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: In order to determine the intravenous energy and nitrogen intakes required to achieve intrauterine rates of nitrogen accretion and growth , 30 studies were completed in 22 premature infants who were provided with various intakes of amino acids and energy ( glucose + /- lipid ) by peripheral vein infusion .  At constant nitrogen intake , increasing energy intake ( as lipid ) from 50 to 80 nonprotein kcal/kg/day result ed in significant increases in nitrogen retention and weight gain . Increasing nitrogen intake from 494 to 655 mg/kg/day at constant low energy intake ( mean = 53 kcal/kg/day ) had no effect on nitrogen retention or weight change ; however , at higher energy intakes ( mean = 81 kcal/kg/day ) increasing nitrogen intake correlated significantly with increasing nitrogen retention . At energy intakes greater than 70 kcal/kg/day the major determinant of nitrogen retention was nitrogen intake . When energy intake was greater than 70 kcal/kg/day , the infusion of nitrogen providing 430 to 560 mg/kg/day ( 2.7 to 3.5 gm protein/kg/day ) result ed in the duplication of intrauterine nitrogen accretion rates BACKGROUND . We hypothesized that in premature infants , retinal vascular growth retardation between birth and postmenstrual age of ∼30 to 32 weeks that initiates retinopathy of prematurity is paralleled by brain growth retardation . METHODS . In a prospect i ve longitudinal study , we measured postnatal head growth , retinopathy of prematurity stage , protein and energy intake , severity of illness and serum insulin-like growth factor-1 levels  in 58 preterm infants ( mean gestational age at birth : 27.6 weeks ) from birth until postmenstrual age of ∼40 weeks . RESULTS . Premature infant head growth decelerates dramatically after birth until postmenstrual age of ∼30 weeks . Head growth retardation coincides with retinal vascular growth suppression . Accelerated growth follows between post menstrual ages of ∼30 to 32 weeks and ∼40 weeks . The degree of head growth retardation up to postmenstrual age of 31 weeks corresponds to the degree of retinopathy of prematurity and to the degree of suppression of serum levels of insulin-like growth factor-1 . At postmenstrual age of 31 weeks , if a child ’s head circumference SD is below −2.5 , then the probability of also developing at least stage 3 retinopathy of prematurity increases fivefold compared with head circumference above −2.5 SD ( 32 % vs 6 % ) suggesting parallel processes in brain and retina . Serum insulin-like growth factor-1 levels correlate positively with head circumference SD score and with the degree of retinopathy of prematurity . CONCLUSIONS . The correlation between head and retinal growth is consistent with insulin growth factor-1 being one of the postnatal growth factors involved in this multifactorial process and also suggests that factors that contribute to retinopathy of prematurity during this critical period may also affect neurological dysfunction . Additional studies are required to establish this connection Objective : The purpose of this study was to determine the association between hyperglycemia and mortality and late-onset infections ( > 72 h ) in extremely low birth weight ( ELBW ) infants . Study design : Retrospective analysis of a prospect i ve cohort study of 201 ELBW infants who survived greater than 3 days after birth .  Mean morning glucose levels were categorized as normoglycemia ( < 120 mg/dl ) , mild-moderate hyperglycemia ( 120 to 179 mg/dl ) and severe hyperglycemia ( ⩾180 mg/dl ) . Hyperglycemia was further divided into early ( first 3 days of age ) and persistent ( first week of age ) . Logistic regression was performed to assess whether hyperglycemia was associated with either mortality or late-onset culture-proven infection , measured after 3 and 7 days of age . Results : Adjusting for age , the odds ratio ( OR ) for either dying or developing a late infection was 5.07 ( 95 % confidence interval ( CI ) : 1.06 to 24.3 ) for infants with early severe hyperglycemia and 6.26 ( 95 % CI : 0.73 to 54.0 ) for infants with persistent severe hyperglycemia . Adjusting for age , both severe early and persistent hyperglycemia were associated with increased mortality . Among survivors , there was no significant association between hyperglycemia and length of mechanical ventilation or length of hospital stay . Persistent severe hyperglycemia was associated with the development of Stage II/III necrotizing enterocolitis , after adjusting for age and male gender ( OR : 9.49 , 95 % CI : 1.52 to 59.3 ) . Conclusion : Severe hyperglycemia in the first few days after birth is associated with increased odds of death and sepsis in ELBW infants OBJECTIVE : Morbidity and mortality of premature infants have decreased considerably over the last decades , therefore , adequate nutrition of the premature is a major concern . Enteral feeding is the route of choice , but when it is not possible the parenteral route , which contains glucose as one of its main components , is used . Glucose infusions are not devoid of risk as they facilitate the development of hyperglycemia leading to intracranial hemorrhage , glucosuria and dehydration . The aim of this paper is to relate hyperglycemia and glucosuria to birth weight , gestational age and glucose infusion rate . METHODS : The study was developed at the Nursery of Santa Catarina Hospital ( São Paulo ) . The authors developed a prospect i ve study ; 511 concurrent determinations of glycemia and qualitative glucosuria were performed in 40 preterm newborn infants receiving parenteral glucose ( mean of 12.8 dosages per newborn ) . RESULTS : Fifty-nine ( 11.5 % ) episodes of hyperglycemia were detected , and their frequency was higher at lower gestational ages ( < /=34 weeks ) , lower birth weights ( < 1500 g ) and higher glucose infusion rates ( > /= 6 mg/kg/min ) . Thirty-one ( 6.1 % ) episodes of glucosuria were detected , and were more frequent in lower gestational ages ( < /= 34 weeks ) , lower birth weights ( < 1500 g ) and higher glucose infusion rates ( > /= 6 mg/kg/min ) . CONCLUSIONS : The frequency of hyperglycemia and glucosuria in preterm newborn infants receiving glucose infusion was higher in lower gestational ages , lower birth weights and higher glucose infusion rates . In preterm newborn infants it is necessary to observe the glucose infusion rate and its respective glycemia , in order to avoid the complications of hyperglycemia ABSTRACT : Small substrate stores and immature enzyme systems make preterm infants prone to develop hypoglycemia . Hy-perglycemia may also occur , particularly when these infants are given i.v . glucose . To evaluate the capacity for regulation of glucose production in response to glucose infusion , 10 newborn infants , born after 25–30 wk of gestation , were studied . Their glucose production rates ( GPR ) were calculated and the concentrations of glucose , insulin , and glucagon in plasma were measured during infusion of glucose at a rate of first 1.7 ± 0.2 and then 6.5 ± 0.3 mg·kg−1·min−1 ( 9.4 ± 1.1 and 36.1 ± 1.7 μmol·kg−1·min−1 ) ( mean ± SD ) . GPR was determined by use of D-6,6–2H2 glucose . When the rate of infusion of glucose was increased , GPR decreased from 4.3 ± 1.3 to 1.4 ± 1.1 mg-kg−1·min−1 ( 23.9 ± 7.2 to 7.8 ± 6.1 μmol·kg−l·min−1 ) ( mean ± SD ) ( p = 0.00006 ) . In addition , the plasma insulin concentration increased from 6±2 to 11±4 μU·mL ' ( p = 0.006 ) and the plasma glucose concentration from 3.6 ± 1.1 to 6.1 ± 1.3 mM ( mean ± SD ) ( p = 0.0002 ) , whereas the glucagon concentration remained unchanged . only the insulin concentration in plasma was significantly related to GPR . The results show that very immature newborn infants have an incomplete and varying capacity to respond to glucose infusion with suppression of glucose production . Insulin seems to be more important than plasma glucose in the regulation of glucose homeostasis in these infants OBJECTIVE Many extremely preterm infants develop hyperglycemia in the first week of life during continuous glucose infusion . The objective of this study was to determine whether defective insulin secretion or resistance to insulin was the primary factor involved in transient hyperglycemia of extremely preterm infants . METHODS A prospect i ve comparative study was conducted in appropriate-for-gestational-age preterm infants < 30 weeks of gestational age with the aim specifically to evaluate the serum levels of proinsulin , insulin , and C-peptide secreted during transient hyperglycemia by specific immunoassays . Three groups of infants were investigated hyperglycemic ( n = 15 ) and normoglycemic preterm neonates ( n = 12 ) and normal , term neonates ( n = 21 ) . In addition , the changes in beta-cell peptide levels were analyzed during and after intravenous insulin infusion in the hyperglycemic group . Data were analyzed using analysis of variance and analysis of variance for repeated measures . RESULTS At inclusion , insulin and C-peptide levels did not differ in hyperglycemic subjects and in preterm controls . Proinsulin concentration was significantly higher in the hyperglycemic group ( 36.5 + /- 3.9 vs 23.2 + /- 0.9 pmol/L ) . Compared with term neonates , proinsulin and C-peptide levels were higher in normoglycemic preterm infants ( 23.2 + /- 0.9 vs 18.9 + /- 2.71 pmol/L and 1.67 + /- 0.3 vs 0.62 + /- 0.12 nmol/L , respectively ) . During and after insulin infusion in hyperglycemic neonates , plasma glucose concentration fell and proinsulin and C-peptide levels were lowered ( 18.4 + /- 7.6 and 20.7 + /- 4.5 pmol/L , respectively ) . CONCLUSION These data suggest that 1 ) preterm neonates are sensitive to changes in plasma glucose concentration , but proinsulin processing to insulin is partially defective in hyperglycemic preterm neonates ; 2 ) hyperglycemic neonates are relatively resistant to insulin because higher insulin levels are needed to achieve euglycemia in this group compared with normoglycemic neonates . These results also show that insulin infusion is beneficial in extremely preterm infants with transient hyperglycemia Abstract Serum-insulin was investigated in eighteen premature infants during their first 24 hours of life .  Glucose infusions that produced blood-sugar levels over 250 mg . per 100 ml . result ed in only a slight elevation of the serum-insulin . Infusion of a mixture of essential aminoacids was associated with a striking increase in serum-insulin , with a mean peak of 153 μU per ml Abstract Background : Tight blood glucose control with intravenous insulin reduces morbidity and mortality in adult surgical intensive care patients . This has never been investigated in premature infants weighing ≤1500 g. We investigate the relationship between blood glucose levels repeatedly elevated > 150 mg/dL and median blood glucose levels in the first week of life on one h and , and morbidity and mortality in premature infants weighing ≤1500 g on the other . Patients and methods : The following data were collected from 252 premature infants weighing ≤1500 g at birth : demographic data , blood glucose levels at three set times during the day ( capillary and arterial ) in the first week of life , actual and relative elevation of blood glucose level ≥150 mg/dL , median blood glucose level , allocation of patients into groups according to number of elevated blood glucose levels ≥150 mg/dL ( 0 , 1–3 or ≥4 incidents ) , and median blood sugar level in relation to mortality and morbidity like IVH , ROP , and sepsis . Results : A significant increase in mortality ( P<0.0001 ) with increasing median blood glucose level and repeated ( ≥4 ) incidents of blood glucose levels ≥150 mg/dL and in infants with low gestational age ( < 27 weeks ) were observed . There was no correlation between blood glucose level and morbidity . Conclusion : Premature infants with low gestational age ( < 27 weeks ) , elevated median blood glucose levels and /or repeatedly elevated blood glucose levels ≥150 mg/dL have a significantly increased mortality . However , further prospect i ve studies considering the gestational age should determine the relationship between tight glucose control and mortality Greater protein intakes are 
    Output:
    
agent
***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: In order to determine the intravenous energy and nitrogen intakes required to achieve intrauterine rates of nitrogen accretion and growth , 30 studies were completed in 22 premature infants who were provided with various intakes of amino acids and energy ( glucose + /- lipid ) by peripheral vein infusion .  At constant nitrogen intake , increasing energy intake ( as lipid ) from 50 to 80 nonprotein kcal/kg/day result ed in significant increases in nitrogen retention and weight gain . Increasing nitrogen intake from 494 to 655 mg/kg/day at constant low energy intake ( mean = 53 kcal/kg/day ) had no effect on nitrogen retention or weight change ; however , at higher energy intakes ( mean = 81 kcal/kg/day ) increasing nitrogen intake correlated significantly with increasing nitrogen retention . At energy intakes greater than 70 kcal/kg/day the major determinant of nitrogen retention was nitrogen intake . When energy intake was greater than 70 kcal/kg/day , the infusion of nitrogen providing 430 to 560 mg/kg/day ( 2.7 to 3.5 gm protein/kg/day ) result ed in the duplication of intrauterine nitrogen accretion rates BACKGROUND . We hypothesized that in premature infants , retinal vascular growth retardation between birth and postmenstrual age of ∼30 to 32 weeks that initiates retinopathy of prematurity is paralleled by brain growth retardation . METHODS . In a prospect i ve longitudinal study , we measured postnatal head growth , retinopathy of prematurity stage , protein and energy intake , severity of illness and serum insulin-like growth factor-1 levels  in 58 preterm infants ( mean gestational age at birth : 27.6 weeks ) from birth until postmenstrual age of ∼40 weeks . RESULTS . Premature infant head growth decelerates dramatically after birth until postmenstrual age of ∼30 weeks . Head growth retardation coincides with retinal vascular growth suppression . Accelerated growth follows between post menstrual ages of ∼30 to 32 weeks and ∼40 weeks . The degree of head growth retardation up to postmenstrual age of 31 weeks corresponds to the degree of retinopathy of prematurity and to the degree of suppression of serum levels of insulin-like growth factor-1 . At postmenstrual age of 31 weeks , if a child ’s head circumference SD is below −2.5 , then the probability of also developing at least stage 3 retinopathy of prematurity increases fivefold compared with head circumference above −2.5 SD ( 32 % vs 6 % ) suggesting parallel processes in brain and retina . Serum insulin-like growth factor-1 levels correlate positively with head circumference SD score and with the degree of retinopathy of prematurity . CONCLUSIONS . The correlation between head and retinal growth is consistent with insulin growth factor-1 being one of the postnatal growth factors involved in this multifactorial process and also suggests that factors that contribute to retinopathy of prematurity during this critical period may also affect neurological dysfunction . Additional studies are required to establish this connection Objective : The purpose of this study was to determine the association between hyperglycemia and mortality and late-onset infections ( > 72 h ) in extremely low birth weight ( ELBW ) infants . Study design : Retrospective analysis of a prospect i ve cohort study of 201 ELBW infants who survived greater than 3 days after birth .  Mean morning glucose levels were categorized as normoglycemia ( < 120 mg/dl ) , mild-moderate hyperglycemia ( 120 to 179 mg/dl ) and severe hyperglycemia ( ⩾180 mg/dl ) . Hyperglycemia was further divided into early ( first 3 days of age ) and persistent ( first week of age ) . Logistic regression was performed to assess whether hyperglycemia was associated with either mortality or late-onset culture-proven infection , measured after 3 and 7 days of age . Results : Adjusting for age , the odds ratio ( OR ) for either dying or developing a late infection was 5.07 ( 95 % confidence interval ( CI ) : 1.06 to 24.3 ) for infants with early severe hyperglycemia and 6.26 ( 95 % CI : 0.73 to 54.0 ) for infants with persistent severe hyperglycemia . Adjusting for age , both severe early and persistent hyperglycemia were associated with increased mortality . Among survivors , there was no significant association between hyperglycemia and length of mechanical ventilation or length of hospital stay . Persistent severe hyperglycemia was associated with the development of Stage II/III necrotizing enterocolitis , after adjusting for age and male gender ( OR : 9.49 , 95 % CI : 1.52 to 59.3 ) . Conclusion : Severe hyperglycemia in the first few days after birth is associated with increased odds of death and sepsis in ELBW infants OBJECTIVE : Morbidity and mortality of premature infants have decreased considerably over the last decades , therefore , adequate nutrition of the premature is a major concern . Enteral feeding is the route of choice , but when it is not possible the parenteral route , which contains glucose as one of its main components , is used . Glucose infusions are not devoid of risk as they facilitate the development of hyperglycemia leading to intracranial hemorrhage , glucosuria and dehydration . The aim of this paper is to relate hyperglycemia and glucosuria to birth weight , gestational age and glucose infusion rate . METHODS : The study was developed at the Nursery of Santa Catarina Hospital ( São Paulo ) . The authors developed a prospect i ve study ; 511 concurrent determinations of glycemia and qualitative glucosuria were performed in 40 preterm newborn infants receiving parenteral glucose ( mean of 12.8 dosages per newborn ) . RESULTS : Fifty-nine ( 11.5 % ) episodes of hyperglycemia were detected , and their frequency was higher at lower gestational ages ( < /=34 weeks ) , lower birth weights ( < 1500 g ) and higher glucose infusion rates ( > /= 6 mg/kg/min ) . Thirty-one ( 6.1 % ) episodes of glucosuria were detected , and were more frequent in lower gestational ages ( < /= 34 weeks ) , lower birth weights ( < 1500 g ) and higher glucose infusion rates ( > /= 6 mg/kg/min ) . CONCLUSIONS : The frequency of hyperglycemia and glucosuria in preterm newborn infants receiving glucose infusion was higher in lower gestational ages , lower birth weights and higher glucose infusion rates . In preterm newborn infants it is necessary to observe the glucose infusion rate and its respective glycemia , in order to avoid the complications of hyperglycemia ABSTRACT : Small substrate stores and immature enzyme systems make preterm infants prone to develop hypoglycemia . Hy-perglycemia may also occur , particularly when these infants are given i.v . glucose . To evaluate the capacity for regulation of glucose production in response to glucose infusion , 10 newborn infants , born after 25–30 wk of gestation , were studied . Their glucose production rates ( GPR ) were calculated and the concentrations of glucose , insulin , and glucagon in plasma were measured during infusion of glucose at a rate of first 1.7 ± 0.2 and then 6.5 ± 0.3 mg·kg−1·min−1 ( 9.4 ± 1.1 and 36.1 ± 1.7 μmol·kg−1·min−1 ) ( mean ± SD ) . GPR was determined by use of D-6,6–2H2 glucose . When the rate of infusion of glucose was increased , GPR decreased from 4.3 ± 1.3 to 1.4 ± 1.1 mg-kg−1·min−1 ( 23.9 ± 7.2 to 7.8 ± 6.1 μmol·kg−l·min−1 ) ( mean ± SD ) ( p = 0.00006 ) . In addition , the plasma insulin concentration increased from 6±2 to 11±4 μU·mL ' ( p = 0.006 ) and the plasma glucose concentration from 3.6 ± 1.1 to 6.1 ± 1.3 mM ( mean ± SD ) ( p = 0.0002 ) , whereas the glucagon concentration remained unchanged . only the insulin concentration in plasma was significantly related to GPR . The results show that very immature newborn infants have an incomplete and varying capacity to respond to glucose infusion with suppression of glucose production . Insulin seems to be more important than plasma glucose in the regulation of glucose homeostasis in these infants OBJECTIVE Many extremely preterm infants develop hyperglycemia in the first week of life during continuous glucose infusion . The objective of this study was to determine whether defective insulin secretion or resistance to insulin was the primary factor involved in transient hyperglycemia of extremely preterm infants . METHODS A prospect i ve comparative study was conducted in appropriate-for-gestational-age preterm infants < 30 weeks of gestational age with the aim specifically to evaluate the serum levels of proinsulin , insulin , and C-peptide secreted during transient hyperglycemia by specific immunoassays . Three groups of infants were investigated hyperglycemic ( n = 15 ) and normoglycemic preterm neonates ( n = 12 ) and normal , term neonates ( n = 21 ) . In addition , the changes in beta-cell peptide levels were analyzed during and after intravenous insulin infusion in the hyperglycemic group . Data were analyzed using analysis of variance and analysis of variance for repeated measures . RESULTS At inclusion , insulin and C-peptide levels did not differ in hyperglycemic subjects and in preterm controls . Proinsulin concentration was significantly higher in the hyperglycemic group ( 36.5 + /- 3.9 vs 23.2 + /- 0.9 pmol/L ) . Compared with term neonates , proinsulin and C-peptide levels were higher in normoglycemic preterm infants ( 23.2 + /- 0.9 vs 18.9 + /- 2.71 pmol/L and 1.67 + /- 0.3 vs 0.62 + /- 0.12 nmol/L , respectively ) . During and after insulin infusion in hyperglycemic neonates , plasma glucose concentration fell and proinsulin and C-peptide levels were lowered ( 18.4 + /- 7.6 and 20.7 + /- 4.5 pmol/L , respectively ) . CONCLUSION These data suggest that 1 ) preterm neonates are sensitive to changes in plasma glucose concentration , but proinsulin processing to insulin is partially defective in hyperglycemic preterm neonates ; 2 ) hyperglycemic neonates are relatively resistant to insulin because higher insulin levels are needed to achieve euglycemia in this group compared with normoglycemic neonates . These results also show that insulin infusion is beneficial in extremely preterm infants with transient hyperglycemia Abstract Serum-insulin was investigated in eighteen premature infants during their first 24 hours of life .  Glucose infusions that produced blood-sugar levels over 250 mg . per 100 ml . result ed in only a slight elevation of the serum-insulin . Infusion of a mixture of essential aminoacids was associated with a striking increase in serum-insulin , with a mean peak of 153 μU per ml Abstract Background : Tight blood glucose control with intravenous insulin reduces morbidity and mortality in adult surgical intensive care patients . This has never been investigated in premature infants weighing ≤1500 g. We investigate the relationship between blood glucose levels repeatedly elevated > 150 mg/dL and median blood glucose levels in the first week of life on one h and , and morbidity and mortality in premature infants weighing ≤1500 g on the other . Patients and methods : The following data were collected from 252 premature infants weighing ≤1500 g at birth : demographic data , blood glucose levels at three set times during the day ( capillary and arterial ) in the first week of life , actual and relative elevation of blood glucose level ≥150 mg/dL , median blood glucose level , allocation of patients into groups according to number of elevated blood glucose levels ≥150 mg/dL ( 0 , 1–3 or ≥4 incidents ) , and median blood sugar level in relation to mortality and morbidity like IVH , ROP , and sepsis . Results : A significant increase in mortality ( P<0.0001 ) with increasing median blood glucose level and repeated ( ≥4 ) incidents of blood glucose levels ≥150 mg/dL and in infants with low gestational age ( < 27 weeks ) were observed . There was no correlation between blood glucose level and morbidity . Conclusion : Premature infants with low gestational age ( < 27 weeks ) , elevated median blood glucose levels and /or repeatedly elevated blood glucose levels ≥150 mg/dL have a significantly increased mortality . However , further prospect i ve studies considering the gestational age should determine the relationship between tight glucose control and mortality Greater protein intakes are 
    Output:
    