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: OBJECTIVE To compare the duration of parenteral nutrition , growth , and morbidity in extremely premature infants fed exclusive diets of either bovine milk-based preterm formula ( BOV ) or donor human milk and human milk-based human milk fortifier ( HUM )  , in a r and omized trial of formula vs human milk . STUDY DESIGN Multicenter r and omized controlled trial . The authors studied extremely preterm infants whose mothers did not provide their milk . Infants were fed either BOV or an exclusive human milk diet of pasteurized donor human milk and HUM . The major outcome was duration of parenteral nutrition . Secondary outcomes were growth , respiratory support , and necrotizing enterocolitis ( NEC ) . RESULTS Birth weight ( 983 vs 996 g ) and  gestational age ( 27.5 vs 27.7 wk ) , in BOV and HUM , respectively , were similar . There was a significant difference in median parenteral nutrition days : 36 vs 27 , in BOV vs HUM , respectively ( P = .04 ) . The incidence of NEC in BOV was 21 % ( 5 cases ) vs 3 % in HUM ( 1 case ) , P = .08 ; surgical NEC was significantly higher in BOV ( 4 cases ) than HUM ( 0 cases ) , P = .04 . CONCLUSIONS In extremely preterm infants given exclusive diets of preterm formula vs human milk , there was a significantly greater duration of parenteral nutrition and higher rate of surgical NEC in infants receiving preterm formula . This trial supports the use of an exclusive human milk diet to nourish extremely preterm infants in the neonatal intensive care unit Background : C and ida is an important cause of infections in premature infants . Gastrointestinal colonization with C and ida is a common site of entry for disseminated disease . The objective of this study was to determine whether a dietary supplement of medium-chain triglycerides ( MCTs ) reduces C and ida colonization in preterm infants . Methods : Preterm infants with C and ida colonization ( n = 12 ) receiving enteral feedings of either infant formula ( n = 5 ) or breast milk ( n = 7 ) were r and omized to MCT supplementation ( n = 8) or no supplementation ( n = 4 ) . Daily stool sample s were collected to determine fungal burden during a 3-week study period . Infants in the MCT group received supplementation during 1 week of the study period . The primary outcome was fungal burden during the supplementation period as compared with the periods before and after supplementation . Results : Supplementation of MCT led to a marked increase in MCT intake relative to unsupplemented breast milk or formula as measured by capric acid content . In the treatment group , there was a significant reduction in fungal burden during the supplementation period as compared with the period before supplementation ( rate ratio , 0.15 ; P = 0.02 ) , with a significant increase after supplementation was stopped ( rate ratio , 61 ; P < 0.001 ) . Fungal burden in the control group did not show similar changes . Conclusions : Dietary supplementation with MCT may be an effective method to reduce C and ida colonization in preterm infants Background : Feeding preterm infants human  milk has a beneficial effect on the risk of late-onset sepsis ( LOS ) . Due to lack of microbiological st and ards , practice s such as pasteurization of mother ’s own milk differ widely among neonatal intensive care units worldwide . Objectives : To investigate whether pasteurization of mother ’s own milk for very-low-birth-weight ( VLBW ) infants influences the incidence and severity of infection-related outcomes . Methods : In this r and omized controlled trial , preterm infants ( gestational age < 32 weeks and /or birth weight < 1,500 g ) received either raw or pasteurized mother ’s own milk during the first 8 weeks of life . The primary outcome was the incidence of proven LOS . A dose-response relation was verified , i.e. the dependence of the risk of sepsis on the actual and cumulative quantities of mother ’s own milk . Results : This study included 303 VLBW infants ( mean birth weight : 1,276 g ; mean gestational age : 29 weeks ) whose baseline and nutritional characteristics were similar . The incidence of laboratory-confirmed sepsis was not statistically different in infants fed raw milk compared to infants who received pasteurized milk : 22/151 ( 0.15 , CI : 0.08–0.20 ) and 31/152 ( 0.20 , CI : 0.14–0.27 ) , respectively ( RR : 0.71 ; 95 % CI : 0.43–1.17 ) . A significant dose-response relation was observed between the adjusted quantity of enteral feeding and the risk of LOS , regardless of the type of feeding . Conclusion : For preterm infants , pasteurization of mother ’s own milk shows a trend towards an increase in infectious morbidity , although no statistical significance was reached . Practice s should focus on collection , storage and labeling procedures to ensure the safety and quality of expressed milk BACKGROUND Zinc plays a pivotal role in the pathogenesis of many diseases and in body growth . Preterm neonates have high zinc requirements . OBJECTIVE The objective of the study was to investigate the efficacy of zinc supplementation in reducing morbidity and mortality in preterm neonates and to promote growth . DESIGN This was a prospect i ve , double-blind , r and omized controlled study of very-low-birth-weight preterm neonates r and omly allocated on the seventh day of life to receive ( zinc group ) or not receive ( control group ) oral zinc supplementation . Total prescribed zinc intake ranged from 9.7 to 10.7 mg/d in the zinc group and from 1.3 to 1.4 mg/d in the placebo control group . The main endpoint was the rate of neonates with ≥ 1 of the following morbidities : late-onset sepsis , necrotizing enterocolitis , bronchopulmonary dysplasia , periventricular leucomalacia , and retinopathy of prematurity . Secondary outcomes were mortality and body growth . RESULTS We enrolled 97 neonates in the zinc group and 96 in the control group .  Morbidities were significantly lower in the zinc group ( 26.8 % compared with 41.7 % ; P = 0.030 ) . The occurrence of necrotizing enterocolitis was significantly higher in the control group ( 6.3 % compared with 0 % ; P = 0.014 ) . Mortality risk was higher in the placebo control group ( RR : 2.37 ; 95 % CI : 1.08 , 5.18 ; P = 0.006 ) . Daily weight gain was similar in the zinc ( 18.2 ± 5.6 g · kg⁻¹ · d⁻¹ ) and control ( 17.0 ± 8.7 g · kg⁻¹ · d⁻¹ ) groups ( P = 0.478 ) . CONCLUSION Oral zinc supplementation given at high doses reduces morbidities and mortality in preterm neonates . This trial was registered in the Australian New Zeal and Clinical Trial Register as ACTRN12612000823875 OBJECTIVE To evaluate the health benefits of an exclusively human milk-based diet compared with a diet of both human milk and bovine milk-based products in extremely premature infants . STUDY DESIGN Infants fed their own mothers ' milk were r and omized to 1 of 3 study groups . Groups HM100 and HM40 received pasteurized donor human milk-based human milk fortifier when the enteral intake was 100 and 40 mL/kg/d , respectively , and both groups received pasteurized donor human milk if no mother 's milk was available . Group BOV received bovine milk-based human milk fortifier when the enteral intake was 100 mL/kg/d and preterm formula if no mother 's milk was available . Outcomes included duration of parenteral nutrition , morbidity , and growth . RESULTS The 3 groups ( total n = 207 infants ) had similar baseline demographic variables , duration of parenteral nutrition , rates of late-onset sepsis , and growth . The groups receiving an exclusively human milk diet had significantly lower rates of necrotizing enterocolitis ( NEC ; P = .02 ) and NEC requiring surgical intervention ( P = .007 ) . CONCLUSIONS For extremely premature infants , an exclusively human milk-based diet is associated with significantly lower rates of NEC and surgical NEC when compared with a mother 's milk-based diet that also includes bovine milk-based products BACKGROUND Colonization by C and ida species is the most important predictor of the development of invasive fungal disease in preterm neonates , and the enteric reservoir is a major site of colonization . We evaluated the effectiveness of an orally supplemented probiotic ( Lactobacillus casei subspecies rhamnosus ; Dicoflor [ Dicofarm spa ] ; 6 x 10(9 ) cfu/day ) in the prevention of gastrointestinal colonization by C and ida species in preterm , very low birth weight ( i.e. , < 1500-g ) neonates during their stay in a neonatal intensive care unit . METHODS Over a 12-month period , a prospect i ve , r and omized , blind , clinical trial that involved 80 preterm neonates with a very low birth weight was conducted in a large tertiary neonatal intensive care unit . During the first 3 days of life , the neonates were r and omly assigned to receive either an oral probiotic added to human ( maternal or pooled donors ' ) milk ( group A ) or human milk alone ( group B ) for 6 weeks or until discharge from the NICU , if the neonate was discharged before 6 weeks . On a weekly basis , specimens obtained from various sites ( i.e. , oropharyngeal , stool , gastric aspirate , and rectal specimens ) were collected from all patients for surveillance culture , to assess the occurrence and intensity of fungal colonization in the gastrointestinal tract . RESULTS The incidence of fungal enteric colonization ( with colonization defined as at least 1 positive culture result for specimens obtained from at least 1 site ) was significantly lower in group A than in group B ( 23.1 % vs. 48.8 % ; relative risk , 0.315 [ 95 % confidence interval , 0.120 - 0.826 ] ; P = .01 ) . The numbers of fungal isolates obtained from each neonate ( P = .005 ) and from each colonized patient ( P = .005 ) were also lower in group A than in group B. L. casei subspecies rhamnosus was more effective in the subgroup of neonates with a birth weight of 1001 - 1500 g. There were no changes in the relative proportions of the different C and ida strains . No adverse effects potentially associated with the probiotic were recorded . CONCLUSIONS Orally administered L. casei subspecies rhamnosus significantly reduces the incidence and the intensity of enteric colonization by C and ida species among very low birth weight neonates OBJECTIVES To determine whether supplementation with L -arginine reduces the incidence of all stages of necrotizing enterocolitis ( NEC ) in premature infants with birth weight < or = 1250 g and gestational age < or = 32 weeks . STUDY DESIGN In a r and omized , double-blind , placebo-controlled study , 152 premature infants were prospect ively , r and omly assigned to receive either supplemental L -arginine ( 1.5 mmol/kg per day ; n = 75 [ group A ] ) or placebo ( control group ; n = 77 [ group B ] ) with oral feeds/parenteral nutrition during the first 28 days of life . Nutrient intake , plasma ammonia , arginine , and amino acid concentrations were measured in all infants at days 3 , 14 , and 28 and at the time of diagnosis of NEC . RESULTS NEC developed in 5 infants in group A compared with 21 infants in group B ( P < .001 ) . Arginine intake and plasma arginine concentrations were similar in both groups at study entry and ( as expected ) increased in group A at days 14 and 28 . Plasma arginine concentrations were lower in both groups at time of diagnosis of NEC . No significant differences in maternal and neonatal demographics , nutrient intake , plasma ammonia and total and essential amino acid concentrations were present between the two groups . CONCLUSIONS Arginine supplementation ( 1.5 mmol/kg per day ) in premature infants reduces the incidence of all stages of NEC OBJECTIVE To test the efficacy of probiotic and prebiotic , alone or combined ( synbiotic ) , on the prevention of necrotizing enterocolitis ( NEC ) in very low birth weight ( VLBW ) infants . STUDY DESIGN A prospect i ve , r and omized , controlled trial was conducted at 5 neonatal intensive care units in Turkey . VLBW infants ( n = 400 ) were assigned to a control group and 3 study groups that were given probiotic ( Bifidobacterium lactis ) , prebiotic ( inulin ) , or synbiotic ( Bifidobacterium lactis plus inulin ) added to breastmilk or formula for a maximum of 8 weeks before discharge or death . The primary outcome was NEC ( Bell stage ≥2 ) . RESULTS The rate of NEC was lower in probiotic ( 2.0 % ) and synbiotic ( 4.0 % ) groups compared with prebiotic 
    Output:
    
agent
In RCTs , pasteurized human donor milk , as opposed to formula , reduced NEC but not infections or mortality .
Pooled data of small trials and a recent large RCT suggested that bovine lactoferrin reduced rates of fungal sepsis without impact on other infections , NEC , or mortality .
Pooled data of RCTs assessing the use of prebiotic oligosaccharides found reduced infection but not mortality .
A meta- analysis sensitivity approach found multiple-strain ( but not single-strain ) probiotics to be highly effective in reducing NEC and mortality .
Thus , selected food components may help to improve outcomes in preterm infants
***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: OBJECTIVE To compare the duration of parenteral nutrition , growth , and morbidity in extremely premature infants fed exclusive diets of either bovine milk-based preterm formula ( BOV ) or donor human milk and human milk-based human milk fortifier ( HUM )  , in a r and omized trial of formula vs human milk . STUDY DESIGN Multicenter r and omized controlled trial . The authors studied extremely preterm infants whose mothers did not provide their milk . Infants were fed either BOV or an exclusive human milk diet of pasteurized donor human milk and HUM . The major outcome was duration of parenteral nutrition . Secondary outcomes were growth , respiratory support , and necrotizing enterocolitis ( NEC ) . RESULTS Birth weight ( 983 vs 996 g ) and  gestational age ( 27.5 vs 27.7 wk ) , in BOV and HUM , respectively , were similar . There was a significant difference in median parenteral nutrition days : 36 vs 27 , in BOV vs HUM , respectively ( P = .04 ) . The incidence of NEC in BOV was 21 % ( 5 cases ) vs 3 % in HUM ( 1 case ) , P = .08 ; surgical NEC was significantly higher in BOV ( 4 cases ) than HUM ( 0 cases ) , P = .04 . CONCLUSIONS In extremely preterm infants given exclusive diets of preterm formula vs human milk , there was a significantly greater duration of parenteral nutrition and higher rate of surgical NEC in infants receiving preterm formula . This trial supports the use of an exclusive human milk diet to nourish extremely preterm infants in the neonatal intensive care unit Background : C and ida is an important cause of infections in premature infants . Gastrointestinal colonization with C and ida is a common site of entry for disseminated disease . The objective of this study was to determine whether a dietary supplement of medium-chain triglycerides ( MCTs ) reduces C and ida colonization in preterm infants . Methods : Preterm infants with C and ida colonization ( n = 12 ) receiving enteral feedings of either infant formula ( n = 5 ) or breast milk ( n = 7 ) were r and omized to MCT supplementation ( n = 8) or no supplementation ( n = 4 ) . Daily stool sample s were collected to determine fungal burden during a 3-week study period . Infants in the MCT group received supplementation during 1 week of the study period . The primary outcome was fungal burden during the supplementation period as compared with the periods before and after supplementation . Results : Supplementation of MCT led to a marked increase in MCT intake relative to unsupplemented breast milk or formula as measured by capric acid content . In the treatment group , there was a significant reduction in fungal burden during the supplementation period as compared with the period before supplementation ( rate ratio , 0.15 ; P = 0.02 ) , with a significant increase after supplementation was stopped ( rate ratio , 61 ; P < 0.001 ) . Fungal burden in the control group did not show similar changes . Conclusions : Dietary supplementation with MCT may be an effective method to reduce C and ida colonization in preterm infants Background : Feeding preterm infants human  milk has a beneficial effect on the risk of late-onset sepsis ( LOS ) . Due to lack of microbiological st and ards , practice s such as pasteurization of mother ’s own milk differ widely among neonatal intensive care units worldwide . Objectives : To investigate whether pasteurization of mother ’s own milk for very-low-birth-weight ( VLBW ) infants influences the incidence and severity of infection-related outcomes . Methods : In this r and omized controlled trial , preterm infants ( gestational age < 32 weeks and /or birth weight < 1,500 g ) received either raw or pasteurized mother ’s own milk during the first 8 weeks of life . The primary outcome was the incidence of proven LOS . A dose-response relation was verified , i.e. the dependence of the risk of sepsis on the actual and cumulative quantities of mother ’s own milk . Results : This study included 303 VLBW infants ( mean birth weight : 1,276 g ; mean gestational age : 29 weeks ) whose baseline and nutritional characteristics were similar . The incidence of laboratory-confirmed sepsis was not statistically different in infants fed raw milk compared to infants who received pasteurized milk : 22/151 ( 0.15 , CI : 0.08–0.20 ) and 31/152 ( 0.20 , CI : 0.14–0.27 ) , respectively ( RR : 0.71 ; 95 % CI : 0.43–1.17 ) . A significant dose-response relation was observed between the adjusted quantity of enteral feeding and the risk of LOS , regardless of the type of feeding . Conclusion : For preterm infants , pasteurization of mother ’s own milk shows a trend towards an increase in infectious morbidity , although no statistical significance was reached . Practice s should focus on collection , storage and labeling procedures to ensure the safety and quality of expressed milk BACKGROUND Zinc plays a pivotal role in the pathogenesis of many diseases and in body growth . Preterm neonates have high zinc requirements . OBJECTIVE The objective of the study was to investigate the efficacy of zinc supplementation in reducing morbidity and mortality in preterm neonates and to promote growth . DESIGN This was a prospect i ve , double-blind , r and omized controlled study of very-low-birth-weight preterm neonates r and omly allocated on the seventh day of life to receive ( zinc group ) or not receive ( control group ) oral zinc supplementation . Total prescribed zinc intake ranged from 9.7 to 10.7 mg/d in the zinc group and from 1.3 to 1.4 mg/d in the placebo control group . The main endpoint was the rate of neonates with ≥ 1 of the following morbidities : late-onset sepsis , necrotizing enterocolitis , bronchopulmonary dysplasia , periventricular leucomalacia , and retinopathy of prematurity . Secondary outcomes were mortality and body growth . RESULTS We enrolled 97 neonates in the zinc group and 96 in the control group .  Morbidities were significantly lower in the zinc group ( 26.8 % compared with 41.7 % ; P = 0.030 ) . The occurrence of necrotizing enterocolitis was significantly higher in the control group ( 6.3 % compared with 0 % ; P = 0.014 ) . Mortality risk was higher in the placebo control group ( RR : 2.37 ; 95 % CI : 1.08 , 5.18 ; P = 0.006 ) . Daily weight gain was similar in the zinc ( 18.2 ± 5.6 g · kg⁻¹ · d⁻¹ ) and control ( 17.0 ± 8.7 g · kg⁻¹ · d⁻¹ ) groups ( P = 0.478 ) . CONCLUSION Oral zinc supplementation given at high doses reduces morbidities and mortality in preterm neonates . This trial was registered in the Australian New Zeal and Clinical Trial Register as ACTRN12612000823875 OBJECTIVE To evaluate the health benefits of an exclusively human milk-based diet compared with a diet of both human milk and bovine milk-based products in extremely premature infants . STUDY DESIGN Infants fed their own mothers ' milk were r and omized to 1 of 3 study groups . Groups HM100 and HM40 received pasteurized donor human milk-based human milk fortifier when the enteral intake was 100 and 40 mL/kg/d , respectively , and both groups received pasteurized donor human milk if no mother 's milk was available . Group BOV received bovine milk-based human milk fortifier when the enteral intake was 100 mL/kg/d and preterm formula if no mother 's milk was available . Outcomes included duration of parenteral nutrition , morbidity , and growth . RESULTS The 3 groups ( total n = 207 infants ) had similar baseline demographic variables , duration of parenteral nutrition , rates of late-onset sepsis , and growth . The groups receiving an exclusively human milk diet had significantly lower rates of necrotizing enterocolitis ( NEC ; P = .02 ) and NEC requiring surgical intervention ( P = .007 ) . CONCLUSIONS For extremely premature infants , an exclusively human milk-based diet is associated with significantly lower rates of NEC and surgical NEC when compared with a mother 's milk-based diet that also includes bovine milk-based products BACKGROUND Colonization by C and ida species is the most important predictor of the development of invasive fungal disease in preterm neonates , and the enteric reservoir is a major site of colonization . We evaluated the effectiveness of an orally supplemented probiotic ( Lactobacillus casei subspecies rhamnosus ; Dicoflor [ Dicofarm spa ] ; 6 x 10(9 ) cfu/day ) in the prevention of gastrointestinal colonization by C and ida species in preterm , very low birth weight ( i.e. , < 1500-g ) neonates during their stay in a neonatal intensive care unit . METHODS Over a 12-month period , a prospect i ve , r and omized , blind , clinical trial that involved 80 preterm neonates with a very low birth weight was conducted in a large tertiary neonatal intensive care unit . During the first 3 days of life , the neonates were r and omly assigned to receive either an oral probiotic added to human ( maternal or pooled donors ' ) milk ( group A ) or human milk alone ( group B ) for 6 weeks or until discharge from the NICU , if the neonate was discharged before 6 weeks . On a weekly basis , specimens obtained from various sites ( i.e. , oropharyngeal , stool , gastric aspirate , and rectal specimens ) were collected from all patients for surveillance culture , to assess the occurrence and intensity of fungal colonization in the gastrointestinal tract . RESULTS The incidence of fungal enteric colonization ( with colonization defined as at least 1 positive culture result for specimens obtained from at least 1 site ) was significantly lower in group A than in group B ( 23.1 % vs. 48.8 % ; relative risk , 0.315 [ 95 % confidence interval , 0.120 - 0.826 ] ; P = .01 ) . The numbers of fungal isolates obtained from each neonate ( P = .005 ) and from each colonized patient ( P = .005 ) were also lower in group A than in group B. L. casei subspecies rhamnosus was more effective in the subgroup of neonates with a birth weight of 1001 - 1500 g. There were no changes in the relative proportions of the different C and ida strains . No adverse effects potentially associated with the probiotic were recorded . CONCLUSIONS Orally administered L. casei subspecies rhamnosus significantly reduces the incidence and the intensity of enteric colonization by C and ida species among very low birth weight neonates OBJECTIVES To determine whether supplementation with L -arginine reduces the incidence of all stages of necrotizing enterocolitis ( NEC ) in premature infants with birth weight < or = 1250 g and gestational age < or = 32 weeks . STUDY DESIGN In a r and omized , double-blind , placebo-controlled study , 152 premature infants were prospect ively , r and omly assigned to receive either supplemental L -arginine ( 1.5 mmol/kg per day ; n = 75 [ group A ] ) or placebo ( control group ; n = 77 [ group B ] ) with oral feeds/parenteral nutrition during the first 28 days of life . Nutrient intake , plasma ammonia , arginine , and amino acid concentrations were measured in all infants at days 3 , 14 , and 28 and at the time of diagnosis of NEC . RESULTS NEC developed in 5 infants in group A compared with 21 infants in group B ( P < .001 ) . Arginine intake and plasma arginine concentrations were similar in both groups at study entry and ( as expected ) increased in group A at days 14 and 28 . Plasma arginine concentrations were lower in both groups at time of diagnosis of NEC . No significant differences in maternal and neonatal demographics , nutrient intake , plasma ammonia and total and essential amino acid concentrations were present between the two groups . CONCLUSIONS Arginine supplementation ( 1.5 mmol/kg per day ) in premature infants reduces the incidence of all stages of NEC OBJECTIVE To test the efficacy of probiotic and prebiotic , alone or combined ( synbiotic ) , on the prevention of necrotizing enterocolitis ( NEC ) in very low birth weight ( VLBW ) infants . STUDY DESIGN A prospect i ve , r and omized , controlled trial was conducted at 5 neonatal intensive care units in Turkey . VLBW infants ( n = 400 ) were assigned to a control group and 3 study groups that were given probiotic ( Bifidobacterium lactis ) , prebiotic ( inulin ) , or synbiotic ( Bifidobacterium lactis plus inulin ) added to breastmilk or formula for a maximum of 8 weeks before discharge or death . The primary outcome was NEC ( Bell stage ≥2 ) . RESULTS The rate of NEC was lower in probiotic ( 2.0 % ) and synbiotic ( 4.0 % ) groups compared with prebiotic 
    Output:
    