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 : Oral colostrum priming ( OCP ) after birth in preterm infants is associated with improved weight gain and modification of the oral immunomicrobial environment . We hypothesized that OCP would modify salivary immune peptides and the oral microbiota in preterm infants . Study design : We conducted a prospect i ve , r and omized clinical trial to determine the effects of OCP on salivary immune peptide representation in preterm infants ( < 32 weeks completed gestation at birth ) .  Saliva sample s were collected before and after OCP . Salivary immune peptide representation was determined via mass spectroscopy . Oral microbiota representation was determined via sequencing of the 16S rRNA gene . Results : Neonates who received OCP ( n=48 ) had a 16-day reduction in the median length of hospitalization as compared with infants who did not receive OCP ( n=51 ) . No differences in salivary immune peptide sequence representation before OCP between groups were found . Longitudinal changes in peptides were detected ( lysozyme C , immunoglobulin A , lactoferrin ) but were limited to a single peptide difference ( α-defensin 1 ) between primed and unprimed infants after OCP . We found no difference in microbial diversity between treatment groups at any time point , but diversity decreased significantly over time in both groups . OCP treatment marginally modified oral taxa with a decline in abundance of Streptococci in the OCP group at 30 days of life . Conclusions : OCP had neither an effect on the salivary peptides we examined nor on overall oral bacterial diversity and composition . Infants who received OCP had a reduced length of hospitalization and warrants further investigation OBJECTIVE To determine the rates , characteristics , risk factors , and outcomes of ventilator-associated pneumonia ( VAP ) in extremely preterm neonates in a neonatal intensive care unit ( NICU ) . METHODS A prospect i ve cohort study was conducted at the St Louis Children 's Hospital on all patients who had birth weight < or=2000 g and were admitted to the NICU for > or=48 hours from October 2000 to July 2001 . Extremely preterm neonates were defined as neonates with estimated gestational age ( EGA ) < 28 weeks . The primary outcome was the development of VAP . Secondary outcomes were death and NICU length of stay ( LOS ) . Multiple logistic regression was performed to determine independent predictors for VAP and mortality . RESULTS A total of 229 patients were enrolled . Sixty-seven ( 29 % ) had EGA < 28 weeks . Nineteen episodes of VAP occurred in 19 ( 28.3 % ) of 67 mechanically ventilated patients . VAP rates were 6.5 per 1000 ventilator days for patients with EGA < 28 weeks and 4 per 1000 ventilator days for EGA > or=28 weeks . By multivariate analysis , bloodstream infection before VAP ( adjusted odds ratio : 3.5 ; 95 % confidence interval [ CI ] : 1.2 - 10.8 ) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation . Ventilator-associated pneumonia ( adjusted odds ratio : 3.4 ; 95 % CI : 1.2 - 12.3 ) was an independent predictor of mortality . A strong association between VAP and mortality was observed in neonates who stayed in the NICU > 30 days ( relative risk : 8.0 ; 95 % CI : 1.9 - 35.0 ) . Patients with VAP also had prolonged NICU LOS ( median : 138 vs 82 days ) . CONCLUSIONS VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality . Additional studies are needed to develop interventions to prevent VAP in NICU patients Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose To evaluate the potential preventive effect of probiotics on  ventilator-associated pneumonia ( VAP ) . Methods This was an open-label , r and omized , controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were r and omized to receive ( 1 ) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis ( Medilac-S ) 0.5 g three times daily through a nasogastric feeding tube plus st and ard preventive strategies or ( 2 ) st and ard preventive strategies alone , for a maximum of 14 days . The development of VAP was evaluated daily , and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter . Results The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients ( 36.4 vs. 50.4 % , respectively ; P = 0.031 ) . The mean time to develop VAP was significantly longer in the probiotics group than in the control group ( 10.4 vs. 7.5 days , respectively ; P = 0.022 ) . The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms ( PPMOs ) was lower in the probiotics group ( 24 % ) than the control group ( 44 % ) ( P = 0.004 ) . However , the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups . The administration of probiotics did not result in any improvement in the incidence of clinical ly suspected VAP , antimicrobial consumption , duration of mechanical ventilation , mortality and length of hospital stay . Conclusion Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach Objectives : Studies have confirmed the safety of oropharyngeal administration of colostrum in very low birth weight infants . However , the effect of oropharyngeal administration of colostrum on immune system is inconclusive . This study aims to evaluate the effect of oropharyngeal administration of colostrum on secretory immunoglobulin A and lactoferrin in very low birth weight infants . Design : R and omized controlled trial . Setting : Forty-bedded neonatal ICU in a university children ’s hospital in the People ’s Republic of China . Patients : Very low birth weight infants were allocated to the study group ( n = 32 ) and control group ( n = 32 ) . Intervention : The intervention was oropharyngeal administration of 0.2 mL of their mother ’s colostrum every 4 hours for 7 days . The control group received saline solution . Measurements and Main Results : Secretory immunoglobulin A and lactoferrin in urine and saliva were measured within 24 hours of life ( baseline ) and at 7 and 21 days . Primary outcomes were changes of secretory immunoglobulin A and lactoferrin in urine and saliva between baseline and at 7 and 21 days . Infant ’s clinical data were also collected during hospitalization . Change from baseline in lactoferrin in saliva at 7 days ( 5.18 ± 7.07 vs –1.74 ± 4.67 µg/mL ; p < 0.001 ) and 21 days ( 5.31 ± 9.74 vs –1.17 ± 10.38 µg/mL ; p = 0.02 ) shows statistic difference . No differences were found of lactoferrin in urine and also no differences of secretory immunoglobulin A in urine and saliva . There were also no differences between days to full enteral feeding , occurrence rate of clinical sepsis , proven sepsis , and necrotizing enterocolitis . Conclusions : Oropharyngeal administration of colostrum can increases the level of lactoferrin in saliva in very low birth weight infants . No effect could be documented of secretory immunoglobulin A and lactoferrin in urine . Larger trials are needed to better describe the benefit of oropharyngeal administration of colostrum , if any , in very low birth weight infants Objective : To study the incidence of sepsis and neonatal intensive care unit ( NICU ) costs as a function of the human milk ( HM ) dose received during the first 28 days post birth for very low birth weight ( VLBW ) infants . Study design : Prospect i ve cohort study of 175 VLBW infants . The average daily dose of HM ( ADDHM ) was calculated from daily nutritional data for the first 28 days post birth ( ADDHM-Days 1–28 ) . Other covariates associated with sepsis were used to create a propensity score , combining multiple risk factors into a single metric . Result : The mean gestational age and birth weight were 28.1±2.4 weeks and 1087±252 g , respectively . The mean ADDHM-Days 1–28 was 54±39 ml kg−1 day−1 ( range 0–135 ) . Binary logistic regression analysis controlling for propensity score revealed that increasing ADDHM-Days 1–28 was associated with lower odds of sepsis ( odds ratio 0.981 , 95 % confidence interval 0.967–0.995 , P=0.008 ) . Increasing ADDHM-Days 1–28 was associated with significantly lower NICU costs . Conclusion : A dose – response relationship was demonstrated between ADDHM-Days 1–28 and a reduction in the odds of sepsis and associated NICU costs after controlling for propensity score . For every HM dose increase of 10 ml kg−1 day−1 , the odds of sepsis decreased by 19 % . NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1–28 OBJECTIVE : To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants . METHODS : We conducted a double-blind , r and omized , placebo-controlled trial involving 48 preterm infants born before 28 weeks ’ gestation . Subjects received 0.2 mL of their mother ’s colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life . To measure concentrations of secretory immunoglobulin A , lactoferrin , and several immune substances , urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days . Clinical data during hospitalization were collected . RESULTS : Urinary levels of secretory immunoglobulin A at 1 week ( 71.4 vs 26.5 ng/g creatinine , P = .04 ) and 2 weeks ( 233.8 vs 48.3 ng/g creatinine , P = .006 ) , and lactoferrin at 1 week ( 3.5 vs 0.9 μg/g creatinine , P = .01 ) were significantly higher in colostrum group . Urine interleukin-1β level was significantly lower in colostrum group at 2 weeks ( 55.3 vs 91.8 μg/g creatinine , P = .01 ) . Salivary transforming growth factor-β1 ( 39.2 vs 69.7 μg/mL , P = .03 ) and interleukin-8 ( 1.2 vs 4.9 ng/mL , P = .04 ) were significantly lower at 2 weeks in colostrum group . A significant reduction in the incidence of clinical sepsis was noted in colostrum group ( 50 % vs 92 % , P = .003 ) . CONCLUSIONS : This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis , inhibit secretion of pro-inflammatory cytokines , and increase levels of circulating immune-protective factors in extremely premature infants . Larger studies to confirm these findings are warranted OBJECTIVES To determine the rates , risk factors , and outcomes of  ventilator-associated pneumonia in pediatric intensive care unit ( PICU ) patients . METHODS A prospect i ve cohort study was conducted at the St Louis Children 's Hospital PICU on all patients who were admitted to the PICU from September 1 , 1999 , to May 31 , 2000 , except those who died within 24 hours , were > or = 18 years of age , or were neonatal intensive care unit patients on extracorporeal membrane oxygenation . The primary outcome measured was the development of ventilator-associated pneumonia . Secondary outcomes were death and hospital and PICU length of stay .  Multiple logistic regression analysis was performed to determine independent predictors for ventilator-associated pneumonia . RESULTS There were 34 episodes of ventilator-associated pneumonia in 30 patients of 911 admissions ( 3.3 % ) and 595 ( 5.1 % ) mechanically ventilated patients . The mean ventilator-associated pneumonia rate was 11.6/1000 ventilator days . By logistic regression analysis , genetic syndrome ( odds ratio [ OR ] : 2.37 ; 95 % confidence interval [ CI ] : 1.01 - 5.46 ) , reintubation ( OR : 2.71 ; 95 % CI : 1.18 - 6.21 ) , and transport out of the P 
    Output:
    
agent
OC could significantly reduce the occurrence of VAP , and consequently , its routine use should be considered for VLBWs to prevent infectious diseases .
OC  significantly reduces the occurrence of VAP and NEC in VLBW infants  .
OC may reduce the incidence of VAP and NEC by increasing IgA levels .
Early OC therapy for mechanical ventilation of low-weight infants may prevent the occurrence of VAP .
OC significantly reduces the occurrence of VAP and NEC in VLBW infants .
OC may reduce the incidence of VAP and NEC by increasing IgA levels .
Early OC therapy for mechanical ventilation of low-weight infants may prevent the occurrence of VAP
***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 : Oral colostrum priming ( OCP ) after birth in preterm infants is associated with improved weight gain and modification of the oral immunomicrobial environment . We hypothesized that OCP would modify salivary immune peptides and the oral microbiota in preterm infants . Study design : We conducted a prospect i ve , r and omized clinical trial to determine the effects of OCP on salivary immune peptide representation in preterm infants ( < 32 weeks completed gestation at birth ) .  Saliva sample s were collected before and after OCP . Salivary immune peptide representation was determined via mass spectroscopy . Oral microbiota representation was determined via sequencing of the 16S rRNA gene . Results : Neonates who received OCP ( n=48 ) had a 16-day reduction in the median length of hospitalization as compared with infants who did not receive OCP ( n=51 ) . No differences in salivary immune peptide sequence representation before OCP between groups were found . Longitudinal changes in peptides were detected ( lysozyme C , immunoglobulin A , lactoferrin ) but were limited to a single peptide difference ( α-defensin 1 ) between primed and unprimed infants after OCP . We found no difference in microbial diversity between treatment groups at any time point , but diversity decreased significantly over time in both groups . OCP treatment marginally modified oral taxa with a decline in abundance of Streptococci in the OCP group at 30 days of life . Conclusions : OCP had neither an effect on the salivary peptides we examined nor on overall oral bacterial diversity and composition . Infants who received OCP had a reduced length of hospitalization and warrants further investigation OBJECTIVE To determine the rates , characteristics , risk factors , and outcomes of ventilator-associated pneumonia ( VAP ) in extremely preterm neonates in a neonatal intensive care unit ( NICU ) . METHODS A prospect i ve cohort study was conducted at the St Louis Children 's Hospital on all patients who had birth weight < or=2000 g and were admitted to the NICU for > or=48 hours from October 2000 to July 2001 . Extremely preterm neonates were defined as neonates with estimated gestational age ( EGA ) < 28 weeks . The primary outcome was the development of VAP . Secondary outcomes were death and NICU length of stay ( LOS ) . Multiple logistic regression was performed to determine independent predictors for VAP and mortality . RESULTS A total of 229 patients were enrolled . Sixty-seven ( 29 % ) had EGA < 28 weeks . Nineteen episodes of VAP occurred in 19 ( 28.3 % ) of 67 mechanically ventilated patients . VAP rates were 6.5 per 1000 ventilator days for patients with EGA < 28 weeks and 4 per 1000 ventilator days for EGA > or=28 weeks . By multivariate analysis , bloodstream infection before VAP ( adjusted odds ratio : 3.5 ; 95 % confidence interval [ CI ] : 1.2 - 10.8 ) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation . Ventilator-associated pneumonia ( adjusted odds ratio : 3.4 ; 95 % CI : 1.2 - 12.3 ) was an independent predictor of mortality . A strong association between VAP and mortality was observed in neonates who stayed in the NICU > 30 days ( relative risk : 8.0 ; 95 % CI : 1.9 - 35.0 ) . Patients with VAP also had prolonged NICU LOS ( median : 138 vs 82 days ) . CONCLUSIONS VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality . Additional studies are needed to develop interventions to prevent VAP in NICU patients Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose To evaluate the potential preventive effect of probiotics on  ventilator-associated pneumonia ( VAP ) . Methods This was an open-label , r and omized , controlled multicenter trial involving 235 critically ill adult patients who were expected to receive mechanical ventilation for ≥48 h. The patients were r and omized to receive ( 1 ) a probiotics capsule containing live Bacillus subtilis and Enterococcus faecalis ( Medilac-S ) 0.5 g three times daily through a nasogastric feeding tube plus st and ard preventive strategies or ( 2 ) st and ard preventive strategies alone , for a maximum of 14 days . The development of VAP was evaluated daily , and throat swabs and gastric aspirate were cultured at baseline and once or twice weekly thereafter . Results The incidence of microbiologically confirmed VAP in the probiotics group was significantly lower than that in the control patients ( 36.4 vs. 50.4 % , respectively ; P = 0.031 ) . The mean time to develop VAP was significantly longer in the probiotics group than in the control group ( 10.4 vs. 7.5 days , respectively ; P = 0.022 ) . The proportion of patients with acquisition of gastric colonization of potentially pathogenic microorganisms ( PPMOs ) was lower in the probiotics group ( 24 % ) than the control group ( 44 % ) ( P = 0.004 ) . However , the proportion of patients with eradication PPMO colonization on both sites of the oropharynx and stomach were not significantly different between the two groups . The administration of probiotics did not result in any improvement in the incidence of clinical ly suspected VAP , antimicrobial consumption , duration of mechanical ventilation , mortality and length of hospital stay . Conclusion Therapy with the probiotic bacteria B. Subtilis and E. faecalis are an effective and safe means for preventing VAP and the acquisition of PPMO colonization in the stomach Objectives : Studies have confirmed the safety of oropharyngeal administration of colostrum in very low birth weight infants . However , the effect of oropharyngeal administration of colostrum on immune system is inconclusive . This study aims to evaluate the effect of oropharyngeal administration of colostrum on secretory immunoglobulin A and lactoferrin in very low birth weight infants . Design : R and omized controlled trial . Setting : Forty-bedded neonatal ICU in a university children ’s hospital in the People ’s Republic of China . Patients : Very low birth weight infants were allocated to the study group ( n = 32 ) and control group ( n = 32 ) . Intervention : The intervention was oropharyngeal administration of 0.2 mL of their mother ’s colostrum every 4 hours for 7 days . The control group received saline solution . Measurements and Main Results : Secretory immunoglobulin A and lactoferrin in urine and saliva were measured within 24 hours of life ( baseline ) and at 7 and 21 days . Primary outcomes were changes of secretory immunoglobulin A and lactoferrin in urine and saliva between baseline and at 7 and 21 days . Infant ’s clinical data were also collected during hospitalization . Change from baseline in lactoferrin in saliva at 7 days ( 5.18 ± 7.07 vs –1.74 ± 4.67 µg/mL ; p < 0.001 ) and 21 days ( 5.31 ± 9.74 vs –1.17 ± 10.38 µg/mL ; p = 0.02 ) shows statistic difference . No differences were found of lactoferrin in urine and also no differences of secretory immunoglobulin A in urine and saliva . There were also no differences between days to full enteral feeding , occurrence rate of clinical sepsis , proven sepsis , and necrotizing enterocolitis . Conclusions : Oropharyngeal administration of colostrum can increases the level of lactoferrin in saliva in very low birth weight infants . No effect could be documented of secretory immunoglobulin A and lactoferrin in urine . Larger trials are needed to better describe the benefit of oropharyngeal administration of colostrum , if any , in very low birth weight infants Objective : To study the incidence of sepsis and neonatal intensive care unit ( NICU ) costs as a function of the human milk ( HM ) dose received during the first 28 days post birth for very low birth weight ( VLBW ) infants . Study design : Prospect i ve cohort study of 175 VLBW infants . The average daily dose of HM ( ADDHM ) was calculated from daily nutritional data for the first 28 days post birth ( ADDHM-Days 1–28 ) . Other covariates associated with sepsis were used to create a propensity score , combining multiple risk factors into a single metric . Result : The mean gestational age and birth weight were 28.1±2.4 weeks and 1087±252 g , respectively . The mean ADDHM-Days 1–28 was 54±39 ml kg−1 day−1 ( range 0–135 ) . Binary logistic regression analysis controlling for propensity score revealed that increasing ADDHM-Days 1–28 was associated with lower odds of sepsis ( odds ratio 0.981 , 95 % confidence interval 0.967–0.995 , P=0.008 ) . Increasing ADDHM-Days 1–28 was associated with significantly lower NICU costs . Conclusion : A dose – response relationship was demonstrated between ADDHM-Days 1–28 and a reduction in the odds of sepsis and associated NICU costs after controlling for propensity score . For every HM dose increase of 10 ml kg−1 day−1 , the odds of sepsis decreased by 19 % . NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1–28 OBJECTIVE : To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants . METHODS : We conducted a double-blind , r and omized , placebo-controlled trial involving 48 preterm infants born before 28 weeks ’ gestation . Subjects received 0.2 mL of their mother ’s colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life . To measure concentrations of secretory immunoglobulin A , lactoferrin , and several immune substances , urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days . Clinical data during hospitalization were collected . RESULTS : Urinary levels of secretory immunoglobulin A at 1 week ( 71.4 vs 26.5 ng/g creatinine , P = .04 ) and 2 weeks ( 233.8 vs 48.3 ng/g creatinine , P = .006 ) , and lactoferrin at 1 week ( 3.5 vs 0.9 μg/g creatinine , P = .01 ) were significantly higher in colostrum group . Urine interleukin-1β level was significantly lower in colostrum group at 2 weeks ( 55.3 vs 91.8 μg/g creatinine , P = .01 ) . Salivary transforming growth factor-β1 ( 39.2 vs 69.7 μg/mL , P = .03 ) and interleukin-8 ( 1.2 vs 4.9 ng/mL , P = .04 ) were significantly lower at 2 weeks in colostrum group . A significant reduction in the incidence of clinical sepsis was noted in colostrum group ( 50 % vs 92 % , P = .003 ) . CONCLUSIONS : This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis , inhibit secretion of pro-inflammatory cytokines , and increase levels of circulating immune-protective factors in extremely premature infants . Larger studies to confirm these findings are warranted OBJECTIVES To determine the rates , risk factors , and outcomes of  ventilator-associated pneumonia in pediatric intensive care unit ( PICU ) patients . METHODS A prospect i ve cohort study was conducted at the St Louis Children 's Hospital PICU on all patients who were admitted to the PICU from September 1 , 1999 , to May 31 , 2000 , except those who died within 24 hours , were > or = 18 years of age , or were neonatal intensive care unit patients on extracorporeal membrane oxygenation . The primary outcome measured was the development of ventilator-associated pneumonia . Secondary outcomes were death and hospital and PICU length of stay .  Multiple logistic regression analysis was performed to determine independent predictors for ventilator-associated pneumonia . RESULTS There were 34 episodes of ventilator-associated pneumonia in 30 patients of 911 admissions ( 3.3 % ) and 595 ( 5.1 % ) mechanically ventilated patients . The mean ventilator-associated pneumonia rate was 11.6/1000 ventilator days . By logistic regression analysis , genetic syndrome ( odds ratio [ OR ] : 2.37 ; 95 % confidence interval [ CI ] : 1.01 - 5.46 ) , reintubation ( OR : 2.71 ; 95 % CI : 1.18 - 6.21 ) , and transport out of the P 
    Output:
    