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: Fifty nine infants of birthweight less than 1500 g were allocated alternately to initial total parenteral nutrition or to transpyloric feeding .  Mortality was similar between the two groups . Ten of the 29 infants in the transpyloric group failed to establish full enteral nutrition during the first week of life . No beneficial effects on growth were shown in infants receiving parenteral nutrition . Acquired bacterial infection was higher in the parenteral group and associated with morbidity and mortality . Conjugated hyperbilirubinaemia occurred only in the parenterally fed infants . The incidence of necrotising enterocolitis was higher in the transpyloric group . Parenteral nutrition does not confer any appreciable benefit and because of greater complexity and higher risk of complications should be reserved for those infants in whom enteral feeding is impossible BACKGROUND : Growth-restricted preterm infants are at increased risk of developing necrotizing enterocolitis ( NEC ) and initiation of enteral feeding is frequently delayed . There is no evidence that this delay is beneficial and it might further compromise nutrition and growth . METHODS : Infants with gestation below 35 weeks , birth weight below the 10th centile , and abnormal antenatal umbilical artery Doppler waveforms were r and omly allocated to commence enteral feeds “ early , ” on day 2 after birth , or “ late , ” on day 6 . Gradual increase in feeds was guided by a “ feeding prescription ” with rate of increase the same for both groups . Primary outcomes were time to achieve full enteral feeding sustained for 72 hours and NEC . RESULTS : Four hundred four infants were r and omly assigned from 54 hospitals in the United Kingdom and Irel and ( 202 to each group ) . Median gestation was 31 weeks . Full , sustained , enteral feeding was achieved at an earlier age in the early group : median age was 18 days compared with 21 days ( hazard ratio : 1.36 [ 95 % confidence interval : 1.11–1.67 ] ) . There was no evidence of a difference in the incidence of NEC : 18 % in the early group and 15 % in the late group ( relative risk : 1.2 [ 95 % confidence interval : 0.77–1.87 ] ) . Early feeding result ed in shorter duration of parenteral nutrition and high-dependency care , lower incidence of cholestatic jaundice , and improved SD score for weight at discharge . CONCLUSIONS : Early introduction of enteral feeds in growth-restricted preterm infants results in earlier achievement of full enteral feeding and does not appear to increase the risk of NEC Background Pregnancies complicated by abnormal umbilical artery Doppler blood flow patterns often result in the baby being born both preterm and growth-restricted . These babies are at high risk of milk intolerance and necrotising enterocolitis , as well as post-natal growth failure , and there is no clinical consensus about how best to feed them . Policies of both early milk feeding and late milk feeding are widely used . This r and omised controlled trial aims to determine whether a policy of early initiation of milk feeds is beneficial compared with late initiation . Optimising neonatal feeding for this group of babies may have long-term health implication s and if either of these policies is shown to be beneficial it can be immediately adopted into clinical practice . Methods and Design Babies with gestational age below 35 weeks , and with birth weight below 10th centile for gestational age , will be r and omly allocated to an " early " or " late " enteral feeding regimen , commencing milk feeds on day 2 and day 6 after birth , respectively . Feeds will be gradually increased over 9 - 13 days ( depending on gestational age ) using a schedule derived from those used in hospitals in the Eastern and South Western Regions of Engl and , based on surveys of feeding practice . Primary outcome measures are time to establish full enteral feeding and necrotising enterocolitis ; secondary outcomes include sepsis and growth .  The target sample size is 400 babies . This sample size is large enough to detect a clinical ly meaningful difference of 3 days in time to establish full enteral feeds between the two feeding policies , with 90 % power and a 5 % 2-sided significance level . Initial recruitment period was 24 months , subsequently extended to 38 months . Discussion There is limited evidence from r and omised controlled trials on which to base decisions regarding feeding policy in high risk preterm infants . This multicentre trial will help to guide clinical practice and may also provide pointers for future research .Trial registration Current Controlled Trials IS RCT N : BACKGROUND Evidence -based practice guidelines for aggressive nutritional intervention by using parenteral amino acids ( AAs ) and minimal enteral feeding ( MEF ) as early as the first day of life have not been tested for benefits to bone mass . OBJECTIVE We investigated whether early introduction of parenteral AAs and MEF improves growth and bone mass achieved by term age in infants born prematurely . DESIGN Twenty-seven infants who were < or = 1200 g and < or = 32 wk gestation at birth were r and omly assigned by using a 2 x 2 design to treatment of either 1 g AAs/kg within the first 24 h or 12 mL MEF x kg(-1 ) x d(-1 ) within the first 72 h of life . Nutrition and growth were documented during hospitalization , and bone mineral content ( BMC ) of lumbar spine 1 - 4 , femur , and whole body was measured at term age . Biomarkers of bone metabolism were measured at weeks 1 , 3 , and 5 and at discharge . Statistical analysis was conducted by using 2 x 2 analysis of variance for intent to treat and for infants receiving protocol nutrition . RESULTS Over the first 14 d of life , a main effect of early AAs elevated total intake of protein , and a main effect of early MEF was a higher frequency of MEF volumes exceeding > 12 mL x kg(-1 ) x d(-1 ) . Main effects on growth were not evident . An interaction effect was observed for osteocalcin whereby early AAs or MEF alone elevated osteocalcin . A main effect of early MEF yielded higher BMC of spine and femur . CONCLUSION Early aggressive nutrition support with MEF enhances BMC in premature infants , but early MEF or AAs do not improve growth INTRODUCTION The development of necrotizing enterocolitis is a common and serious risk to newborns . It is caused by splanchnic bed vasoconstriction that can produce intestinal necrosis . The role of onset time , type and , speed enhancements of The factors of enteral feeding related with necrotizing enterocolitis genesis such as feeding onset , type and frequency are not well understood . OBJECTIVE The incidence of necrotizing enterocolitis and mortality among infants will be compared in infants whose enteral feeding was initiated 48 hours after birth to those whose feeding began on day 5 postpartum . MATERIAL S AND METHODS A controlled clinical trial was conducted among 239 newborns weighing between 750 - 1,500 g and a gestation age of 27 - 32 weeks of gestational age . The infants were r and omly assigned to two groups--135 to an early feeding regime and 104 to delayed feeding . Breast milk or formula milk was used . Feeding was begun with one ml every six hours , progressing to three hour intervals and 20 ml/kg daily . This was increased to 150 ml/kg-d if the infant condition remained stable and it manifested no oral intolerance . RESULTS In the early feeding group , 14 ( 10;4 % ) necrotizing enterocolitis cases occurred , and in the late feeding group , 9 ( 8.7 % ) occurred ( RR= 1.22 , 95 % CI 0.49 - 3.20 , p= 0.65 ) . Five children died in early feeding group ( 3.7 % , 95 % CI 1.4 - 8.9 ) and eight in late feeding group ( 7.7 % , 95 % CI 3.6 - 15.0 , RR=0.46 , 95 % CI 0.12 - 1,60 , p= 0.18 ) . CONCLUSION Early enteral feeding in preterm newborns does not increase the risk of necrotizing enterocolitis or mortality among them ; however it represents nutritional advantages for these infants We studied the effect of early ( < or = 5 days ) versus delayed ( > or = 6 days ) initiation of minimal enteral feeding ( MEF ) on the incidence of necrotizing enterocolitis ( NEC ) and feeding intolerance in preterm infants with intrauterine growth restriction ( IUGR ) and abnormal antenatal Doppler results . We performed a r and omized , nonblinded pilot trial of infants receiving early or delayed MEF in addition to parenteral feeding within 48 hours of life .  Demographic data , maternal preeclampsia , antenatal steroid exposure , Doppler studies , as well as cases of NEC and feeding intolerance were all recorded . Of the 84 infants enrolled , 81 completed the study : 40 received early ( median age : 2 days , range : 1 to 5 days ) and 41 delayed ( median age : 7 days , range : 6 to 14 days ) MEF . The incidence of NEC and feeding intolerance was not significantly different between groups ( p = 0.353 and p = 0.533 , respectively ) . Birth weight was an independent risk factor for NEC in both groups . Early MEF of preterm infants with IUGR and abnormal antenatal Doppler results may not have a significant effect on the incidence of NEC or feeding intolerance . Furthermore , birth weight seems to be an independent risk factor for the development of NEC , irrespectively of the timing of MEF introduction Objective To describe feeding and gastrointestinal outcomes in growth-restricted infants < 29 weeks ’ gestation and to determine the rate of feed advancement which they tolerate . Design Analysis of prospect ively collected data from a r and omised feeding trial , the Abnormal Doppler Enteral Prescription Trial ( ADEPT ) . Setting 54 neonatal units in the UK and Irel and . Participants 404 preterm , growth-restricted infants with abnormal antenatal Doppler studies from ADEPT . 83 infants < 29 weeks and 312 infants ≥29 weeks ’ gestation were included in this analysis . Interventions In ADEPT , infants were r and omised to start milk ‘ early ’ on day 2 after birth , or ‘ late ’ on day 6 . Subsequent feed advancement followed a regimen , which should have achieved full feeds by day 16 in the early and day 20 in the late group . Main outcome measures Full feeds were achieved later in infants < 29 weeks ; median age 28 days { IQR 22–40 } compared with 19 days { IQR 17–23 } in infants ≥29 weeks ( HR 0.35 , 95 % CI 0.3 to 0.5 ) . The incidence of necrotising enterocolitis was also higher in this group ; 32/83 ( 39 % ) compared to 32/312 ( 10 % ) in those ≥29 weeks ( RR 3.7 , 95 % CI 2.4 to 5.7 ) . Infants < 29 weeks tolerated very little milk for the first 10 days of life and reached full feeds 9 days later than predicted from the trial regimen . Conclusions Growth-restricted infants born < 29 weeks ’ gestation with abnormal antenatal Doppler failed to tolerate even the careful feeding regimen of ADEPT . A slower advancement of feeds may be required for these infants . Trial registration number IS RCT N87351483 OBJECTIVES : Infants who develop encephalopathy after perinatal asphyxia have an increased risk of death and adverse neurologic outcome . Conflicting results exist concerning outcome in healthy infants with metabolic acidosis at birth . The aim of the current study was to evaluate whether metabolic acidosis at birth in term infants who appear healthy is associated with long-term developmental abnormalities . METHODS : From a population -based cohort ( 14 687 deliveries ) , 78 infants were prospect ively identified as having metabolic acidosis ( umbilical artery pH < 7.05 and base deficit in the extracellular fluid > 12.0 mmol/L ) . Two matched controls per case were selected . The child health and school health care records were scrutinized for developmental abnormalities . RESULTS : Outcome measures at 6.5 years of age for 227 of 234 children ( 97 % ) were obtained . No differences were found concerning neurologic or behavioral problems in need of referral action or neurodevelopmental diagnosis in comparison of control children with acidotic children who had appeared healthy at birth , ie , had not required special neonatal care or had no signs of encephalopathy . CONCLUSIONS : Infants born with cord metabolic acidosis and who appear well do not have an increased risk for neurologic or behavioral problems in need of referral actions or special teaching approaches at the age of 6.5 years Background : The interrelations between early enteral feeding , necrotising enterocolitis ( NEC ) , and nosocomial sepsis ( NS ) remain unclear . Objective : To evaluate the effect of age at the introduction of enteral feeding on the incidence of NS and NEC in very low birthweight ( VLBW < 1500 g ) infants . Methods : Data were collected on the pattern of enteral feeding  and perinatal and neonatal morbidity on all VLBW infants born in one centre during 1 
    Output:
    
agent
The evidence available from r and omised controlled trials suggested that delaying the introduction of progressive enteral feeds beyond four days after birth did not reduce the risk of developing NEC in very preterm or VLBW infants , including growth-restricted infants .
Delaying the introduction of progressive enteral feeds result ed in a few days ' delay in establishing full enteral feeds but the clinical importance of this effect was unclear .
***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: Fifty nine infants of birthweight less than 1500 g were allocated alternately to initial total parenteral nutrition or to transpyloric feeding .  Mortality was similar between the two groups . Ten of the 29 infants in the transpyloric group failed to establish full enteral nutrition during the first week of life . No beneficial effects on growth were shown in infants receiving parenteral nutrition . Acquired bacterial infection was higher in the parenteral group and associated with morbidity and mortality . Conjugated hyperbilirubinaemia occurred only in the parenterally fed infants . The incidence of necrotising enterocolitis was higher in the transpyloric group . Parenteral nutrition does not confer any appreciable benefit and because of greater complexity and higher risk of complications should be reserved for those infants in whom enteral feeding is impossible BACKGROUND : Growth-restricted preterm infants are at increased risk of developing necrotizing enterocolitis ( NEC ) and initiation of enteral feeding is frequently delayed . There is no evidence that this delay is beneficial and it might further compromise nutrition and growth . METHODS : Infants with gestation below 35 weeks , birth weight below the 10th centile , and abnormal antenatal umbilical artery Doppler waveforms were r and omly allocated to commence enteral feeds “ early , ” on day 2 after birth , or “ late , ” on day 6 . Gradual increase in feeds was guided by a “ feeding prescription ” with rate of increase the same for both groups . Primary outcomes were time to achieve full enteral feeding sustained for 72 hours and NEC . RESULTS : Four hundred four infants were r and omly assigned from 54 hospitals in the United Kingdom and Irel and ( 202 to each group ) . Median gestation was 31 weeks . Full , sustained , enteral feeding was achieved at an earlier age in the early group : median age was 18 days compared with 21 days ( hazard ratio : 1.36 [ 95 % confidence interval : 1.11–1.67 ] ) . There was no evidence of a difference in the incidence of NEC : 18 % in the early group and 15 % in the late group ( relative risk : 1.2 [ 95 % confidence interval : 0.77–1.87 ] ) . Early feeding result ed in shorter duration of parenteral nutrition and high-dependency care , lower incidence of cholestatic jaundice , and improved SD score for weight at discharge . CONCLUSIONS : Early introduction of enteral feeds in growth-restricted preterm infants results in earlier achievement of full enteral feeding and does not appear to increase the risk of NEC Background Pregnancies complicated by abnormal umbilical artery Doppler blood flow patterns often result in the baby being born both preterm and growth-restricted . These babies are at high risk of milk intolerance and necrotising enterocolitis , as well as post-natal growth failure , and there is no clinical consensus about how best to feed them . Policies of both early milk feeding and late milk feeding are widely used . This r and omised controlled trial aims to determine whether a policy of early initiation of milk feeds is beneficial compared with late initiation . Optimising neonatal feeding for this group of babies may have long-term health implication s and if either of these policies is shown to be beneficial it can be immediately adopted into clinical practice . Methods and Design Babies with gestational age below 35 weeks , and with birth weight below 10th centile for gestational age , will be r and omly allocated to an " early " or " late " enteral feeding regimen , commencing milk feeds on day 2 and day 6 after birth , respectively . Feeds will be gradually increased over 9 - 13 days ( depending on gestational age ) using a schedule derived from those used in hospitals in the Eastern and South Western Regions of Engl and , based on surveys of feeding practice . Primary outcome measures are time to establish full enteral feeding and necrotising enterocolitis ; secondary outcomes include sepsis and growth .  The target sample size is 400 babies . This sample size is large enough to detect a clinical ly meaningful difference of 3 days in time to establish full enteral feeds between the two feeding policies , with 90 % power and a 5 % 2-sided significance level . Initial recruitment period was 24 months , subsequently extended to 38 months . Discussion There is limited evidence from r and omised controlled trials on which to base decisions regarding feeding policy in high risk preterm infants . This multicentre trial will help to guide clinical practice and may also provide pointers for future research .Trial registration Current Controlled Trials IS RCT N : BACKGROUND Evidence -based practice guidelines for aggressive nutritional intervention by using parenteral amino acids ( AAs ) and minimal enteral feeding ( MEF ) as early as the first day of life have not been tested for benefits to bone mass . OBJECTIVE We investigated whether early introduction of parenteral AAs and MEF improves growth and bone mass achieved by term age in infants born prematurely . DESIGN Twenty-seven infants who were < or = 1200 g and < or = 32 wk gestation at birth were r and omly assigned by using a 2 x 2 design to treatment of either 1 g AAs/kg within the first 24 h or 12 mL MEF x kg(-1 ) x d(-1 ) within the first 72 h of life . Nutrition and growth were documented during hospitalization , and bone mineral content ( BMC ) of lumbar spine 1 - 4 , femur , and whole body was measured at term age . Biomarkers of bone metabolism were measured at weeks 1 , 3 , and 5 and at discharge . Statistical analysis was conducted by using 2 x 2 analysis of variance for intent to treat and for infants receiving protocol nutrition . RESULTS Over the first 14 d of life , a main effect of early AAs elevated total intake of protein , and a main effect of early MEF was a higher frequency of MEF volumes exceeding > 12 mL x kg(-1 ) x d(-1 ) . Main effects on growth were not evident . An interaction effect was observed for osteocalcin whereby early AAs or MEF alone elevated osteocalcin . A main effect of early MEF yielded higher BMC of spine and femur . CONCLUSION Early aggressive nutrition support with MEF enhances BMC in premature infants , but early MEF or AAs do not improve growth INTRODUCTION The development of necrotizing enterocolitis is a common and serious risk to newborns . It is caused by splanchnic bed vasoconstriction that can produce intestinal necrosis . The role of onset time , type and , speed enhancements of The factors of enteral feeding related with necrotizing enterocolitis genesis such as feeding onset , type and frequency are not well understood . OBJECTIVE The incidence of necrotizing enterocolitis and mortality among infants will be compared in infants whose enteral feeding was initiated 48 hours after birth to those whose feeding began on day 5 postpartum . MATERIAL S AND METHODS A controlled clinical trial was conducted among 239 newborns weighing between 750 - 1,500 g and a gestation age of 27 - 32 weeks of gestational age . The infants were r and omly assigned to two groups--135 to an early feeding regime and 104 to delayed feeding . Breast milk or formula milk was used . Feeding was begun with one ml every six hours , progressing to three hour intervals and 20 ml/kg daily . This was increased to 150 ml/kg-d if the infant condition remained stable and it manifested no oral intolerance . RESULTS In the early feeding group , 14 ( 10;4 % ) necrotizing enterocolitis cases occurred , and in the late feeding group , 9 ( 8.7 % ) occurred ( RR= 1.22 , 95 % CI 0.49 - 3.20 , p= 0.65 ) . Five children died in early feeding group ( 3.7 % , 95 % CI 1.4 - 8.9 ) and eight in late feeding group ( 7.7 % , 95 % CI 3.6 - 15.0 , RR=0.46 , 95 % CI 0.12 - 1,60 , p= 0.18 ) . CONCLUSION Early enteral feeding in preterm newborns does not increase the risk of necrotizing enterocolitis or mortality among them ; however it represents nutritional advantages for these infants We studied the effect of early ( < or = 5 days ) versus delayed ( > or = 6 days ) initiation of minimal enteral feeding ( MEF ) on the incidence of necrotizing enterocolitis ( NEC ) and feeding intolerance in preterm infants with intrauterine growth restriction ( IUGR ) and abnormal antenatal Doppler results . We performed a r and omized , nonblinded pilot trial of infants receiving early or delayed MEF in addition to parenteral feeding within 48 hours of life .  Demographic data , maternal preeclampsia , antenatal steroid exposure , Doppler studies , as well as cases of NEC and feeding intolerance were all recorded . Of the 84 infants enrolled , 81 completed the study : 40 received early ( median age : 2 days , range : 1 to 5 days ) and 41 delayed ( median age : 7 days , range : 6 to 14 days ) MEF . The incidence of NEC and feeding intolerance was not significantly different between groups ( p = 0.353 and p = 0.533 , respectively ) . Birth weight was an independent risk factor for NEC in both groups . Early MEF of preterm infants with IUGR and abnormal antenatal Doppler results may not have a significant effect on the incidence of NEC or feeding intolerance . Furthermore , birth weight seems to be an independent risk factor for the development of NEC , irrespectively of the timing of MEF introduction Objective To describe feeding and gastrointestinal outcomes in growth-restricted infants < 29 weeks ’ gestation and to determine the rate of feed advancement which they tolerate . Design Analysis of prospect ively collected data from a r and omised feeding trial , the Abnormal Doppler Enteral Prescription Trial ( ADEPT ) . Setting 54 neonatal units in the UK and Irel and . Participants 404 preterm , growth-restricted infants with abnormal antenatal Doppler studies from ADEPT . 83 infants < 29 weeks and 312 infants ≥29 weeks ’ gestation were included in this analysis . Interventions In ADEPT , infants were r and omised to start milk ‘ early ’ on day 2 after birth , or ‘ late ’ on day 6 . Subsequent feed advancement followed a regimen , which should have achieved full feeds by day 16 in the early and day 20 in the late group . Main outcome measures Full feeds were achieved later in infants < 29 weeks ; median age 28 days { IQR 22–40 } compared with 19 days { IQR 17–23 } in infants ≥29 weeks ( HR 0.35 , 95 % CI 0.3 to 0.5 ) . The incidence of necrotising enterocolitis was also higher in this group ; 32/83 ( 39 % ) compared to 32/312 ( 10 % ) in those ≥29 weeks ( RR 3.7 , 95 % CI 2.4 to 5.7 ) . Infants < 29 weeks tolerated very little milk for the first 10 days of life and reached full feeds 9 days later than predicted from the trial regimen . Conclusions Growth-restricted infants born < 29 weeks ’ gestation with abnormal antenatal Doppler failed to tolerate even the careful feeding regimen of ADEPT . A slower advancement of feeds may be required for these infants . Trial registration number IS RCT N87351483 OBJECTIVES : Infants who develop encephalopathy after perinatal asphyxia have an increased risk of death and adverse neurologic outcome . Conflicting results exist concerning outcome in healthy infants with metabolic acidosis at birth . The aim of the current study was to evaluate whether metabolic acidosis at birth in term infants who appear healthy is associated with long-term developmental abnormalities . METHODS : From a population -based cohort ( 14 687 deliveries ) , 78 infants were prospect ively identified as having metabolic acidosis ( umbilical artery pH < 7.05 and base deficit in the extracellular fluid > 12.0 mmol/L ) . Two matched controls per case were selected . The child health and school health care records were scrutinized for developmental abnormalities . RESULTS : Outcome measures at 6.5 years of age for 227 of 234 children ( 97 % ) were obtained . No differences were found concerning neurologic or behavioral problems in need of referral action or neurodevelopmental diagnosis in comparison of control children with acidotic children who had appeared healthy at birth , ie , had not required special neonatal care or had no signs of encephalopathy . CONCLUSIONS : Infants born with cord metabolic acidosis and who appear well do not have an increased risk for neurologic or behavioral problems in need of referral actions or special teaching approaches at the age of 6.5 years Background : The interrelations between early enteral feeding , necrotising enterocolitis ( NEC ) , and nosocomial sepsis ( NS ) remain unclear . Objective : To evaluate the effect of age at the introduction of enteral feeding on the incidence of NS and NEC in very low birthweight ( VLBW < 1500 g ) infants . Methods : Data were collected on the pattern of enteral feeding  and perinatal and neonatal morbidity on all VLBW infants born in one centre during 1 
    Output:
    