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: Vomiting , large gastric residuals and abdominal distension are common in very immature infants on formula feeding . The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants . Fifteen preterm infants ( median gestational age 29 ( 24–32 ) wk , birthweight 1241 ( 660–1900 ) g , postnatal age 18 ( 5–54 ) d ) on full enteral feeds ( > 150 ml/kg*d ) were enrolled . It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with st and ard preterm formula . In a r and omized cross‐over design study , each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red . The protein hydrolysate formula had a markedly shorter gastrointestinal transit time ( 9.8 h ) than the st and ard formula ( 19 h ) ( p= 0.0022 , two‐sided Mann‐Whitney U test ) BACKGROUND Gastro-esophageal reflux ( GER ) is diagnosed frequently in preterm infants . Pharmacological treatment of GER has some potential side effects . Conservative treatment of GER should be the first-line approach and should include body positioning and diet modifications . Formula-fed preterm infants experience frequently symptoms of feeding intolerance . Hydrolyzed protein formula ( HPF ) is often used in these infants due to their effects on gastrointestinal motility . AIMS To investigate the role of an extensively HPF ( eHPF ) on GER indexes in formula-fed preterm infants with symptoms of both GER and feeding intolerance . STUDY DESIGN R and omized crossover trial . SUBJECTS Preterm infants ( gestational age ≤33 weeks ) with symptoms of feeding intolerance ( large gastric residuals , abdominal distension and constipation ) and GER ( frequent regurgitations and /or postpr and ial desaturations ) . OUTCOME MEASURES GER indexes detected by 24-h combined multichannel intraluminal impedance and pH monitoring . GER indexes detected after 4 feeds of an eHPF were compared to those detected after 4 feeds of a st and ard preterm formula ( SPF ) by Wilcoxon signed ranks test . A p<0.05 was considered statistically significant . RESULTS eHPF significantly reduced the number of GERs detected by pH monitoring ( p=0.036 ) and also the reflux index ( p=0.044 ) compared to SPF . No differences in impedance bolus exposure indexes nor in GER height were detected . CONCLUSIONS The use of an eHPF should be evaluated for reducing esophageal acid exposure in preterm infants with feeding intolerance and symptoms of GER . Future research should focus on the evaluation of an eHPF adequate for preterm infants in improving clinical symptoms of GER The allergy preventive effect of extensively ( N ) and partially ( PH ) hydrolysed cows ’ milk formulas compared with a regular formula ( RM ) was assessed in 155 infants with a family history of allergy . No cows ’ milk was given during the first nine months of life and no egg and fish  up to 12 months of age . Breast feeding mothers avoided the same foods . At weaning the infants were r and omised to one of the formula groups . The cumulative incidence of atopic symptoms at 18 months was 51 , 64 , and 84 % in the N , PH , and RM groups , respectively . From 6 to 18 months there were significantly less cumulative atopic symptoms in the N group compared with the RM group , and significantly less than the PH group up to 6 ( N = 25 % ; PH = 46 % ) and 9 months ( N = 34 % , PH = 58 % ) . At 9 months significantly fewer infants in the N group ( 10 % ) than in the PH group ( 33 % ) had a positive skin prick test to eggs . The findings support an allergy preventive effect of an extensively hydrolysed formula , but not of a partially hydrolysed formula , during the first 18 months of life of high risk infants Objective : To compare feeding tolerance , nutrient intake and growth in preterm infants ( ⩽32 weeks , ⩽1750 g ) fed either a st and ard nonhydrolyzed whey – casein ( nHWC ) or a partially hydrolyzed whey ( pHW ) preterm infant formula .  Study Design : In this double-blind r and omized controlled trial infants were fed either formula for at least 3 weeks . Intake was monitored daily , serum chemistries and growth weekly . Data were analyzed using analysis of covariance . Result : A total of 80 infants were enrolled , 72 completed the study . No differences were noted in demographic characteristics . No differences were detected in feeding tolerance , intakes ( 118±21 vs 119±14 ; nHWC vs pHW ) or growth weight , 28±1.5 vs 28±1.6 g per day ; length , 1.0±0.7 vs 1.0±0.6 cm per week ; head circumference , 0.9±0.4 vs 1.0±0.44 cm per week ) . At the end of study , blood urea nitrogen ( 5.2±3.1 < 6.7±2.3 mg per 100 ml , nHWC < pHW ) , total serum proteins ( 4.7±0.4 > 4.4±0.5 g per 100 ml ) and albumin ( 2.7±0.3 > 2.6±0.4 g per 100 ml ) differed . Conclusion : A pHW preterm infant formula was not associated with improved feeding tolerance , enteral intake or growth but differences in serum chemistries . These are unlikely to be clinical ly relevant because values were well within normal limits for preterm infants , whereas growth was identical in both groups and paralleled that ‘ in utero ’ Background The average incidence of preterm birth in the world is up to 11.1 % , and deaths of preterm children account for more than 50 % of neonatal deaths . Gastrointestinal function of preterm children with a gestational age less than 34 weeks is immaturely developed . For preterm children who can only be fed with formula due to their mothers ’ sickness , choosing a suitable formula can not only meet the high nutritional needs of preterm children , but also solve their low gastrointestinal tolerability , and is thus very important . Methods / Design The study is a prospect i ve , r and omized , single-blind and controlled clinical trial . Preterm children with a gestational age less than 34 weeks meeting the inclusion criteria who can not be breastfed will be included . To demonstrate the application effect of extensively hydrolyzed milk protein formula on the target population , preterm children will be r and omized into two groups , 185 subjects in each group . The observation group will be fed with extensively hydrolyzed milk protein ( 100 % whey protein ) formula , while the control group will be fed with preterm children ’s formula until the children are discharged from the neonatal intensive care unit ( NICU ) . All the formula involved in this study will be from Dumex . After discharge , both groups will be uniformly fed with formula for 0 to 6-month-old infants . For statistical analysis , a chi-square test and Student ’s t test will be applied using SAS 9.4 . Discussion This will be the first r and omized controlled clinical study with long-term observation of the growth and development of preterm children during the NICU stay and at 3-month follow-up after discharge from the NICU . Results from this study will be used to determine whether the extensively hydrolyzed formula is more suitable for the low gastrointestinal tolerability of preterm children , and also whether feeding preterm children who are fed with such formula during the NICU stay with ordinary infant formula after discharge from the NICU would affect the normal growth and development of preterm children in the early stage of their lives . Trial registration This study was registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) with number ChiCTR-IOR-14005696 , on December 22 , 2014 Background Because infant formulas containing hydrolyzed cow milk protein are used to reduce feeding intolerance and to improve gastric emptying , the effect on gastrointestinal motility of a hydrolysate formula was compared with that of a st and ard preterm formula . Methods Thirty-six preterm newborns with a gestational age of 32.2 ± 2.3 weeks were assigned r and omly to st and ard formula or hydrolyzed formula .  Cutaneous electrogastrography and ultrasound examination of gastric emptying were performed simultaneously to evaluate gastrointestinal motility before and after the test meal . All recording sessions were performed 1 week after infants had reached full enteral feeding . Results No significant difference in gastrointestinal symptoms was noted in the newborns fed the different formulas . In particular , regurgitation and vomiting were observed in 78 % versus 64 % of preterm newborns after st and ard and hydrolyzed formula , respectively ( Fisher exact test , not significant ) . No differences were found in terms of gastric electrical activity and gastric emptying time between the two groups . Conclusions It seems unnecessary to use hydrolysate formulas to improve motility in preterm infants OBJECTIVE To study the effects of extensively hydrolyzed protein formula ( eHF ) on the feeding and growth in preterm infants through a multicenter controlled clinical study . METHODS Preterm infants admitted to eight upper first-class hospitals in China between February 2012 and December 2013 were r and omly selected . They were divided into two observation groups and two control groups . The first observation group consisted of preterm infants with a gestational age of < 32 weeks , who were fed with eHF for 10 - 14 days after birth and then with st and ard preterm formula ( SPF ) until discharge . The second observation group consisted of preterm infants with a gestational age of 32 - 34 weeks , who were fed with SPF after birth , but were switched to eHF ( 7 - 14 days ) if suffering feeding intolerance at 6 - 8 days after birth . The two control groups with corresponding gestational ages kept to be fed with SPF after birth . Clinical data were recorded to compare feeding condition , physical growth , blood biochemical indices , and major complications between different groups . RESULTS A total of 328 preterm infants were enrolled . Preterm infants with a gestational age of < 32 weeks in the observation group had a significantly shorter meconium evacuation time than in the corresponding control group ( P<0.05 ) . They also had significantly lower levels of serum total bilirubin at weeks 1 and 2 after birth compared with the control group ( P<0.05 ) . The observation group needed more time in reaching enteral nutrition ( EN ) basic energy uptake of 50 kcal/(kg·d ) , partial parenteral nutrition ( PPN ) , hospitalization , and corrected gestational age at discharge compared with the controlled infants ( P<0.05 ) . There was no difference in the incidence of extrauterine growth retardation ( EUGR ) at discharge between the two groups ( P>0.05 ) . Preterm infants with a gestational age of 32 - 34 weeks in the observation group had significantly lower serum total bilirubin levels at 2 weeks after birth compared with the corresponding control group ( P<0.05 ) . They required more time in achieving EN basic energy and PPN than in the control group ( P<0.05 ) . There was no difference in the incidence of EUGR at discharge between the two groups ( P>0.05 ) . CONCLUSIONS For preterm infants  , eHF can improve gastrointestinal motility , accelerate bilirubin metabolism and excretion and does not increase the incidence of EUGR BACKGROUND Feeding intolerance is common in very low birth weight ( VLBW ; < 1500 g ) infants .  Hydrolyzed protein preterm infant formula ( HPF ) has been shown to accelerate the gastrointestinal transit of formula . The aim of this study was to investigate whether HPF improves early feeding tolerance compared with st and ard preterm infant formula ( SPF ) . We hypothesized that HPF would accelerate early enteral feeding advancement . METHODS Primary outcome was the time from initiation of milk feeds until full feeds ( 150 mL/kg birth weight/d ) were achieved in infants who received < 10 % human milk ( HM ) to exclude HM as a confounder . Because the availability of HM was not predictable at the time of enrollment , all eligible VLBW infants ( n = 129 ) were r and omly assigned in a r and omized , controlled trial to receive HPF or SPF if HM was not available . Infants who received > 10 % HM ( n = 42 ) were excluded . Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d . Prepr and ial gastric residuals were tolerated up to 5 mL/kg ; otherwise , feedings were reduced or withheld . Data are shown as median ( 5th and 95th percentile ) . RESULTS Forty-six and 41 ( HPF vs SPF ) infants received < 10 % HM . There was no significant difference with regard to birth weight , gestational age , and onset of milk feeds ( day 3 [ 1 - 8 ] vs 4 [ 2 - 6 ] ) . The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding ( 10 [ 9 - 27 ] vs 12 [ 9 -  
    Output:
    
agent
The identified trials provide only low quality evidence about the effects of feeding preterm infants  with protein hydrolysate versus st and ard formula .
The existing data did not support conclusions that feeding with protein hydrolysate affects the risk of feed intolerance or necrotising enterocolitis .
***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: Vomiting , large gastric residuals and abdominal distension are common in very immature infants on formula feeding . The present trial investigated whether a protein hydrolysate formula reduces the gastrointestinal transit time in preterm infants . Fifteen preterm infants ( median gestational age 29 ( 24–32 ) wk , birthweight 1241 ( 660–1900 ) g , postnatal age 18 ( 5–54 ) d ) on full enteral feeds ( > 150 ml/kg*d ) were enrolled . It was hypothesized that the gastrointestinal transit time is at least 2 h shorter when protein hydrolysate formula is fed compared with st and ard preterm formula . In a r and omized cross‐over design study , each formula was fed for 5 d. On days 4 and 9 the gastrointestinal transit time was estimated using carmine red . The protein hydrolysate formula had a markedly shorter gastrointestinal transit time ( 9.8 h ) than the st and ard formula ( 19 h ) ( p= 0.0022 , two‐sided Mann‐Whitney U test ) BACKGROUND Gastro-esophageal reflux ( GER ) is diagnosed frequently in preterm infants . Pharmacological treatment of GER has some potential side effects . Conservative treatment of GER should be the first-line approach and should include body positioning and diet modifications . Formula-fed preterm infants experience frequently symptoms of feeding intolerance . Hydrolyzed protein formula ( HPF ) is often used in these infants due to their effects on gastrointestinal motility . AIMS To investigate the role of an extensively HPF ( eHPF ) on GER indexes in formula-fed preterm infants with symptoms of both GER and feeding intolerance . STUDY DESIGN R and omized crossover trial . SUBJECTS Preterm infants ( gestational age ≤33 weeks ) with symptoms of feeding intolerance ( large gastric residuals , abdominal distension and constipation ) and GER ( frequent regurgitations and /or postpr and ial desaturations ) . OUTCOME MEASURES GER indexes detected by 24-h combined multichannel intraluminal impedance and pH monitoring . GER indexes detected after 4 feeds of an eHPF were compared to those detected after 4 feeds of a st and ard preterm formula ( SPF ) by Wilcoxon signed ranks test . A p<0.05 was considered statistically significant . RESULTS eHPF significantly reduced the number of GERs detected by pH monitoring ( p=0.036 ) and also the reflux index ( p=0.044 ) compared to SPF . No differences in impedance bolus exposure indexes nor in GER height were detected . CONCLUSIONS The use of an eHPF should be evaluated for reducing esophageal acid exposure in preterm infants with feeding intolerance and symptoms of GER . Future research should focus on the evaluation of an eHPF adequate for preterm infants in improving clinical symptoms of GER The allergy preventive effect of extensively ( N ) and partially ( PH ) hydrolysed cows ’ milk formulas compared with a regular formula ( RM ) was assessed in 155 infants with a family history of allergy . No cows ’ milk was given during the first nine months of life and no egg and fish  up to 12 months of age . Breast feeding mothers avoided the same foods . At weaning the infants were r and omised to one of the formula groups . The cumulative incidence of atopic symptoms at 18 months was 51 , 64 , and 84 % in the N , PH , and RM groups , respectively . From 6 to 18 months there were significantly less cumulative atopic symptoms in the N group compared with the RM group , and significantly less than the PH group up to 6 ( N = 25 % ; PH = 46 % ) and 9 months ( N = 34 % , PH = 58 % ) . At 9 months significantly fewer infants in the N group ( 10 % ) than in the PH group ( 33 % ) had a positive skin prick test to eggs . The findings support an allergy preventive effect of an extensively hydrolysed formula , but not of a partially hydrolysed formula , during the first 18 months of life of high risk infants Objective : To compare feeding tolerance , nutrient intake and growth in preterm infants ( ⩽32 weeks , ⩽1750 g ) fed either a st and ard nonhydrolyzed whey – casein ( nHWC ) or a partially hydrolyzed whey ( pHW ) preterm infant formula .  Study Design : In this double-blind r and omized controlled trial infants were fed either formula for at least 3 weeks . Intake was monitored daily , serum chemistries and growth weekly . Data were analyzed using analysis of covariance . Result : A total of 80 infants were enrolled , 72 completed the study . No differences were noted in demographic characteristics . No differences were detected in feeding tolerance , intakes ( 118±21 vs 119±14 ; nHWC vs pHW ) or growth weight , 28±1.5 vs 28±1.6 g per day ; length , 1.0±0.7 vs 1.0±0.6 cm per week ; head circumference , 0.9±0.4 vs 1.0±0.44 cm per week ) . At the end of study , blood urea nitrogen ( 5.2±3.1 < 6.7±2.3 mg per 100 ml , nHWC < pHW ) , total serum proteins ( 4.7±0.4 > 4.4±0.5 g per 100 ml ) and albumin ( 2.7±0.3 > 2.6±0.4 g per 100 ml ) differed . Conclusion : A pHW preterm infant formula was not associated with improved feeding tolerance , enteral intake or growth but differences in serum chemistries . These are unlikely to be clinical ly relevant because values were well within normal limits for preterm infants , whereas growth was identical in both groups and paralleled that ‘ in utero ’ Background The average incidence of preterm birth in the world is up to 11.1 % , and deaths of preterm children account for more than 50 % of neonatal deaths . Gastrointestinal function of preterm children with a gestational age less than 34 weeks is immaturely developed . For preterm children who can only be fed with formula due to their mothers ’ sickness , choosing a suitable formula can not only meet the high nutritional needs of preterm children , but also solve their low gastrointestinal tolerability , and is thus very important . Methods / Design The study is a prospect i ve , r and omized , single-blind and controlled clinical trial . Preterm children with a gestational age less than 34 weeks meeting the inclusion criteria who can not be breastfed will be included . To demonstrate the application effect of extensively hydrolyzed milk protein formula on the target population , preterm children will be r and omized into two groups , 185 subjects in each group . The observation group will be fed with extensively hydrolyzed milk protein ( 100 % whey protein ) formula , while the control group will be fed with preterm children ’s formula until the children are discharged from the neonatal intensive care unit ( NICU ) . All the formula involved in this study will be from Dumex . After discharge , both groups will be uniformly fed with formula for 0 to 6-month-old infants . For statistical analysis , a chi-square test and Student ’s t test will be applied using SAS 9.4 . Discussion This will be the first r and omized controlled clinical study with long-term observation of the growth and development of preterm children during the NICU stay and at 3-month follow-up after discharge from the NICU . Results from this study will be used to determine whether the extensively hydrolyzed formula is more suitable for the low gastrointestinal tolerability of preterm children , and also whether feeding preterm children who are fed with such formula during the NICU stay with ordinary infant formula after discharge from the NICU would affect the normal growth and development of preterm children in the early stage of their lives . Trial registration This study was registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ) with number ChiCTR-IOR-14005696 , on December 22 , 2014 Background Because infant formulas containing hydrolyzed cow milk protein are used to reduce feeding intolerance and to improve gastric emptying , the effect on gastrointestinal motility of a hydrolysate formula was compared with that of a st and ard preterm formula . Methods Thirty-six preterm newborns with a gestational age of 32.2 ± 2.3 weeks were assigned r and omly to st and ard formula or hydrolyzed formula .  Cutaneous electrogastrography and ultrasound examination of gastric emptying were performed simultaneously to evaluate gastrointestinal motility before and after the test meal . All recording sessions were performed 1 week after infants had reached full enteral feeding . Results No significant difference in gastrointestinal symptoms was noted in the newborns fed the different formulas . In particular , regurgitation and vomiting were observed in 78 % versus 64 % of preterm newborns after st and ard and hydrolyzed formula , respectively ( Fisher exact test , not significant ) . No differences were found in terms of gastric electrical activity and gastric emptying time between the two groups . Conclusions It seems unnecessary to use hydrolysate formulas to improve motility in preterm infants OBJECTIVE To study the effects of extensively hydrolyzed protein formula ( eHF ) on the feeding and growth in preterm infants through a multicenter controlled clinical study . METHODS Preterm infants admitted to eight upper first-class hospitals in China between February 2012 and December 2013 were r and omly selected . They were divided into two observation groups and two control groups . The first observation group consisted of preterm infants with a gestational age of < 32 weeks , who were fed with eHF for 10 - 14 days after birth and then with st and ard preterm formula ( SPF ) until discharge . The second observation group consisted of preterm infants with a gestational age of 32 - 34 weeks , who were fed with SPF after birth , but were switched to eHF ( 7 - 14 days ) if suffering feeding intolerance at 6 - 8 days after birth . The two control groups with corresponding gestational ages kept to be fed with SPF after birth . Clinical data were recorded to compare feeding condition , physical growth , blood biochemical indices , and major complications between different groups . RESULTS A total of 328 preterm infants were enrolled . Preterm infants with a gestational age of < 32 weeks in the observation group had a significantly shorter meconium evacuation time than in the corresponding control group ( P<0.05 ) . They also had significantly lower levels of serum total bilirubin at weeks 1 and 2 after birth compared with the control group ( P<0.05 ) . The observation group needed more time in reaching enteral nutrition ( EN ) basic energy uptake of 50 kcal/(kg·d ) , partial parenteral nutrition ( PPN ) , hospitalization , and corrected gestational age at discharge compared with the controlled infants ( P<0.05 ) . There was no difference in the incidence of extrauterine growth retardation ( EUGR ) at discharge between the two groups ( P>0.05 ) . Preterm infants with a gestational age of 32 - 34 weeks in the observation group had significantly lower serum total bilirubin levels at 2 weeks after birth compared with the corresponding control group ( P<0.05 ) . They required more time in achieving EN basic energy and PPN than in the control group ( P<0.05 ) . There was no difference in the incidence of EUGR at discharge between the two groups ( P>0.05 ) . CONCLUSIONS For preterm infants  , eHF can improve gastrointestinal motility , accelerate bilirubin metabolism and excretion and does not increase the incidence of EUGR BACKGROUND Feeding intolerance is common in very low birth weight ( VLBW ; < 1500 g ) infants .  Hydrolyzed protein preterm infant formula ( HPF ) has been shown to accelerate the gastrointestinal transit of formula . The aim of this study was to investigate whether HPF improves early feeding tolerance compared with st and ard preterm infant formula ( SPF ) . We hypothesized that HPF would accelerate early enteral feeding advancement . METHODS Primary outcome was the time from initiation of milk feeds until full feeds ( 150 mL/kg birth weight/d ) were achieved in infants who received < 10 % human milk ( HM ) to exclude HM as a confounder . Because the availability of HM was not predictable at the time of enrollment , all eligible VLBW infants ( n = 129 ) were r and omly assigned in a r and omized , controlled trial to receive HPF or SPF if HM was not available . Infants who received > 10 % HM ( n = 42 ) were excluded . Milk bolus feeding every 2 to 3 hours was started at the discretion of the attending physician and advanced by 16 mL/kg/d . Prepr and ial gastric residuals were tolerated up to 5 mL/kg ; otherwise , feedings were reduced or withheld . Data are shown as median ( 5th and 95th percentile ) . RESULTS Forty-six and 41 ( HPF vs SPF ) infants received < 10 % HM . There was no significant difference with regard to birth weight , gestational age , and onset of milk feeds ( day 3 [ 1 - 8 ] vs 4 [ 2 - 6 ] ) . The time from initiation of milk feeds to full feeds was significantly shorter with HPF feeding ( 10 [ 9 - 27 ] vs 12 [ 9 -  
    Output:
    