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 In previous cases , we have observed occasional hypoglycaemic episodes in preterm infants after initial intensive care . In this prospect i ve study , we determined the frequency and severity of abnormal tissue glucose ( TG ) in clinical ly stable preterm infants on full enteral nutrition . Methods Preterm infants born at < 1000 g ( n=23 ; G1 ) and birth weight 1000–1500 g ( n=18 ; G2 ) were studied at a postmenstrual age of 32±2 weeks ( G1 ) and 33±2 weeks ( G2 ) . Infants were fed two or three hourly , according to a st and ard bolus-nutrition protocol , and continuous subcutaneous glucose measurements were performed for 72 h. Normal glucose values were assumed at ≥2.5 mmol/L ( 45 mg/dL ) and ≤8.3 mmol/L ( 150 mg/dL ) . Frequency , severity and duration of glucose values beyond normal values were determined . Results We observed asymptomatic low TG values in 39 % of infants in G1 and in 44 % in G2 . High TG values were detected in 83 % in G1 and 61 % in G2 . Infants in G1 experienced prolonged and more severe low TG episodes , and also more frequent and severe high TG episodes . In G1 and G2 , 87 % and 67 % of the infants , respectively , showed glucose fluctuations characterised by rapid glucose increase followed by a rapid glucose drop after feeds . In more mature infants , glucose fluctuations were less pronounced and less dependent on enteral feeds . Conclusions Clinical ly stable well-developing preterm infants beyond their initial period of intensive care  show interstitial glucose instabilities exceeding values as low as 2.5 mmol/L and as high as 8.3 mmol/L. This novel observation may play an important role for the susceptibility of these high-risk infants for the development of the metabolic syndrome . Trial registration number German trial registration number DRKS00004590 In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias BACKGROUND Although feedings that are organized on an ad lib basis ( i.e. , in response to infant cues of hunger and of satiation ) could enhance an infant 's self-regulatory capacities for feeding , ad lib feeding of fully nipple-fed premature infants in a special care nursery has not been examined . OBJECTIVE To study whether the caloric and protein intake and weight change of fully nipple-fed preterm infants differed by the feeding regimen ( prescribed or ad lib ) and by the caloric density of the formula ( 20- or 24-kcalories per ounce ) . METHOD The 78 infants who participated in the study were r and omized to prescribed or ad lib feeding regimens and , within each regimen , were further r and omized to receive either 20-calorie or 24-kcalorie per ounce formula .  Dietary intake ( volume/kg , caloric intake/kg ) and weight change ( grams/kg gained or lost ) were assessed for each of the 5 study days . Multivariate data analysis was used to examine the effects of feeding regimen and caloric density on dietary intake and weight change , controlling biologic variables ( infant gender , race , lung disease diagnosis , treatment with supplemental oxygen , gestational age and weight at birth , and weight on the day prior to full nipple-feeding ) . RESULTS Overall , the ad lib feeding regimen had a negative effect on volume intake and caloric intake . Weight gain was influenced by caloric intake , but not by feeding regimen or the caloric density of the diet . With increased full nipple-feeding experience , caloric intake of ad lib feeders approached that of the infants fed on the prescribed regimen . CONCLUSIONS Development of self-regulatory capacities through ad lib feeding experience was indicated by infant regulation of the volume of intake by the caloric density of the formula , an unexpected finding . Furthermore , the approach of the caloric intake of infants on the ad lib regimen to that of infants on the prescribed regimen suggests they had gained skill in regulating intake with experience . Whether or not the trend for similar intakes would continue beyond 5 days is a question for further study In a series of 79 consecutive preterm infants who were ready for discharge , 14 ( 18 % ) infants were unable to maintain normal concentrations of blood glucose . This finding suggests that a significant number of preterm infants are at risk of hypoglycemia at home if a feed is omitted or delayed OBJECTIVE To examine the association of missed oral feeding opportunities among preterm infants with achievement of full oral feedings and length of hospitalization .  STUDY DESIGN A secondary analysis of clinical trial data was conducted . Study infants included in the analysis ( N = 89 ) were r and omized to one of four st and ardized feeding progression approaches ; detailed records on all feedings were maintained . The proportion of oral feeding opportunities reported as missed due to factors unrelated to the infant 's clinical condition was calculated for each infant . RESULTS The proportion of missed oral feeding opportunities per infant ranged from 0 to 0.12 ; 30 infants experienced one or more missed oral feeding opportunity . Each 1 % increase in the proportion of missed oral feeding opportunities extended the time to achieve full oral feeding by 1.45 days ( p = 0.007 ) and time to discharge by 1.36 days ( p = 0.047 ) . CONCLUSION Preterm infants ' missed oral feeding opportunities may adversely affect feeding outcomes and extend hospitalization Background Neurobehavioral disabilities occur in 5–15 % of preterm infants with an estimated 50–70 % of very low birth weight preterm infants experiencing later dysfunction , including cognitive , behavioral , and social delays that often persist into adulthood . Factors implicated in poor neurobehavioral and developmental outcomes are hospitalization in the neonatal intensive care unit ( NICU ) and inconsistent caregiving patterns . Although much underlying brain damage occurs in utero or shortly after birth , neuroprotective strategies can stop lesions from progressing , particularly when these strategies are used during the most sensitive periods of neural plasticity occurring months before term age . The purpose of this r and omized trial is to test the effect of a patterned feeding experience on preterm infants ’ neurobehavioral organization and development , cognitive function , and clinical outcomes . Methods This trial uses an experimental , longitudinal , 2-group design with 120 preterm infants . Infants are enrolled within the first week of life and r and omized to an experimental group receiving a patterned feeding experience from the first gavage feeding through discharge or to a control group receiving usual feeding care experience . The intervention involves a continuity of tactile experiences associated with feeding to train and build neuronal networks supportive of normal infant feeding experience . Primary outcomes are neurobehavioral organization as measured by Neurobehavioral Assessment of the Preterm Infant at 3 time points : the transition to oral feedings , NICU discharge , and 2 months corrected age . Secondary aims are cognitive function measured using the Bayley Scales of Infant and Toddler Development , Third Edition at 6 months corrected age , neurobehavioral development ( sucking organization , feeding performance , and heart rate variability ) , and clinical outcomes ( length of NICU stay and time to full oral feeding ) . The potential effects of demographic and biobehavioral factors ( perinatal events and conditions of maternal or fetal/newborn origin and immunologic and genetic biomarkers ) on the outcome variables will also be considered . Discussion Theoretically , the intervention provided at a critical time in neurologic system development and associated with a recurring event ( feeding ) should enhance neural connections that may be important for later development , particularly language and other cognitive and neurobehavioral organization skills . Trial registration NCT01577615 11 April 2012 Objective : To study whether a cue-based clinical pathway for oral feeding initiation and advancement of premature infants would result in earlier achievement of full oral feeding . Study Design : Age of achievement of full oral intake was compared for two groups of preterm infants ; a prospect i ve study group vs historic cohort controls . Study infants had oral feedings managed by nurses using a clinical pathway that relied on infant behavioral readiness signs to initiate and advance oral feedings . Controls had oral feedings managed by physician orders . Result : Fifty-one infants ( n=28 study and n=23 control ) were studied  . Gender distribution , gestational age , birth weight and ventilator days were not different between groups . Study infants reached full oral feedings 6 days earlier than controls ( 36±1 3/7 weeks of postmenstrual age ( PMA ) vs 36 6/7±1 4/7 weeks of PMA , P=0.02 ) . Conclusion : The cue-based clinical pathway for oral feeding initiation and advancement of premature infants result ed in earlier achievement of full oral feeding To compare the effects of dem and and schedule feeding in premature infants who weighed less than 2500 grams at birth and who were appropriate for gestational age , 36 premature infants were studied . Premature infants were assigned r and omly to either dem and ( N = 18 ) or scheduled ( N = 18 ) feedings in a regional NICU in a metropolitan hospital . Infants that were allowed to feed on dem and took amounts of formula and calories similar to those infants who were fed specified amounts of formula every three or four hours . Dem and -fed infants were bottle-feeding well enough to be discharged earlier than schedule-fed infants , required fewer feedings per day , and needed fewer gavage feedings . No complications related to feedings were seen in either group OBJECTIVE To investigate the effects of neonatal hypoglycemia on physical growth and neurocognitive function . STUDY DESIGN A systematic detection of  hypoglycemia  ( < 2.6 mmol/L or 47 mg/dL ) was carried out in 85 small-for-gestational-age preterm neonates . Prospect i ve serial evaluations of physical growth and psychomotor development were performed . Retrospectively , infants were grouped according to their glycemic status . RESULTS The incidence of hypoglycemia was 72.9 % . Infants with repeated episodes of hypoglycemia had significantly reduced head circumferences and lower scores in specific psychometric tests at 3.5 years of age . Hypoglycemia also caused reduced head circumferences at 18 months and lower psychometric scores at 5 years of age . Infants with moderate recurrent hypoglycemia had lower scores at 3.5 and 5 years of age compared with the group of infants who had 1 single severe hypoglycemic episode . CONCLUSION Recurrent episodes of hypoglycemia were strongly correlated with persistent neurodevelopmental and physical growth deficits until 5 years of age . Recurrent hypoglycemia also was a more predictable factor for long-term effects than the severity of a single hypoglycemic episode . Therefore repetitive blood glucose monitoring and rapid treatment even for mild hypoglycemia are recommended for small-for-gestational-age infants in the neonatal period BACKGROUND AND PURPOSE In hospitals , preterm infants are routinely fed specified amounts of formula on a fixed schedule . This results in the baby 's intake volume being regular and easily confirmed , but does not consider the individual baby 's needs . The purpose of this study was to compare the effects of dem and feeding and fixed schedule feeding for healthy premature newborn babies . METHODS A 2-feeding-type , 2-period crossover study design was employed , in which each period consisted of 2 days , the first of which was a washout period , comprising a self-comparison protocol design ed to identify any differences in the feeding characteristics of premature infants on dem and or scheduled bottle-feeding . Eleven preterm infants were included . The sample size was monitored during the observation period by power calculation . The mean weight at study entry was 1897.27 + /- 175.94 g and the mean postconceptional age was 35.34 + /- 1.54 weeks . RESULTS Compared with scheduled feeding , dem and feeding was associated with a longer daily mean interval ( 4.17 vs 3.02 hours ; p = 0.00 ) , greater volume per feed for dem and feeding ( 67.28 vs 51.11 ; p = 0.00 ) , greater feeding speed ( 5.73 vs 4.51 mL/min ; p = 0.00 ) , but a similar daily total duration of feeding . There was no significant difference in the daily total feeding volume . CONCLUSIONS Dem and feeding provides superior volume per feed , and feeding speed and short 
    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: Objective In previous cases , we have observed occasional hypoglycaemic episodes in preterm infants after initial intensive care . In this prospect i ve study , we determined the frequency and severity of abnormal tissue glucose ( TG ) in clinical ly stable preterm infants on full enteral nutrition . Methods Preterm infants born at < 1000 g ( n=23 ; G1 ) and birth weight 1000–1500 g ( n=18 ; G2 ) were studied at a postmenstrual age of 32±2 weeks ( G1 ) and 33±2 weeks ( G2 ) . Infants were fed two or three hourly , according to a st and ard bolus-nutrition protocol , and continuous subcutaneous glucose measurements were performed for 72 h. Normal glucose values were assumed at ≥2.5 mmol/L ( 45 mg/dL ) and ≤8.3 mmol/L ( 150 mg/dL ) . Frequency , severity and duration of glucose values beyond normal values were determined . Results We observed asymptomatic low TG values in 39 % of infants in G1 and in 44 % in G2 . High TG values were detected in 83 % in G1 and 61 % in G2 . Infants in G1 experienced prolonged and more severe low TG episodes , and also more frequent and severe high TG episodes . In G1 and G2 , 87 % and 67 % of the infants , respectively , showed glucose fluctuations characterised by rapid glucose increase followed by a rapid glucose drop after feeds . In more mature infants , glucose fluctuations were less pronounced and less dependent on enteral feeds . Conclusions Clinical ly stable well-developing preterm infants beyond their initial period of intensive care  show interstitial glucose instabilities exceeding values as low as 2.5 mmol/L and as high as 8.3 mmol/L. This novel observation may play an important role for the susceptibility of these high-risk infants for the development of the metabolic syndrome . Trial registration number German trial registration number DRKS00004590 In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias BACKGROUND Although feedings that are organized on an ad lib basis ( i.e. , in response to infant cues of hunger and of satiation ) could enhance an infant 's self-regulatory capacities for feeding , ad lib feeding of fully nipple-fed premature infants in a special care nursery has not been examined . OBJECTIVE To study whether the caloric and protein intake and weight change of fully nipple-fed preterm infants differed by the feeding regimen ( prescribed or ad lib ) and by the caloric density of the formula ( 20- or 24-kcalories per ounce ) . METHOD The 78 infants who participated in the study were r and omized to prescribed or ad lib feeding regimens and , within each regimen , were further r and omized to receive either 20-calorie or 24-kcalorie per ounce formula .  Dietary intake ( volume/kg , caloric intake/kg ) and weight change ( grams/kg gained or lost ) were assessed for each of the 5 study days . Multivariate data analysis was used to examine the effects of feeding regimen and caloric density on dietary intake and weight change , controlling biologic variables ( infant gender , race , lung disease diagnosis , treatment with supplemental oxygen , gestational age and weight at birth , and weight on the day prior to full nipple-feeding ) . RESULTS Overall , the ad lib feeding regimen had a negative effect on volume intake and caloric intake . Weight gain was influenced by caloric intake , but not by feeding regimen or the caloric density of the diet . With increased full nipple-feeding experience , caloric intake of ad lib feeders approached that of the infants fed on the prescribed regimen . CONCLUSIONS Development of self-regulatory capacities through ad lib feeding experience was indicated by infant regulation of the volume of intake by the caloric density of the formula , an unexpected finding . Furthermore , the approach of the caloric intake of infants on the ad lib regimen to that of infants on the prescribed regimen suggests they had gained skill in regulating intake with experience . Whether or not the trend for similar intakes would continue beyond 5 days is a question for further study In a series of 79 consecutive preterm infants who were ready for discharge , 14 ( 18 % ) infants were unable to maintain normal concentrations of blood glucose . This finding suggests that a significant number of preterm infants are at risk of hypoglycemia at home if a feed is omitted or delayed OBJECTIVE To examine the association of missed oral feeding opportunities among preterm infants with achievement of full oral feedings and length of hospitalization .  STUDY DESIGN A secondary analysis of clinical trial data was conducted . Study infants included in the analysis ( N = 89 ) were r and omized to one of four st and ardized feeding progression approaches ; detailed records on all feedings were maintained . The proportion of oral feeding opportunities reported as missed due to factors unrelated to the infant 's clinical condition was calculated for each infant . RESULTS The proportion of missed oral feeding opportunities per infant ranged from 0 to 0.12 ; 30 infants experienced one or more missed oral feeding opportunity . Each 1 % increase in the proportion of missed oral feeding opportunities extended the time to achieve full oral feeding by 1.45 days ( p = 0.007 ) and time to discharge by 1.36 days ( p = 0.047 ) . CONCLUSION Preterm infants ' missed oral feeding opportunities may adversely affect feeding outcomes and extend hospitalization Background Neurobehavioral disabilities occur in 5–15 % of preterm infants with an estimated 50–70 % of very low birth weight preterm infants experiencing later dysfunction , including cognitive , behavioral , and social delays that often persist into adulthood . Factors implicated in poor neurobehavioral and developmental outcomes are hospitalization in the neonatal intensive care unit ( NICU ) and inconsistent caregiving patterns . Although much underlying brain damage occurs in utero or shortly after birth , neuroprotective strategies can stop lesions from progressing , particularly when these strategies are used during the most sensitive periods of neural plasticity occurring months before term age . The purpose of this r and omized trial is to test the effect of a patterned feeding experience on preterm infants ’ neurobehavioral organization and development , cognitive function , and clinical outcomes . Methods This trial uses an experimental , longitudinal , 2-group design with 120 preterm infants . Infants are enrolled within the first week of life and r and omized to an experimental group receiving a patterned feeding experience from the first gavage feeding through discharge or to a control group receiving usual feeding care experience . The intervention involves a continuity of tactile experiences associated with feeding to train and build neuronal networks supportive of normal infant feeding experience . Primary outcomes are neurobehavioral organization as measured by Neurobehavioral Assessment of the Preterm Infant at 3 time points : the transition to oral feedings , NICU discharge , and 2 months corrected age . Secondary aims are cognitive function measured using the Bayley Scales of Infant and Toddler Development , Third Edition at 6 months corrected age , neurobehavioral development ( sucking organization , feeding performance , and heart rate variability ) , and clinical outcomes ( length of NICU stay and time to full oral feeding ) . The potential effects of demographic and biobehavioral factors ( perinatal events and conditions of maternal or fetal/newborn origin and immunologic and genetic biomarkers ) on the outcome variables will also be considered . Discussion Theoretically , the intervention provided at a critical time in neurologic system development and associated with a recurring event ( feeding ) should enhance neural connections that may be important for later development , particularly language and other cognitive and neurobehavioral organization skills . Trial registration NCT01577615 11 April 2012 Objective : To study whether a cue-based clinical pathway for oral feeding initiation and advancement of premature infants would result in earlier achievement of full oral feeding . Study Design : Age of achievement of full oral intake was compared for two groups of preterm infants ; a prospect i ve study group vs historic cohort controls . Study infants had oral feedings managed by nurses using a clinical pathway that relied on infant behavioral readiness signs to initiate and advance oral feedings . Controls had oral feedings managed by physician orders . Result : Fifty-one infants ( n=28 study and n=23 control ) were studied  . Gender distribution , gestational age , birth weight and ventilator days were not different between groups . Study infants reached full oral feedings 6 days earlier than controls ( 36±1 3/7 weeks of postmenstrual age ( PMA ) vs 36 6/7±1 4/7 weeks of PMA , P=0.02 ) . Conclusion : The cue-based clinical pathway for oral feeding initiation and advancement of premature infants result ed in earlier achievement of full oral feeding To compare the effects of dem and and schedule feeding in premature infants who weighed less than 2500 grams at birth and who were appropriate for gestational age , 36 premature infants were studied . Premature infants were assigned r and omly to either dem and ( N = 18 ) or scheduled ( N = 18 ) feedings in a regional NICU in a metropolitan hospital . Infants that were allowed to feed on dem and took amounts of formula and calories similar to those infants who were fed specified amounts of formula every three or four hours . Dem and -fed infants were bottle-feeding well enough to be discharged earlier than schedule-fed infants , required fewer feedings per day , and needed fewer gavage feedings . No complications related to feedings were seen in either group OBJECTIVE To investigate the effects of neonatal hypoglycemia on physical growth and neurocognitive function . STUDY DESIGN A systematic detection of  hypoglycemia  ( < 2.6 mmol/L or 47 mg/dL ) was carried out in 85 small-for-gestational-age preterm neonates . Prospect i ve serial evaluations of physical growth and psychomotor development were performed . Retrospectively , infants were grouped according to their glycemic status . RESULTS The incidence of hypoglycemia was 72.9 % . Infants with repeated episodes of hypoglycemia had significantly reduced head circumferences and lower scores in specific psychometric tests at 3.5 years of age . Hypoglycemia also caused reduced head circumferences at 18 months and lower psychometric scores at 5 years of age . Infants with moderate recurrent hypoglycemia had lower scores at 3.5 and 5 years of age compared with the group of infants who had 1 single severe hypoglycemic episode . CONCLUSION Recurrent episodes of hypoglycemia were strongly correlated with persistent neurodevelopmental and physical growth deficits until 5 years of age . Recurrent hypoglycemia also was a more predictable factor for long-term effects than the severity of a single hypoglycemic episode . Therefore repetitive blood glucose monitoring and rapid treatment even for mild hypoglycemia are recommended for small-for-gestational-age infants in the neonatal period BACKGROUND AND PURPOSE In hospitals , preterm infants are routinely fed specified amounts of formula on a fixed schedule . This results in the baby 's intake volume being regular and easily confirmed , but does not consider the individual baby 's needs . The purpose of this study was to compare the effects of dem and feeding and fixed schedule feeding for healthy premature newborn babies . METHODS A 2-feeding-type , 2-period crossover study design was employed , in which each period consisted of 2 days , the first of which was a washout period , comprising a self-comparison protocol design ed to identify any differences in the feeding characteristics of premature infants on dem and or scheduled bottle-feeding . Eleven preterm infants were included . The sample size was monitored during the observation period by power calculation . The mean weight at study entry was 1897.27 + /- 175.94 g and the mean postconceptional age was 35.34 + /- 1.54 weeks . RESULTS Compared with scheduled feeding , dem and feeding was associated with a longer daily mean interval ( 4.17 vs 3.02 hours ; p = 0.00 ) , greater volume per feed for dem and feeding ( 67.28 vs 51.11 ; p = 0.00 ) , greater feeding speed ( 5.73 vs 4.51 mL/min ; p = 0.00 ) , but a similar daily total duration of feeding . There was no significant difference in the daily total feeding volume . CONCLUSIONS Dem and feeding provides superior volume per feed , and feeding speed and short 
    Output:
    