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: PURPOSE The aim of this study was to investigate the effect of the application of the odor of breast milk in preterm infants during gavage feeding  on the period of transition to total oral feeding . DESIGN This prospect i ve experimental study was performed on a total of 80 preterm infants : 40 infants in the study group and 40 in the control group . METHODS This experimental study was performed in eastern Turkey at the Neonatal Intensive Care and Premature Unit of a university hospital between September 2007 and December 2008 . The demographic data were collected via a question naire , and an intervention and follow-up table was prepared by the research er based on relevant literature . The study was approved by the local institution , and written informed consent was obtained from all parents . FINDINGS The findings of the study indicated that the preterm infants who were stimulated by the odor of breast milk during gavage feeding transitioned to oral feeding 3 days earlier than control subjects . Moreover , the mean hospitalization time of these infants was 4 days shorter . CONCLUSIONS The results show that stimulation with breast milk odor is an effective method for decreasing transition of preterm infants from gavage to oral feeding . CLINICAL RELEVANCE Nurses can train mothers to pump their breast milk , stimulate their infants with the odor of their breast milk , and feed it to their infants in the premature unit . This may lead to a quicker transition to oral feeding Objective The aim of the present work was to assess the value of  non-nutritive sucking ( NNS ) measures as predictors of oral feeding performance in comparison to other putative predictors of feeding skills : respiratory support , post-menstrual age ( PMA ) at birth and the neonatal oral motor assessment score ( NOMAS ) . Methods This was a prospect i ve , observational study . Cox proportional hazards and non-parametric rank sum tests were used to assess the relationship between NNS and feeding outcome measures . The setting was neonatal intensive care units ( NICU ) in rural/academic , urban/tertiary centres in the USA . In all , 51 premature infants born between 25 and 34 weeks ' PMA , birth weight 1512.3±499.4 g , were included in this study . Interventions were measurement of NNS , st and ardised feeding advance schedule , performance of NOMAS , and st and ardised , permissive , oral feeding advance schedule . Main outcome measures were transition time from first to full oral feeding ( FOF ) and gestational age at FOF . Results Higher NNS organisation scores predicted shorter transition to FOF ( p<0.05 ) : infants with a more organised suck pattern reached independent oral feeding 3 days earlier ( 16 vs 13 day transition ) than infants with more chaotic patterns of suck bursts . Consistency of the suck waves also corresponded with feeding milestones : infants with more regular suck wave pressure deflections became competent oral feeders approximately 3 days earlier than those with irregular suck pressure waves . PMA at birth was inversely associated with PMA at FOF . NOMAS measures were not associated with outcome measures . Conclusions Measures of NNS organisation and suck consistency constitute useful c and i date predictors of feeding performance by premature infants . The results accord with previous findings linking PMA at birth with age at independent feeding OBJECTIVE To determine the influence of non-nutritive sucking and oral stimulation programs on breastfeeding rates at discharge , at 3 and at 6 months of corrected age in preterm infants with very low birth weight . METHODS Preterm infants were r and omized into experimental and control groups . Ninety-eight preterm infants were r and omized and 96 remained in the study until reaching the corrected age of 6 months . The experimental group received sensory-motor-oral stimulation and non-nutritive sucking , while infants in the control group received a sham stimulation program . Both were administered from reaching enteral feeding ( 100 kcal/kg/day ) until the beginning of oral feeding . RESULTS Fifty-nine infants ( 61.5 % ) were breastfeeding at the time of hospital discharge , 31 ( 36.9 % ) at 3 months , and only 18 ( 20.5 % ) at 6 months of corrected age . At discharge , 46.9 % of the control group and 76.5 % of the experimental group were breastfeeding . There were statistically significant differences between rates of breastfeeding at discharge ( 47 vs. 76 % ) , 3 months ( 18 vs. 47 % ) and 6 months after discharge ( 10 vs. 27 % ) . The experimental group showed significantly higher rates of breastfeeding ( p < 0.05 ) . CONCLUSION Non-nutritive sucking , associated with oral stimulation programs , can contribute to the improvement of breastfeeding rates among preterm infants with very low birth weight We have shown that a controlled-flow vacuum-free bottle system ( CFVFB ) vs. a st and ard bottle ( SB ) facilitates overall transfer and rate of milk transfer , and shortens oral feeding duration in very-low-birth-weight ( VLBW ) infants . We aim ed to underst and the basis by which this occurs . Thirty infants ( 19 males ; 27 ± 1 weeks gestation ) were r and omized to a CFVFB or SB . Outcomes monitored at 1–2 and 6–8 oral feedings/day when infants were around 34 and 36 weeks postmenstrual age , respectively , included : overall transfer ( % volume taken/volume prescribed ) , rate of milk transfer ( ml/min ) , sucking stage , frequency of suction ( # S/s ) and expression ( # E/s ) , suction amplitude ( mmHg ) , and sucking burst duration ( s ) . At both periods we confirmed that infants using a CFVFB vs. SB demonstrated greater overall transfer and rate of milk transfer , along with more mature sucking stages . Suction and expression frequencies were decreased with CFVFB vs. SB at 1–2 oral feeding/day ; only that of suction was reduced at 6–8 oral feedings/day . No group differences in suction amplitude and burst duration were observed . We speculate that oral feeding performance improves without significant change in sucking effort with a CFVFB vs. SB . In addition , we have shown that VLBW infants can tolerate faster milk flow than currently presumed . Finally , the use of a CFVFB may reduce energy expenditure as it enhances feeding performance without increasing sucking effort 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 AIM The aim of this study was to determine whether oral , tactile/kinaesthetic ( T/K ) , or combined ( oral+T/K ) interventions enhance oral feeding performance and whether combined interventions have an additive/synergistic effect . METHOD Seventy-five preterm infants ( mean gestational age 29 wk ; st and ard error of the mean [ SEM ] 0.3 wk ; mean birthweight 1340.3 g ; SEM 52.5 g ; 49 males and 26 females ) were r and omly assigned to one of three intervention groups or a control group . The oral group received sensorimotor input to the oral structures , the T/K group received sensorimotor input to the trunk and limbs , and the combined group received both . The outcomes were time from introduction of nipple feeding to independent oral feeding ( d ) , proficiency ( intake in the first 5 min , % ) , volume transfer ( % ) , rate of transfer ( mL/min ) , volume loss ( % ) , and length of hospital stay ( d ) . RESULTS Infants in the three intervention groups achieved independent oral feeding 9 - 10 days earlier than those in the control group ( p<0.001 ; effect size 1.9 - 2.1 ) . Proficiency ( p ≤ 0.002 ; effect size 0.7 - 1.4 ) at the time of one to two and three to five oral feedings per day , volume transfer ( p ≤ 0.001 ; effect size 0.8 - 1.1 ) at one to two , three to five , and six to eight oral feedings per day , and overall rate of transfer ( p ≤ 0.018 ; effect size 0.8 - 1.1 ) were greater , and overall volume losses were less ( p ≤ 0.007 ; effect size 0.9 - 1.1 ) , than in the control group ( p ≤ 0.042 ) . The combined group attained independent oral feeding at a significantly younger postmenstrual age than controls ( p=0.020 ) and had clinical ly greater proficiency than the T/K group ( p=0.020 ; effect size 0.7 ) and oral group ( p=0.109 ; effect size 0.5 ) . Length of hospital stay was not significantly different between groups ( p=0.792 ; effect size 0.02 - 0.3 ) . INTERPRETATION Oral and T/K interventions accelerated the transition from introduction to independent oral feeding and enhanced oral feeding skills . T/K has beneficial effects beyond the specific targeted system . The combined sensorimotor intervention led to an additive/synergistic effect for proficiency , further benefiting this population The objective of the present study was to determine the  oral motor capacity  and the feeding performance of preterm newborn infants when they were permitted to start oral feeding . This was an observational and prospect i ve study conducted on 43 preterm newborns admitted to the Neonatal Intensive Care Unit of UFSM , RS , Brazil . Exclusion criteria were the presence of head and neck malformations , genetic disease , neonatal asphyxia , intracranial hemorrhage , and kernicterus . When the infants were permitted to start oral feeding , non-nutritive sucking was evaluated by a speech therapist regarding force ( strong vs weak ) , rhythm ( rapid vs slow ) , presence of adaptive oral reflexes ( search ing , sucking and swallowing ) and coordination between sucking , swallowing and respiration . Feeding performance was evaluated on the basis of competence ( defined by rate of milk intake , mL/min ) and overall transfer ( percent ingested volume/total volume ordered ) . The speech therapist 's evaluation showed that 33 % of the newborns presented weak sucking , 23 % slow rhythm , 30 % absence of at least one adaptive oral reflex , and 14 % with no coordination between sucking , swallowing and respiration . Mean feeding competence was greater in infants with strong sucking fast rhythm . The presence of sucking-swallowing-respiration coordination decreased the days for an overall transfer of 100 % . Evaluation by a speech therapist proved to be a useful tool for the safe indication of the beginning of oral feeding for premature infants This study assessed the effect of an oral stimulation program on the maturation of sucking skills of preterm infants . Thirty-two preterm infants ( 13 males , 19 females ) , appropriate size for gestational age ( gestational age at birth 28 wks , SD 1.2wks ; birthweight 1002 g , SD 251 g ) , were r and omly placed into experimental and control groups . The experimental group received a daily 15-minute oral stimulation program , consisting of stroking the peri- and intra-oral structures , for 10 days before the start of oral feedings .  Sucking measures were monitored with a specially- design ed nipple-bottle apparatus . Results indicate that the experimental group achieved full oral feedings 7 days sooner than the control group , and demonstrated greater overall intake ( % ) , rate of milk transfer ( mL/min ) , and amplitude of the expression component of sucking ( mmHg ) . There was no difference in sucking stage maturation , sucking frequency , and amplitude of the suction component of sucking . Endurance , defined as ability to sustain the same sucking stage , sucking burst duration , and suction and expression amplitudes throughout a feeding session , was not significantly different between the two groups . The stimulation program enhanced the expression component of sucking , result ing in better oral feeding performance OBJECTIVE To assess whether an oral stimulation program , before the introduction of oral feeding , enhances the oral feeding performance of preterm infants born between 26 and 29 weeks ' gestational age . STUDY DESIGN Preterm infants ( n = 32 ) were r and omized into an experimental and control group . Infants in the experimental group received an oral stimulation program consisting of stimulation of the oral structures for 15 minutes . Infants in the control group received a sham stimulation program . Both were administered once per day for 10 consecutive days , 48 hours after discontinuation of nasal continuous positive air pressure . RESULTS Independent oral feeding was attained significantly earlier in the experimental group than the control group , 11 + /- 4 days ( mean + /- SD ) versus 1 
    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: PURPOSE The aim of this study was to investigate the effect of the application of the odor of breast milk in preterm infants during gavage feeding  on the period of transition to total oral feeding . DESIGN This prospect i ve experimental study was performed on a total of 80 preterm infants : 40 infants in the study group and 40 in the control group . METHODS This experimental study was performed in eastern Turkey at the Neonatal Intensive Care and Premature Unit of a university hospital between September 2007 and December 2008 . The demographic data were collected via a question naire , and an intervention and follow-up table was prepared by the research er based on relevant literature . The study was approved by the local institution , and written informed consent was obtained from all parents . FINDINGS The findings of the study indicated that the preterm infants who were stimulated by the odor of breast milk during gavage feeding transitioned to oral feeding 3 days earlier than control subjects . Moreover , the mean hospitalization time of these infants was 4 days shorter . CONCLUSIONS The results show that stimulation with breast milk odor is an effective method for decreasing transition of preterm infants from gavage to oral feeding . CLINICAL RELEVANCE Nurses can train mothers to pump their breast milk , stimulate their infants with the odor of their breast milk , and feed it to their infants in the premature unit . This may lead to a quicker transition to oral feeding Objective The aim of the present work was to assess the value of  non-nutritive sucking ( NNS ) measures as predictors of oral feeding performance in comparison to other putative predictors of feeding skills : respiratory support , post-menstrual age ( PMA ) at birth and the neonatal oral motor assessment score ( NOMAS ) . Methods This was a prospect i ve , observational study . Cox proportional hazards and non-parametric rank sum tests were used to assess the relationship between NNS and feeding outcome measures . The setting was neonatal intensive care units ( NICU ) in rural/academic , urban/tertiary centres in the USA . In all , 51 premature infants born between 25 and 34 weeks ' PMA , birth weight 1512.3±499.4 g , were included in this study . Interventions were measurement of NNS , st and ardised feeding advance schedule , performance of NOMAS , and st and ardised , permissive , oral feeding advance schedule . Main outcome measures were transition time from first to full oral feeding ( FOF ) and gestational age at FOF . Results Higher NNS organisation scores predicted shorter transition to FOF ( p<0.05 ) : infants with a more organised suck pattern reached independent oral feeding 3 days earlier ( 16 vs 13 day transition ) than infants with more chaotic patterns of suck bursts . Consistency of the suck waves also corresponded with feeding milestones : infants with more regular suck wave pressure deflections became competent oral feeders approximately 3 days earlier than those with irregular suck pressure waves . PMA at birth was inversely associated with PMA at FOF . NOMAS measures were not associated with outcome measures . Conclusions Measures of NNS organisation and suck consistency constitute useful c and i date predictors of feeding performance by premature infants . The results accord with previous findings linking PMA at birth with age at independent feeding OBJECTIVE To determine the influence of non-nutritive sucking and oral stimulation programs on breastfeeding rates at discharge , at 3 and at 6 months of corrected age in preterm infants with very low birth weight . METHODS Preterm infants were r and omized into experimental and control groups . Ninety-eight preterm infants were r and omized and 96 remained in the study until reaching the corrected age of 6 months . The experimental group received sensory-motor-oral stimulation and non-nutritive sucking , while infants in the control group received a sham stimulation program . Both were administered from reaching enteral feeding ( 100 kcal/kg/day ) until the beginning of oral feeding . RESULTS Fifty-nine infants ( 61.5 % ) were breastfeeding at the time of hospital discharge , 31 ( 36.9 % ) at 3 months , and only 18 ( 20.5 % ) at 6 months of corrected age . At discharge , 46.9 % of the control group and 76.5 % of the experimental group were breastfeeding . There were statistically significant differences between rates of breastfeeding at discharge ( 47 vs. 76 % ) , 3 months ( 18 vs. 47 % ) and 6 months after discharge ( 10 vs. 27 % ) . The experimental group showed significantly higher rates of breastfeeding ( p < 0.05 ) . CONCLUSION Non-nutritive sucking , associated with oral stimulation programs , can contribute to the improvement of breastfeeding rates among preterm infants with very low birth weight We have shown that a controlled-flow vacuum-free bottle system ( CFVFB ) vs. a st and ard bottle ( SB ) facilitates overall transfer and rate of milk transfer , and shortens oral feeding duration in very-low-birth-weight ( VLBW ) infants . We aim ed to underst and the basis by which this occurs . Thirty infants ( 19 males ; 27 ± 1 weeks gestation ) were r and omized to a CFVFB or SB . Outcomes monitored at 1–2 and 6–8 oral feedings/day when infants were around 34 and 36 weeks postmenstrual age , respectively , included : overall transfer ( % volume taken/volume prescribed ) , rate of milk transfer ( ml/min ) , sucking stage , frequency of suction ( # S/s ) and expression ( # E/s ) , suction amplitude ( mmHg ) , and sucking burst duration ( s ) . At both periods we confirmed that infants using a CFVFB vs. SB demonstrated greater overall transfer and rate of milk transfer , along with more mature sucking stages . Suction and expression frequencies were decreased with CFVFB vs. SB at 1–2 oral feeding/day ; only that of suction was reduced at 6–8 oral feedings/day . No group differences in suction amplitude and burst duration were observed . We speculate that oral feeding performance improves without significant change in sucking effort with a CFVFB vs. SB . In addition , we have shown that VLBW infants can tolerate faster milk flow than currently presumed . Finally , the use of a CFVFB may reduce energy expenditure as it enhances feeding performance without increasing sucking effort 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 AIM The aim of this study was to determine whether oral , tactile/kinaesthetic ( T/K ) , or combined ( oral+T/K ) interventions enhance oral feeding performance and whether combined interventions have an additive/synergistic effect . METHOD Seventy-five preterm infants ( mean gestational age 29 wk ; st and ard error of the mean [ SEM ] 0.3 wk ; mean birthweight 1340.3 g ; SEM 52.5 g ; 49 males and 26 females ) were r and omly assigned to one of three intervention groups or a control group . The oral group received sensorimotor input to the oral structures , the T/K group received sensorimotor input to the trunk and limbs , and the combined group received both . The outcomes were time from introduction of nipple feeding to independent oral feeding ( d ) , proficiency ( intake in the first 5 min , % ) , volume transfer ( % ) , rate of transfer ( mL/min ) , volume loss ( % ) , and length of hospital stay ( d ) . RESULTS Infants in the three intervention groups achieved independent oral feeding 9 - 10 days earlier than those in the control group ( p<0.001 ; effect size 1.9 - 2.1 ) . Proficiency ( p ≤ 0.002 ; effect size 0.7 - 1.4 ) at the time of one to two and three to five oral feedings per day , volume transfer ( p ≤ 0.001 ; effect size 0.8 - 1.1 ) at one to two , three to five , and six to eight oral feedings per day , and overall rate of transfer ( p ≤ 0.018 ; effect size 0.8 - 1.1 ) were greater , and overall volume losses were less ( p ≤ 0.007 ; effect size 0.9 - 1.1 ) , than in the control group ( p ≤ 0.042 ) . The combined group attained independent oral feeding at a significantly younger postmenstrual age than controls ( p=0.020 ) and had clinical ly greater proficiency than the T/K group ( p=0.020 ; effect size 0.7 ) and oral group ( p=0.109 ; effect size 0.5 ) . Length of hospital stay was not significantly different between groups ( p=0.792 ; effect size 0.02 - 0.3 ) . INTERPRETATION Oral and T/K interventions accelerated the transition from introduction to independent oral feeding and enhanced oral feeding skills . T/K has beneficial effects beyond the specific targeted system . The combined sensorimotor intervention led to an additive/synergistic effect for proficiency , further benefiting this population The objective of the present study was to determine the  oral motor capacity  and the feeding performance of preterm newborn infants when they were permitted to start oral feeding . This was an observational and prospect i ve study conducted on 43 preterm newborns admitted to the Neonatal Intensive Care Unit of UFSM , RS , Brazil . Exclusion criteria were the presence of head and neck malformations , genetic disease , neonatal asphyxia , intracranial hemorrhage , and kernicterus . When the infants were permitted to start oral feeding , non-nutritive sucking was evaluated by a speech therapist regarding force ( strong vs weak ) , rhythm ( rapid vs slow ) , presence of adaptive oral reflexes ( search ing , sucking and swallowing ) and coordination between sucking , swallowing and respiration . Feeding performance was evaluated on the basis of competence ( defined by rate of milk intake , mL/min ) and overall transfer ( percent ingested volume/total volume ordered ) . The speech therapist 's evaluation showed that 33 % of the newborns presented weak sucking , 23 % slow rhythm , 30 % absence of at least one adaptive oral reflex , and 14 % with no coordination between sucking , swallowing and respiration . Mean feeding competence was greater in infants with strong sucking fast rhythm . The presence of sucking-swallowing-respiration coordination decreased the days for an overall transfer of 100 % . Evaluation by a speech therapist proved to be a useful tool for the safe indication of the beginning of oral feeding for premature infants This study assessed the effect of an oral stimulation program on the maturation of sucking skills of preterm infants . Thirty-two preterm infants ( 13 males , 19 females ) , appropriate size for gestational age ( gestational age at birth 28 wks , SD 1.2wks ; birthweight 1002 g , SD 251 g ) , were r and omly placed into experimental and control groups . The experimental group received a daily 15-minute oral stimulation program , consisting of stroking the peri- and intra-oral structures , for 10 days before the start of oral feedings .  Sucking measures were monitored with a specially- design ed nipple-bottle apparatus . Results indicate that the experimental group achieved full oral feedings 7 days sooner than the control group , and demonstrated greater overall intake ( % ) , rate of milk transfer ( mL/min ) , and amplitude of the expression component of sucking ( mmHg ) . There was no difference in sucking stage maturation , sucking frequency , and amplitude of the suction component of sucking . Endurance , defined as ability to sustain the same sucking stage , sucking burst duration , and suction and expression amplitudes throughout a feeding session , was not significantly different between the two groups . The stimulation program enhanced the expression component of sucking , result ing in better oral feeding performance OBJECTIVE To assess whether an oral stimulation program , before the introduction of oral feeding , enhances the oral feeding performance of preterm infants born between 26 and 29 weeks ' gestational age . STUDY DESIGN Preterm infants ( n = 32 ) were r and omized into an experimental and control group . Infants in the experimental group received an oral stimulation program consisting of stimulation of the oral structures for 15 minutes . Infants in the control group received a sham stimulation program . Both were administered once per day for 10 consecutive days , 48 hours after discontinuation of nasal continuous positive air pressure . RESULTS Independent oral feeding was attained significantly earlier in the experimental group than the control group , 11 + /- 4 days ( mean + /- SD ) versus 1 
    Output:
    