 's normal diet , is being carried out by a working group of The European Society of Paediatrics , Gastroenterology and Nutrition ( ESPGAN ) A blind controlled trial was performed to test the hypothesis that early introduction of full-strength cow 's milk ( FCM ) during an attack of acute infantile gastroenteritis does not prolong the course of the illness . A total of 74 children matched for age was admitted to the trial , which compared the effect of FCM with that of graduated milk ( the strength of which was gradually increased ) . Thirteen children ( 17.5 % ) were withdrawn because of lactose malabsorption ; of those remaining , 29 were given FCM and 32 graduated milk . The mean duration of diarrhoea was 2,62 days for those on FCM and 2,64 days for those given graduated milk ( P = 0,71 , not significant ) . Early introduction of FCM therefore does not prolong the course of acute infantile gastroenteritis . Because of the prevalence of malnutrition in South Africa the practice of giving clear fluids or diluted milk during an attack of gastro-enteritis is unnecessary and dangerous OBJECTIVE To evaluate the effect of feeding infants a soy-based formula with lactose compared with a soy-based formula with sucrose during an acute diarrheal episode . PARTICIPANTS AND METHODS Two hundred boys , aged 3 to 18 months , who were admitted to the hospital with acute diarrhea and signs of dehydration were r and omly assigned to receive a soy-based formula with lactose or sucrose after initial rehydration . Intake and output ( stool , urine , and vomit ) were measured and recorded every 3 hours until diarrhea resolved . RESULTS The stool output during the first 24 hours of maintenance therapy , the total stool output during maintenance therapy , and the stool output during the entire illness ( measured in grams per kilograms ) were significantly lower among patients who received the soy-based formula with sucrose ( P<.05 , P<.001 , and P<.001 , respectively ) than among patients who received the soy-based formula with lactose . The duration of diarrhea was significantly shorter among patients who received the soy-based formula with sucrose ( P<.001 ) . The relative risk of being withdrawn from the study increased to 1.95 ( 95 % confidence interval , 0.65 - 9.2 ) and the relative risk of recurrence of dehydration after feeding was initiated increased significantly to 3.49 ( 95 % confidence interval , 1.1 - 9.6 ; P<.01 ) in the group receiving the soy-based formula with lactose . CONCLUSION During diarrheal episodes , feeding infants a soy-based formula with sucrose has a better outcome ( lower stool output , shorter duration of diarrhea , and lower failure rates ) than feeding infants a soy-based formula with lactose Thirty-eight moderately to severely malnourished children with severe acute or subacute diarrhea were treated according to two different feeding schemes , divided at r and om half of the children received semi-elemental diet ( SED ) with an osmolarity of 302 milliosmol per liter , a low lactose content and a relatively high content of lactalbumine hydrolysate ( 1 g/100 ml ) . The other half of the patients received available proprietory formulas or diluted cow 's milk with added carbohydrates . The results obtained showed that the children who were fed the SED had a better average weight gain during the 
    Output:
    
In young children with acute diarrhoea who are not predominantly breast-fed , change to a lactose-free diet may result in earlier resolution of acute diarrhoea and reduce treatment failure .
There are no trials from low-income countries , where mortality for diarrhoea is high , and malnutrition is more common