***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: AIMS To determine the effect of trophic feeding on clinical outcome in ill preterm infants . METHODS A r and omised , controlled , prospect i ve study of 100 preterm infants , weighing less than 1750 g at birth and requiring ventilatory support and parenteral nutrition , was performed . Group TF ( 48 infants ) received trophic feeding from day 3 ( 0.5–1 ml/h ) along with parenteral nutrition until ventilatory support finished . Group C ( 52 infants ) received parenteral nutrition alone . “ Nutritive ” milk feeding was then introduced to both groups . Clinical outcomes measured included total energy intake and growth over the first six postnatal weeks , sepsis incidence , liver function , milk tolerance , duration of respiratory support , duration of hospital stay and complication incidence . RESULTS Groups were well matched for birthweight , gestation and CRIB scores . Infants in group TF had significantly greater energy intake , mean difference 41.4 ( 95 % confidence interval 9 , 73.7 ) kcal/kg p=0.02 ; weight gain , 130 ( CI 1 , 250 ) g p = 0.02 ; head circumference gain , mean difference 0.7 ( CI 0.1 , 1.3 ) cm , p = 0.04 ; fewer episodes of culture confirmed sepsis , mean difference −0.7 ( −1.3 , −0.2 ) episodes , p = 0.04 ; less parenteral nutrition , mean difference −11.5 ( CI −20 , −3 ) days , p = 0.03 ; tolerated full milk feeds ( 165 ml/kg/day ) earlier , mean difference −11.2 ( CI −19 , −3 ) days , p = 0.03 ; reduced requirement for supplemental oxygen , mean difference −22.4 ( CI−41.5 , −3.3 ) days , p = 0.02 ; and were discharged home earlier , mean difference −22.1 ( CI −42.1 , −2.2 ) days , p = 0.04 . There was no significant difference in the relative risk of any complication . CONCLUSIONS Trophic feeding improves clinical outcome in ill preterm infants requiring parenteral nutrition . Key messages Timing of the introduction of milk feeds in sick low birthweight infants is controversial . Almost all infants with non-surgical illness can tolerate at least some milk as trophic feeds . Trophic feeding leads to improved energy intake , weight gain , milk tolerance , less sepsis and earlier hospital discharge . No increase in major complication rate is seen following trophic feeding A study was performed to determine if the addition of a fortifier to expressed breast milk ( EBM ) affected gastric emptying in low birthweight infants . Using ultrasonography , the gastric emptying of EBM alone was compared with that containing a fortifier , in a blind , crossover study . Twenty two low birthweight infants were studied : median ( range ) gestation 31.5 weeks ( 28 - 37 ) ; birthweight 1495 g ( 1000 - 2480 g ) . The gastric antral cross-sectional area ( ACSA ) was measured by ultrasonography before each feed and then sequentially after its completion until the ACSA returned to its pre-feed value . The half emptying time was calculated as the time taken for the ACSA to decrease to half the maximum increment . The mean difference ( st and ard error ) between half emptying times for EBM alone and for EBM with added fortifier was not significant : 1.48 ( 4.9 ) minutes . These data show that fortifying breast milk does not affect gastric emptying and suggests that the practice is unlikely to affect feed tolerance in low birthweight infants BACKGROUND Preterm children are at high risk of poor growth performance . In 2 r and omized trials , preterm infants fed preterm formula grew better in the neonatal period than those fed banked donor breast milk or st and ard term formula . OBJECTIVE Our objective was to test the hypothesis that for preterm infants , the neonatal period is a critical one for programming growth performance and that early diet influences long-term growth . DESIGN A total of 926 preterm infants were recruited into 2 parallel , r and omized trials of neonatal diet . In trial 1 , infants were fed either banked donor breast milk or preterm formula whereas in trial 2 , infants were fed either st and ard term formula or preterm formula . Within each trial , the allocated milk was the sole diet for some infants ( study A ) , whereas for others it was a supplement to maternal breast milk , given when not enough expressed breast milk was available ( study B ) . We followed up 781 of 833 survivors ( 94 % ) to age 7.5 - 8 y. Trained assessors obtained anthropometric measurements according to a st and ard protocol . RESULTS Despite significantly better neonatal growth performance in infants fed preterm formula ( compared with either banked donor breast milk or st and ard formula ) , early diet had no influence on weight , height , head circumference , or skinfold thicknesses at 9 or 18 mo postterm or at age 7.5 - 8 y. CONCLUSIONS These findings suggest that the preterm period is not a critical window for nutritional programming of growth , which contrasts with evidence from these trials showing that early diet influences later neurodevelopment Despite potential benefits , human milk may fail to meet preterm infants ' nutrient requirements . We tested the hypothesis that fortified breast milk , fed alone or with preterm formula , would improve neurodevelopment and growth at 18-mo follow-up without adverse short-term clinical or biochemical consequences . Two hundred seventy-five preterm infants from two medical centers ( birth weight < 1850 g ; mean gestation 29.8 + /- 2.7 wk ) whose mothers chose to provide breast milk were r and omly assigned to receive for a mean of 39 d a multinutrient fortifier or control supplement containing phosphate and vitamins . Breast milk comprised 47.6 % and 46.4 % of enteral intake in fortified and control groups , respectively ; preterm formula supplements were used when insufficient breast milk was available . Overall , there were no significant growth advantages with fortification ; although , when breast milk exceeded 50 % of intake , fortification promoted faster weight gain ( an advantage of 1.6 g.kg-1.d-1 ; 95 % CI : 0.1 , 3.1 ; P < 0.05 ) . Compared with control infants , the fortified group showed 1 ) higher plasma urea from week 2 ( P = 0.04 ) , 2 ) higher plasma calcium ( mean 2.34 + /- 0.01 compared with 2.27 + /- 0.02 mmol/L ; P = 0.003 ) , 3 ) a greater rise in alkaline phosphatase by week 6 ( P = 0.04 ) , 4 ) more clinical infections ( suspected plus proven ; 43 % compared with 31 % , P = 0.04 ) , 5 ) a nonsignificantly increased incidence of necrotizing enterocolitis ( 5.8 % compared with 2.2 % , P = 0.12 ) , and 6 ) higher white cell and platelet counts . Developmental scores at 18 mo were slightly but not significantly higher in the fortified group . This study confirmed that breast milk fortifiers can improve short-term growth ( when breast milk intakes are high ) ; but beneficial effects on long-term development remained unproven . Future research is required to evaluate potential adverse consequences and explore more optimal fortification strategies OBJECTIVE To compare the effects of continuous versus intermittent feedings on physical growth , gastrointestinal tolerance , and macronutrient retention in very low birth weight infants ( < 1500 gm ) . STUDY DESIGN Very low birth weight neonates stratified by birth weight were r and omly assigned to either continuous ( 24-hour ) or intermittent ( every 3 hours ) nasogastric feedings . Feedings with half-strength Similac Special Care formula were initiated between day 2 and 3 and were advanced isoenergetically to goal . Daily weights , volume/caloric intakes , weekly anthropometric and dynamic skin-fold thickness measurements , and data on feeding milestones and clinical complications were collected . Nitrogen , carbohydrate , and fat balance studies were performed on a subset of male subjects . RESULTS Eighty-two neonates with birth weights between 750 and 1500 gm who were born between 27 and 34 weeks of gestation were r and omly assigned to continuous ( n = 42 ) and intermittent ( n = 40 ) feeding groups . There were no significant differences in baseline demographics and severity of respiratory distress between groups . There were no significant differences in days to regain birth weight , days to full enteral feedings , days to discharge , and discharge anthropometric measurements between continuously fed and intermittently fed infants , both when evaluated together and according to 250 gm weight intervals . Retention rates of nitrogen , fat , total carbohydrate , and lactose were comparable in the continuously fed ( n = 17 ) and intermittently fed ( n = 13 ) male neonates . Very low birth weight neonates who were fed continuously did not have feeding-related complications . CONCLUSION Very low birth weight infants achieve similar growth and macronutrient retention rates and have comparable lengths of hospital stay whether they are fed with continuous or intermittent feedings OBJECTIVE To test the hypothesis that very low birth weight infants fed by continuous nasogastric gavage ( CNG )  would achieve full enteral feedings ( 100 kcal/kg/d ) at an earlier postnatal age and have less feeding intolerance ( FI ) than infants fed by intermittent bolus gavage ( IBG ) . METHODS Eighty infants were stratified by birth weight ( 700 to 1000 g and 1001 to 1250 g ) and r and omized into CNG or IBG  feeding groups . CNG infants were comparable with IBG in birth weight , gestational age , sex , race , and day of onset of feeding ( 5.7 + /- 2.1 days vs 5.6 + /- 2.2 days , respectively ) . Feedings were given as undiluted Similac Special Care formula ( Ross Laboratories , Columbus , OH ) via a specific protocol design ed for each 50 to 100 g birth weight category . Feedings were advanced isoenergetically by a maximum of 25 mL/kg/d until an endpoint of 100/kcal/kg/d for at least 48 hours was reached . An infant whose feedings were withheld for > 12 hours based on predetermined criteria was considered to have an episode of FI . RESULTS Infants in the CNG group reached full enteral feeding at 17.1 + /- 8.9 days compared with 15.5 + /- 5.5 days in the IBG group ; these were not statistically different . Secondary outcome variables such as days to regain birth weight ( CNG , 12.6 + /- 5 days vs IBG , 12.5 + /- 3.7 days ) , days to reach discharge weight of 2040 g ( CNG , 60 + /- 13.4 days vs IBG , 62 + /- 13.6 days ) , and number of episodes of FI were not significantly different between feeding methods . FI was primarily associated with birth weight < /=1000 g ( 71 % ) vs 1001 to 1250 g ( 38 % ) . CONCLUSION Feeding methods are associated with similar outcomes when feeding regimens are comparable Forty three infants under 1400 g were fed by a bolus nasogastric , continuous nasogastric , or transpyloric route . There were more complications with transpyloric feeding and no identifiable benefits in the growth rate , oral energy input , or chosen biochemical indices of nutrition .  Bolus or continuous nasogastric feeds rather than transpyloric are better routine methods in infants of low birth weight In a prospect i ve multicentre study on 926 preterm infants formally assigned to their early diet , necrotising enterocolitis developed in 51 ( 5.5 % ) .  Mortality was 26 % in stringently confirmed cases . In exclusively  formula-fed  babies confirmed disease was 6 - 10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk . Pasteurised donor milk seemed to be as protective as raw maternal milk . Among babies born at more than 30 weeks ' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk ; it was 20 times more common in those fed formula only . Other risk factors included very low  gestational age , respiratory disease , umbilical artery catheterisation , and polycythaemia . In formula-fed but not breast-milk-fed infants , delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis . With the fall in the use of breast milk in British neonatal units , exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year . About 100 of these infants would die Whether breast milk influences later neurodevelopment  has been explored in non-r and omised studies , potentially confounded by social and demographic differences between feed groups . Here in a strictly r and omised prospect i ve multicentre trial , Bayley psychomotor and mental development indices ( PDI and MDI ) were assessed at 18 months postterm in survivors of 502 preterm infants assigned to receive , during their early weeks , mature donor breast milk or a preterm formula .  These diets were compared as sole enteral feeds or as supplements to the mother 's expressed breast milk . No differences in outcome at 18 months were 
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On the other h and , enteral feeding ( with milk , not water2 ) in the first five days of life promotes endocrine adaptation and the maturation of motility patterns,3 provides luminal nutrient , and probably benefits immune function.4Potential clinical benefits are therefore earlier tolerance of enteral feeds , reduced risk of infection , and earlier discharge .
A systematic review of studies published to 1997 concluded that it reduced