***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: 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 Fifty-two children aged 6–46 months ( mean 19 months ) , hospitalized for acute gastroenteritis ( GE ) , were  r and omized after oral rehydration to receive 7 days of either traditional gradual refeeding ( GR ) or rapid refeeding ( RR ) , the latter consisting of a full-strength lactose-limited diet , including lactase-treated whole milk . The study focused on the effect of a high energy intake , excluding possible negative effects of lactose . Both dietary regimens were well tolerated , the only difference in the clinical symptoms between the two regimens being a higher stool frequency within the RR group(p < 0.02 ) . The total energy intake , as well as energy derived from fat and protein , was significantly higher in the RR than in the GR group ( p < 0.0001 ) . The mean daily energy intake of the latter group never reached recommended daily allowance ( RDA ) levels , while that of the RR group did on day 5 . Moreover , during the whole period of dietary regimen , the RR group exceeded the RDA protein requirements ( mean intake ranged 175–252 % ) , while the GR group did not reach this RDA level until day 4 . Milk was a major source of energy in the RR group , providing 47–59 % of the daily energy intake . The short- and long-term weight gains in the RR group were only a little higher than those of the GR group , the difference being insignificant . The chief asset of RR compared with GR was , therefore , psychological , in the sense that after rehydration the hospitalized child with mild to moderate GE can , by and large , be offered the quality and quantity of food and drink that he/she prefers without the fear of negative effects on the outcome A controlled study was conducted comparing the st and ard method of treating hospitalized infants with acute diarrhea ( limited starvation ) with the initiation of " early feeding " using a soy-based , lactose-free formula in infants of an American Indian tribe 12 months of age or younger . Forty-three patients , r and omly assigned to group A , were given a soy-based , lactose-free formula four hours after hospitalization , and 44 patients , r and omly assigned to group B , received st and ard therapy ( food was withheld for the first 48 hours of hospitalization ) . After the first 48 hours , the same soy-based , lactose-free formula was given to the group B patients . Fluid intake and output of stool , urine , and vomitus were measured until the diarrhea resolved . Overall , group A patients showed less mean stool output ( 121 + /- 129 ( SD ) mL/kg ) than group B patients ( 299 + /- 319 mL/kg ) ( P less than .001 ) . Furthermore , the duration of illness was significantly shorter in group A patients ( 54 + /- 28 hours v 93 + /- 56 hours ) ( P less than .001 ) . It was concluded that soy-based , lactose-free formulas can be safely used during the acute phase of diarrheal illness in infants and that their use shortens the duration of illness and decreases stool output in comparison with st and ard therapy 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 We compared early versus late re‐feeding in the management of acute diarrhoea in the first year of life . In the study group ( 73 patients )  breast feeding was resumed or early re‐feeding was performed in non‐breast‐fed infants , so that the feeding regimen used prior to the onset of the disease was reached within 2‐3 days . In the control group ( 49 patients )  late re‐feeding was performed so that the infants returned to their original feeding pattern after 4‐6 days . There were no significant differences between the two groups in the number of stools and stool output per day , or in the duration of the disease . No weight gain or loss during the diet was noted more frequently in the late re‐feeding group ( 67.2 % versus 23.4 % ) . This study confirms the favourable effect on body weight of early re‐feeding in the management of acute diarrhoea Forty-eight children , aged 2 - 5 years , presenting with watery diarrhoea of less than 48 h duration at home prior to hospitalization , were admitted into a r and omized controlled clinical trial , 24 children being treated during the first 24 h of admission with oral rehydration solution ( ORS ) alone and 24 children being given ' ORS plus boiled-rice feeding ' .  The latter group received boiled-rice to supply at least 55 kcal/kg/d ( about 150 g boiled-rice per feed , given four times daily ) . Vibrio cholerae were isolated by stool culture on admission from all children . No antibiotics were given . Clinical characteristics of children in the two treatment groups were comparable . Among children given ' ORS plus boiled rice ' , there was a significant increase in volume of diarrhoea stools ( P less than 0.05 ) , duration of diarrhoea in hospital ( P less than 0.01 ) , and more frequent diarrhoea motions ( not significant statistically ) . However , the children fed boiled rice absorbed and retained 176 ml more fluid , and had gain in body weight comparable to that observed in children who were not fed during the first 24 h of hospitalization 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 A r and omized ambulatory trial was performed to compare early ( 6-h ) vs. late ( 24-h ) refeeding in  acute infantile diarrhea . Ninety infants with mild dehydration were enrolled in the study . Following an initial oral rehydration period ( WHO formula ) , refeeding was introduced using a diet based on either breast milk or cow 's milk . Early ( n = 53 ) and late ( n = 37 ) refeeding groups were similar in ethnic background , socioeconomic level , relevant past history , nutritional and clinical state , and stool pathogens . Infants were assessed upon their initial visit , at 24 and 48 h , and at 7 and 14 days thereafter for evaluation of weight , hydration state , stool frequency and need of hospitalization . No significant differences in the above parameters were observed between the two groups . Different patterns of refeeding ( breast milk vs. cow 's milk ) in both early and late refeeding groups showed no significant differences in the features studied . Since the short-term clinical outcome following early refeeding in acute infantile diarrhea is not different from late refeeding , we suggest that early refeeding should be preferred , particularly in developing population s , in order to minimize the adverse nutritional effects of prolonged fasting during recurrent bouts of gastroenteritis 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 We compared two feeding regimens , continuous intragastric feedings and intermittent oral feeding , in nine infants with protracted diarrhea and malnutrition and two infants with surgically created short bowel . Continuous nasogastric feeding caused significant increases in enteral balance of the major nutrients , whereas intermittent feedings result ed in negative or only slightly positive enteral balance . The improvements in enteral balance from intermittent to continuous feeding in infants with diarrhea were as follows : Fat from 13 + /- 0.8 to 22 + /- 2.0 gm/24 hours ; nitrogen from 0.63 
    Output:
    
There was no evidence that early refeeding increases the risk of unscheduled intravenous fluid use , episodes of vomiting , and development of persistent diarrhoea .
No conclusion could be made regarding the duration of diarrhoea