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: OBJECTIVES The purpose s of this study were to report the neurodevelopmental , neurosensory , and functional outcomes of 1151 extremely low birth weight ( 401 - 1000 g ) survivors cared for in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network , and to identify medical , social , and environmental factors associated with these outcomes . STUDY DESIGN A multicenter cohort study in which surviving extremely low birth weight infants born in 1993 and 1994 underwent neurodevelopmental , neurosensory , and functional assessment  at 18 to 22 months ' corrected age . Data regarding pregnancy and neonatal outcome were collected prospect ively . Socioeconomic status and a detailed interim medical history were obtained at the time of the assessment . Logistic regression models were used to identify maternal and neonatal risk factors for poor neurodevelopmental outcome . RESULTS Of the 1480 infants alive at 18 months of age , 1151 ( 78 % ) were evaluated . Study characteristics included a mean birth weight of 796 + /- 135 g , mean gestation ( best obstetric date s ) 26 + /- 2 weeks , and 47 % male . Birth weight distributions of infants included 15 infants at 401 to 500 g ; 94 at 501 to 600 g ; 208 at 601 to 700 g ; 237 at 701 to 800 g ; 290 at 801 to 900 g ; and 307 at 901 to 1000 g. Twenty-five percent of the children had an abnormal neurologic examination , 37 % had a Bayley II Mental Developmental Index < 70 , 29 % had a Psychomotor Developmental Index < 70 , 9 % had vision impairment , and 11 % had hearing impairment . Neurologic , developmental , neurosensory , and functional morbidities increased with decreasing birth weight . Factors significantly associated with increased neurodevelopmental morbidity included chronic lung disease , grade s 3 to 4 intraventricular hemorrhage/periventricular leukomalacia , steroids for chronic lung disease , necrotizing enterocolitis , and male gender . Factors significantly associated with decreased morbidity included increased birth weight , female gender , higher maternal education , and white race . CONCLUSION ELBW infants are at significant risk of neurologic abnormalities , developmental delays , and functional delays at 18 to 22 months ' corrected age Background The immune consequences of adding 20:4n-6 and 22:6n-3 fatty acids to preterm infant formula are not known . Methods The effect of feeding preterm infants ( 14–42 days of age ) human milk ( Human Milk group ) , infant formula ( Formula group )  , or formula with added long-chain polyunsaturated fatty acids 20:4n-6 and 22:6n-3 ( Formula + LCP group ) on isolated peripheral blood lymphocytes ( by flow cytometry ) and lipid composition ( by gas – liquid chromatography ) was determined . Lymphocytes were stimulated in vitro with phytohemagglutinin to measure soluble interleukin (sIL)-2R and IL-10 production ( by enzyme-linked immunosorbent assay ) . Results With age , the percentage of CD3+CD4 + T cells and the percentage of CD20 + cells increased in the Human Milk and Formula + LCP groups ( P < 0.05 ) , but not in the unsupplemented Formula group . Compared with the Formula group , CD4 + cells from the Formula + LCP and Human Milk groups expressed more CD45R0 ( antigen mature ) and less CD45RA ( antigen naive ) at 42 days of age ( P < 0.05 ) . At 42 days , IL-10 production was lower ( P < 0.05 ) in cells of the Formula group than in cells of the Human Milk group . Production of IL-10 by the cells of the Formula + LCP group was not different from that produced by the Human Milk group cells . An age-related decrease ( P < 0.05 ) in sIL-2R production by Formula + LCP lymphocytes was observed , but sIL-2R production at 42 days in the Formula + LCP group did not differ significantly from that in the Human Milk group . Compared with Formula alone , adding LCP to formula result ed in a lower C18:2n-6 and higher C20:4n-6 content in lymphocyte phospholipids ( P < 0.05 ) . Conclusions Adding LCP to a preterm infant formula result ed in lymphocyte population s , phospholipid composition , cytokine production , and antigen maturity that are more consistent with that in human milk – fed infants . This may affect the ability of the infant to respond to immune challenges OBJECTIVES To investigate if supplementation of preterm infant formula  with a high docosahexaenoic acid/eicosapentaenoic acid ( DHA/EPA ) ratio together with alpha-linolenic acid ( ALA ) was able to maintain plasma and red blood cell DHA levels similar to that obtained with breast milk feeding without altering n-6 fatty acid status . DESIGN AND SUBJECTS Preterm infants of mothers who elected not to breast feed ( n=13 ) were assigned to ALA- and DHA-enriched formula ( DHA group : DHA/EPA=5/l ) . Infants fed breast milk ( n=25 ) constituted a reference group ( BM group ) . Anthropometric and fatty acid parameters ( plasma phospholipids , cholesterol esters , triglycerides and red blood cell phosphatidylethanolamine , PL , CE , TG , RBC-PE , respectively ) were obtained after 2 days ( D2 ) and 15 days ( D15 ) of enteral feeding and at the 37th week ( W37 ) of post-conception age and 1 month later ( W37 + 30 ) in the DHA group . Mean DHA intake ranged between 16.5+/-1.6 and 17.9+/-2.9 mg/kg/day between D2 and W37 + 30 . RESULTS At W37 , infant weights , heights , and head circumferences were similar in DHA and BM groups . PL DHA was maintained in the DHA group at the same level as in the BM group and the same for DHA in PE at W37 . In RBC-PE and at W37 , AA status was the same in both groups . In PL , AA levels remained very stable throughout the study ; however , in the DHA group AA levels in PL remained in the range observed with st and ard formulas . CONCLUSION The combined 18:3 n-3 and DHA supplementation of infant formula with DHA/EPA ratio 5/l is compatible with growth and n-3 fatty acid metabolism similar to that of preterm infants fed human milk Necrotizing enterocolitis ( NEC ) causes approximately 4000 deaths/y and significant morbidity among U.S.-born preterm infants alone . Various combinations of inadequate tissue oxygenation , bacterial overgrowth , and enteral feeding with immaturity may cause the initial damage to intestinal mucosa that culminates in necrosis . Presently , there is not a way to predict the onset of the disease or to prevent its occurrence . As part of risk-benefit assessment , we compared disease in hospitalized preterm infants fed a commercial ( control ) preterm formula or an experimental formula with egg phospholipids  for a r and omized , double-masked , clinical study of diet and infant neurodevelopment . Infants fed the experimental formula developed significantly less stage II and III NEC compared with infants fed the control formula ( 2.9 versus 17.6 % , p < 0.05 ) , but had similar rates of bronchopulmonary dysplasia ( 23.4 versus 23.5 % ) , septicemia ( 26 versus 31 % ) , and retinopathy of prematurity ( 38 versus 40 % ) . Compared with the control formula , the experimental formula provided 7-fold more esterified choline , arachidonic acid ( AA , 0.4 % of total fatty acids ) , and docosahexaenoic acid ( 0.13 % ) . Phospholipids are constituents of mucosal membranes and intestinal surfactant , and their components , AA and choline , are substrates for intestinal vasodilatory and cytoprotective eicosanoids ( AA ) and the vasodilatory neurotransmitter , acetylcholine ( choline ) , respectively . One or more of these components of egg phospholipids may have enhanced one or more immature intestinal functions to lower the incidence of NEC in this study . Regardless of the potential mechanism , a larger r and omized trial design ed to test the effect of this egg phospholipid-containing formula on NEC seems warranted Several studies have reported that feeding γ-linolenic acid ( GLA ) has result ed in no increase in arachidonic acid ( AA ) in newborns . This result was ascribed to the eicosapentaenoic acid (EPA)-rich fish oil used in these formulas . Docosahexaenoic acid ( DHA ) sources with only minor amounts of EPA are now available , thus the addition of GLA to infant formulas might be considered an alternative to AA supplementation . Sixty-six premature infants were r and omized to feeding one of four formulas [ ST : no GLA , no long-chain polyunsaturated fatty acids ; BO : 0.6 % GLA ( borage oil ) ; BO + FOLOW : 0.6 % GLA , 0.3 % DHA , 0.06 % EPA ; BO + FOHIGH : 0.6 % GLA , 0.3 % DHA , 0.2 % EPA ] or human milk ( HM , nonr and omized ) for 4 wk . Anthropometric measures and blood sample s were obtained at study entry and after 14 and 28 d. There were no significant differences between groups in anthropometric measures , tocopherol , and retinol status at any of the studied time points . The AA content of plasma phospholipids was similar between groups at study start and decreased significantly until day 28 in all formulafed groups , but not in the breast-fed infants [ ST : 6.6±0.2 % , BO : 6.9±0.3 % , BO + FOLOW : 6.9±0.4 % , BO + FOHIGH : 6.7±0.2 % , HM : 8.6±0.5 % , where values are reported as mean ±st and ard error ; all formulas significantly different ( P≤0.05 ) from HM ] . There was no significant influence  of GLA or fish oil addition to the diet . GLA had only a very limited effect on AA status which was too small to obtain satisfactory concentrations ( concentrations similar to breast-fed babies ) under the circumstances tested . The effect of GLA on AA is independent of the EPA and DHA content in the diet within the dose ranges studied Docosahexaenoic acid ( DHA ; 22:6n-3 ) is important for normal visual development . We hypothesized that preterm infants fed formulas with marine oil as a source of DHA  would have better visual acuity than infants fed formulas without marine oil  , as measured by the Teller Acuity Card procedure . Marine oil ( P < 0.001 ) and age ( P < 0.0001 ) influenced visual acuity , by repeated- measures analysis of variance ( ANOVA ) corrected for the effect of subject . Marine-oil-supplemented infants had better visual acuity than those fed st and ard formulas at 2 and 4 mo of age , by Fishers ' least-squares difference ( LSD ) . Acuity of both dietary groups improved through 6.5 mo of age , then plateaued . Through 4 mo of age , acuity was inversely related to oxygen supplementation ( log10 h ) and positively related to DHA status , by general-linear-models ( GLM ) analysis . After 4 mo of age , birth weight and gestational age were the only variables consistently related to visual acuity by GLM . We conclude that marine-oil-supplemented formula improved visual acuity of preterm infants through 4 mo of age by improving DHA status Healthy preterm infants fed formula with long-chain n-3 fatty acids ( n-3 LCFAs ) from marine oil have better early visual acuity but lower plasma phosphatidylcholine ( PC ) arachidonic acid ( AA ) and growth than infants fed formula containing  linolenic acid ( LLA ) as the sole n-3 fatty acid . This r and omized , double-blind trial was design ed to study the effects of a different source of n-3 LCFAs and a shorter feeding interval on visual acuity ( by Teller Acuity Card ) and growth of preterm infants ( n = 59 ; 747 - 1275 g birth wt ) , some of whom required long periods of supplemental oxygen and developed bronchopulmonary dysplasia ( BPD ) . Infants were studied at 0 , 2 , 4 , 6 , 9 , and 12 mo past term . Plasma PC AA , and normalized weight , length , and head circumference were not influenced by BPD or n-3 LCFAs except that n-3 LCFA-supplemented infants weighed less at 6 ( P<0.05 ) and 9 ( P<0.01 ) mo and had smaller head circumferences at 9 mo ( P<0.05 ) . Compared with control infants , however , those fed n-3 LCFAs had lower weight-for-length at 2 , 6 , 9 , and 12 mo ( P<0.0003 , P<0.0114 , P<0.0008 , and P<0.006 , respectively ) . n-3 LCFAs  improved early (  
    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: OBJECTIVES The purpose s of this study were to report the neurodevelopmental , neurosensory , and functional outcomes of 1151 extremely low birth weight ( 401 - 1000 g ) survivors cared for in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network , and to identify medical , social , and environmental factors associated with these outcomes . STUDY DESIGN A multicenter cohort study in which surviving extremely low birth weight infants born in 1993 and 1994 underwent neurodevelopmental , neurosensory , and functional assessment  at 18 to 22 months ' corrected age . Data regarding pregnancy and neonatal outcome were collected prospect ively . Socioeconomic status and a detailed interim medical history were obtained at the time of the assessment . Logistic regression models were used to identify maternal and neonatal risk factors for poor neurodevelopmental outcome . RESULTS Of the 1480 infants alive at 18 months of age , 1151 ( 78 % ) were evaluated . Study characteristics included a mean birth weight of 796 + /- 135 g , mean gestation ( best obstetric date s ) 26 + /- 2 weeks , and 47 % male . Birth weight distributions of infants included 15 infants at 401 to 500 g ; 94 at 501 to 600 g ; 208 at 601 to 700 g ; 237 at 701 to 800 g ; 290 at 801 to 900 g ; and 307 at 901 to 1000 g. Twenty-five percent of the children had an abnormal neurologic examination , 37 % had a Bayley II Mental Developmental Index < 70 , 29 % had a Psychomotor Developmental Index < 70 , 9 % had vision impairment , and 11 % had hearing impairment . Neurologic , developmental , neurosensory , and functional morbidities increased with decreasing birth weight . Factors significantly associated with increased neurodevelopmental morbidity included chronic lung disease , grade s 3 to 4 intraventricular hemorrhage/periventricular leukomalacia , steroids for chronic lung disease , necrotizing enterocolitis , and male gender . Factors significantly associated with decreased morbidity included increased birth weight , female gender , higher maternal education , and white race . CONCLUSION ELBW infants are at significant risk of neurologic abnormalities , developmental delays , and functional delays at 18 to 22 months ' corrected age Background The immune consequences of adding 20:4n-6 and 22:6n-3 fatty acids to preterm infant formula are not known . Methods The effect of feeding preterm infants ( 14–42 days of age ) human milk ( Human Milk group ) , infant formula ( Formula group )  , or formula with added long-chain polyunsaturated fatty acids 20:4n-6 and 22:6n-3 ( Formula + LCP group ) on isolated peripheral blood lymphocytes ( by flow cytometry ) and lipid composition ( by gas – liquid chromatography ) was determined . Lymphocytes were stimulated in vitro with phytohemagglutinin to measure soluble interleukin (sIL)-2R and IL-10 production ( by enzyme-linked immunosorbent assay ) . Results With age , the percentage of CD3+CD4 + T cells and the percentage of CD20 + cells increased in the Human Milk and Formula + LCP groups ( P < 0.05 ) , but not in the unsupplemented Formula group . Compared with the Formula group , CD4 + cells from the Formula + LCP and Human Milk groups expressed more CD45R0 ( antigen mature ) and less CD45RA ( antigen naive ) at 42 days of age ( P < 0.05 ) . At 42 days , IL-10 production was lower ( P < 0.05 ) in cells of the Formula group than in cells of the Human Milk group . Production of IL-10 by the cells of the Formula + LCP group was not different from that produced by the Human Milk group cells . An age-related decrease ( P < 0.05 ) in sIL-2R production by Formula + LCP lymphocytes was observed , but sIL-2R production at 42 days in the Formula + LCP group did not differ significantly from that in the Human Milk group . Compared with Formula alone , adding LCP to formula result ed in a lower C18:2n-6 and higher C20:4n-6 content in lymphocyte phospholipids ( P < 0.05 ) . Conclusions Adding LCP to a preterm infant formula result ed in lymphocyte population s , phospholipid composition , cytokine production , and antigen maturity that are more consistent with that in human milk – fed infants . This may affect the ability of the infant to respond to immune challenges OBJECTIVES To investigate if supplementation of preterm infant formula  with a high docosahexaenoic acid/eicosapentaenoic acid ( DHA/EPA ) ratio together with alpha-linolenic acid ( ALA ) was able to maintain plasma and red blood cell DHA levels similar to that obtained with breast milk feeding without altering n-6 fatty acid status . DESIGN AND SUBJECTS Preterm infants of mothers who elected not to breast feed ( n=13 ) were assigned to ALA- and DHA-enriched formula ( DHA group : DHA/EPA=5/l ) . Infants fed breast milk ( n=25 ) constituted a reference group ( BM group ) . Anthropometric and fatty acid parameters ( plasma phospholipids , cholesterol esters , triglycerides and red blood cell phosphatidylethanolamine , PL , CE , TG , RBC-PE , respectively ) were obtained after 2 days ( D2 ) and 15 days ( D15 ) of enteral feeding and at the 37th week ( W37 ) of post-conception age and 1 month later ( W37 + 30 ) in the DHA group . Mean DHA intake ranged between 16.5+/-1.6 and 17.9+/-2.9 mg/kg/day between D2 and W37 + 30 . RESULTS At W37 , infant weights , heights , and head circumferences were similar in DHA and BM groups . PL DHA was maintained in the DHA group at the same level as in the BM group and the same for DHA in PE at W37 . In RBC-PE and at W37 , AA status was the same in both groups . In PL , AA levels remained very stable throughout the study ; however , in the DHA group AA levels in PL remained in the range observed with st and ard formulas . CONCLUSION The combined 18:3 n-3 and DHA supplementation of infant formula with DHA/EPA ratio 5/l is compatible with growth and n-3 fatty acid metabolism similar to that of preterm infants fed human milk Necrotizing enterocolitis ( NEC ) causes approximately 4000 deaths/y and significant morbidity among U.S.-born preterm infants alone . Various combinations of inadequate tissue oxygenation , bacterial overgrowth , and enteral feeding with immaturity may cause the initial damage to intestinal mucosa that culminates in necrosis . Presently , there is not a way to predict the onset of the disease or to prevent its occurrence . As part of risk-benefit assessment , we compared disease in hospitalized preterm infants fed a commercial ( control ) preterm formula or an experimental formula with egg phospholipids  for a r and omized , double-masked , clinical study of diet and infant neurodevelopment . Infants fed the experimental formula developed significantly less stage II and III NEC compared with infants fed the control formula ( 2.9 versus 17.6 % , p < 0.05 ) , but had similar rates of bronchopulmonary dysplasia ( 23.4 versus 23.5 % ) , septicemia ( 26 versus 31 % ) , and retinopathy of prematurity ( 38 versus 40 % ) . Compared with the control formula , the experimental formula provided 7-fold more esterified choline , arachidonic acid ( AA , 0.4 % of total fatty acids ) , and docosahexaenoic acid ( 0.13 % ) . Phospholipids are constituents of mucosal membranes and intestinal surfactant , and their components , AA and choline , are substrates for intestinal vasodilatory and cytoprotective eicosanoids ( AA ) and the vasodilatory neurotransmitter , acetylcholine ( choline ) , respectively . One or more of these components of egg phospholipids may have enhanced one or more immature intestinal functions to lower the incidence of NEC in this study . Regardless of the potential mechanism , a larger r and omized trial design ed to test the effect of this egg phospholipid-containing formula on NEC seems warranted Several studies have reported that feeding γ-linolenic acid ( GLA ) has result ed in no increase in arachidonic acid ( AA ) in newborns . This result was ascribed to the eicosapentaenoic acid (EPA)-rich fish oil used in these formulas . Docosahexaenoic acid ( DHA ) sources with only minor amounts of EPA are now available , thus the addition of GLA to infant formulas might be considered an alternative to AA supplementation . Sixty-six premature infants were r and omized to feeding one of four formulas [ ST : no GLA , no long-chain polyunsaturated fatty acids ; BO : 0.6 % GLA ( borage oil ) ; BO + FOLOW : 0.6 % GLA , 0.3 % DHA , 0.06 % EPA ; BO + FOHIGH : 0.6 % GLA , 0.3 % DHA , 0.2 % EPA ] or human milk ( HM , nonr and omized ) for 4 wk . Anthropometric measures and blood sample s were obtained at study entry and after 14 and 28 d. There were no significant differences between groups in anthropometric measures , tocopherol , and retinol status at any of the studied time points . The AA content of plasma phospholipids was similar between groups at study start and decreased significantly until day 28 in all formulafed groups , but not in the breast-fed infants [ ST : 6.6±0.2 % , BO : 6.9±0.3 % , BO + FOLOW : 6.9±0.4 % , BO + FOHIGH : 6.7±0.2 % , HM : 8.6±0.5 % , where values are reported as mean ±st and ard error ; all formulas significantly different ( P≤0.05 ) from HM ] . There was no significant influence  of GLA or fish oil addition to the diet . GLA had only a very limited effect on AA status which was too small to obtain satisfactory concentrations ( concentrations similar to breast-fed babies ) under the circumstances tested . The effect of GLA on AA is independent of the EPA and DHA content in the diet within the dose ranges studied Docosahexaenoic acid ( DHA ; 22:6n-3 ) is important for normal visual development . We hypothesized that preterm infants fed formulas with marine oil as a source of DHA  would have better visual acuity than infants fed formulas without marine oil  , as measured by the Teller Acuity Card procedure . Marine oil ( P < 0.001 ) and age ( P < 0.0001 ) influenced visual acuity , by repeated- measures analysis of variance ( ANOVA ) corrected for the effect of subject . Marine-oil-supplemented infants had better visual acuity than those fed st and ard formulas at 2 and 4 mo of age , by Fishers ' least-squares difference ( LSD ) . Acuity of both dietary groups improved through 6.5 mo of age , then plateaued . Through 4 mo of age , acuity was inversely related to oxygen supplementation ( log10 h ) and positively related to DHA status , by general-linear-models ( GLM ) analysis . After 4 mo of age , birth weight and gestational age were the only variables consistently related to visual acuity by GLM . We conclude that marine-oil-supplemented formula improved visual acuity of preterm infants through 4 mo of age by improving DHA status Healthy preterm infants fed formula with long-chain n-3 fatty acids ( n-3 LCFAs ) from marine oil have better early visual acuity but lower plasma phosphatidylcholine ( PC ) arachidonic acid ( AA ) and growth than infants fed formula containing  linolenic acid ( LLA ) as the sole n-3 fatty acid . This r and omized , double-blind trial was design ed to study the effects of a different source of n-3 LCFAs and a shorter feeding interval on visual acuity ( by Teller Acuity Card ) and growth of preterm infants ( n = 59 ; 747 - 1275 g birth wt ) , some of whom required long periods of supplemental oxygen and developed bronchopulmonary dysplasia ( BPD ) . Infants were studied at 0 , 2 , 4 , 6 , 9 , and 12 mo past term . Plasma PC AA , and normalized weight , length , and head circumference were not influenced by BPD or n-3 LCFAs except that n-3 LCFA-supplemented infants weighed less at 6 ( P<0.05 ) and 9 ( P<0.01 ) mo and had smaller head circumferences at 9 mo ( P<0.05 ) . Compared with control infants , however , those fed n-3 LCFAs had lower weight-for-length at 2 , 6 , 9 , and 12 mo ( P<0.0003 , P<0.0114 , P<0.0008 , and P<0.006 , respectively ) . n-3 LCFAs  improved early (  
    Output:
    