***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 
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    ***EXAMPLES*** 
    Input: A prospect i ve , r and omized , cross-over trial was performed to compare the efficacy of nasal intermittent positive-pressure ventilation with nasal continuous positive airway pressure in infants of less than 32 weeks of gestation .  Continuous positive airway pressure was delivered at end-expiratory pressures of 4 cm H2O , while peak pressures of 20 cm H2O and end-expiratory pressures of 4 cm H2O were used during nasal intermittent positive-pressure ventilation at ventilatory rates of 20 breaths per minute . The frequency and extent of apnea and bradycardia during a 6-hour period in a patient receiving nasal continuous positive airway pressure  were compared with a similar crossover period of nasal intermittent positive-pressure ventilation . Although the infants had slightly less frequent episodes of apnea per hour ( 0.6 + /- 0.7 vs 0.5 + /- 0.7 ) and bradycardia per hour ( 1.2 + /- 1.3 vs 0.9 + /- 1.0 ) during nasal intermittent positive-pressure ventilation , these differences were not significant . There were no significant differences in the severity of these events as assessed by the duration and fall in transcutaneous oxygen pressure during apnea and heart rate during bradycardia . There were no significant changes in blood gases throughout the study . Nasal intermittent positive-pressure ventilation appears to have no advantages over nasal continuous positive airway pressure in preventing apnea and does not alter gas exchange in infants of less than 32 weeks of gestation CONTEXT : Strategies for reducing exposure to endotracheal ventilation through the use of early noninvasive ventilation has proven to be safe and effective , but the option with the greatest benefits needs to be determined . OBJECTIVE : To determine , in infants with respiratory distress syndrome , if early nasal intermittent positive-pressure ventilation ( NIPPV ) compared with nasal continuous positive airway pressure ( NCPAP ) decreases the need for mechanical ventilation . PATIENTS AND METHODS : In this single-center , r and omized controlled trial , infants ( gestational ages 26 to 3367 weeks ) with respiratory distress syndrome were r and omly assigned to receive early NIPPV or NCPAP . Surfactant was administered as rescue therapy . The primary outcome was the need for mechanical ventilation within the first 72 hours of life . RESULTS : A total of 200 infants , 100 in each arm , were r and omly assigned . Rates of the primary outcome did not differ significantly between the NIPPV ( 25 % ) and NCPAP ( 34 % ) groups ( relative risk [ RR ] : 0.71 [ 95 % confidence interval ( CI ) : 0.48–1.14 ] ) . In posthoc analysis , from 24 to 72 hours of life , significantly more infants in the NIPPV group remained extubated compared with those in the NCPAP groups ( 10 vs 22 % ; RR : 0.45 [ 95 % CI : 0.22–0.91 ] ) . This difference was also noted in the group of infants who received surfactant therapy , NIPPV ( 10.9 % ) , and NCPAP ( 27.1 % ) ( RR : 0.40 [ 95 % CI : 0.18–0.86 ] ) . CONCLUSIONS : Early NIPPV did not decrease the need for mechanical ventilation compared with NCPAP , overall , in the first 72 hours of life . However , further studies to assess the potential benefits of noninvasive ventilation are warranted , especially for the most vulnerable or preterm infants Objective : Comparison of outcomes of infants with respiratory distress syndrome ( RDS ) , post-surfactant , extubated to synchronized nasal intermittent positive pressure ventilation ( SNIPPV ) or continued on conventional ventilation ( CV ) .  Study Design : Prospect i ve post-surfactant r and omized controlled trial of primary mode SNIPPV compared with CV  in infants ( born from July 2000 to March 2005 ) with birth weights ( BW ) of 600 to 1250 g. Primary mode SNIPPV was defined as its use in the acute phase of RDS , following the administration of the first dose of surfactant . Result : There were no significant differences in the maternal demographics , antenatal steroid use , mode of delivery , BW , gestational age , gender or Apgar at 5 min between infants continued on CV ( n=21 ) and those extubated to primary mode SNIPPV ( n=20 ) . Significantly , more babies in the CV group had the primary outcome of bronchopulmonary dysplasia (BPD)/death , compared to the SNIPPV group ( 52 versus 20 % , P=0.03 ) . There was no difference in the incidence of other common neonatal morbidities . There were no differences in the Mental or Psychomotor Developmental Index scores on follow-up between the two groups . Conclusion : Infants of BW 600 to 1250 g with RDS receiving surfactant with early extubation to SNIPPV had a significantly lower incidence of BPD/death . Primary mode SNIPPV is a feasible method of ventilation in small premature infants OBJECTIVE To compare the rate of reintubation within 7 days after extubation and study the complications in premature infants who were r and omized in the immediate postextubation period to either nsNIMV or NCPAP . MATERIAL AND METHOD This study was conducted in the neonatal unit of Queen Sirikit National Institute of Child Health between June 1 and November 30 , 2006 . Intubated premature infants born at GA < or = 34 weeks or with birth weight < or = 1500 gm , ready to be extubated before 4 weeks of age were recruited . Infants were r and omized to either nsNIMV or NCPAP after extubation . Non-synchronized NIMV setting was the same as ventilator setting before extubation and NCPAP pressure was set at the same mean airway pressure of pre extubation ventilator value . Extubation was performed after intravenous loading dose of aminophylline . Primary outcome measurement was reintubation within 7 days of initial extubation and the secondary outcome was possible complications such as apnea , abdominal distension , gastrointestinal ( GI ) perforation , necrotizing enterocolitis ( NEC ) , sepsis and death . RESULTS A total of 70 VLBW infants were admitted to the neonatal unit during the study period . A total of 57 infants were intubated of which 48 infants were recruited for the study ; 24 were in the nsNIMV group and 24 were in the  NCPAP group . Infants in the nsNIMV group had mean birth weight and body weight at the start of study less than that in the NCPAP group ( 984.8 + /- 218 vs. 1067 + /- 214 and 1185 + /- 219 vs. 1205 + /-191 , p = 0.003 , 0.02 ) . The nsNIMV group also had a higher rate of RDS and antenatal steroid used when compared to the NCPAP group ( 19/24 vs. 12/24 and 17/24 vs. 8/24 , p = 0.03 , 0.01 ) . The nsNIMV group had fewer males than in the NCPAP group ( 8/24 vs. 17/24 , p = 0.01 ) . Reintubation was similar in both groups but atelectasis and sepsis were statistically significant risk factor for reintubation in NCPAP group . There were no significant differences in treatment related complications between the two groups , with respect to incidence of apnea ( 41.7 % in nsNIMV vs. 62.5 % in NCPAP ) , abdominal distensions ( 8.3 % in nsNIMVvs . 16.7 % in NCPAP ) , NEC ( 4.2 % in nsNIMVvs . 12.5 in NCPAP ) , sepsis ( 4.2 % in nsNIMVvs . 8.3 % NCPAP ) . No GI perforation was observed in both groups . CONCLUSION Non-invasive mode of ventilation , both NIMV and NCPAP , for weaning ofpre-term infants from ventilator may reduce the rate of reintubation in this group . Both modes seem to be equally safe . We believe that the use of non-invasive ventilator techniques will significantly reduce neonatal morbidity in the future . Additional prospect i ve evaluation of these approaches should be conducted in the future OBJECTIVE To determine whether synchronized nasal intermittent positive pressure ventilation ( SNIPPV ) would decrease extubation failure compared with nasal continuous positive airway pressure ( NCPAP ) in preterm infants being ventilated for respiratory distress syndrome ( RDS ) . METHODS Infants who were < /=34 weeks ' gestational age and who were ventilated for RDS were r and omized to either SNIPPV or NCPAP  after extubation . The criteria for extubation were peak inspiratory pressure of < /=16 cm H(2)O , positive end expiratory pressure of < /=5 cm H(2)O , intermittent m and atory ventilation rate of 15 to 25 , and fraction of inspired oxygen < /=0.35 . Pulmonary function tests ( PFT ) were obtained before extubation . After extubation , blood gases were monitored for a minimum of 72 hours . Success was defined as remaining in the selected mode of treatment or demonstrating improvement ( switching to oxyhood/nasal cannula/room air ) by 72 hours . RESULTS Thirty-two ( 94 % ) of 34 infants were extubated successfully with the use of SNIPPV versus 18 ( 60 % ) of 30 with the use of NCPAP ( P < .01 ) . There was no difference in apnea/bradycardia episodes in the 2 groups during the 72-hour study period . Among 55 infants who had PFT , 80 % ( 8 of 10 ) with dynamic lung compliance of > /=0.5 mL/kg/cm H(2)O and expiratory airway resistance of < /=70 cm H(2)O/L/s were extubated successfully . In infants with poor lung function ( dynamic lung compliance : < 0.5 mL/kg/cm H(2)O ; expiratory airway resistance : > 70 cm H(2)O/L/s ) , successful extubation was seen in 93 % ( 27 of 29 ) in the SNIPPV group and 60 % ( 15 of 25 ) in the NCPAP group . When weight was controlled for at the time of extubation , the odds of success in the SNIPPV group were 21.1 times higher ( 95 % confidence interval : 3.4 , 130.1 ) than that of the NCPAP group . CONCLUSIONS SNIPPV is more effective than NCPAP in weaning infants with RDS from the ventilator . PFT may be useful in predicting successful extubation OBJECTIVE : To compare the outcome of infants with respiratory distress syndrome ( RDS ) in the neonatal intensive care unit ( NICU ) who were extubated to synchronized nasal intermittent positive pressure ventilation ( SNIPPV ) or continued on conventional ventilation ( CV )  , immediately postsurfactant . STUDY DESIGN : Prospect i ve observational study of postsurfactant ventilatory management of consecutive infants ( born between 10/99 and 12/02 ) of 28 to 34 weeks gestation . Extubation to SNIPPV was at the attending neonatologists ' discretion . Babies in the CV group remained intubated , postsurfactant . RESULTS : There were no significant differences in the maternal demographics , antenatal steroid use , mode of delivery , birth weight ( BW ) , gestational age ( GA ) , gender , Apgar at 5 minutes , age at surfactant instillation , or oxygenation index ( OI ) prior to surfactant administration , between infants continued on CV ( n=35 ) and those extubated to SNIPPV ( n=24 ) . The total duration of endotracheal intubation ( mean±SEM ; CV versus SNIPPV ; 2.4±0.4 versus 0.3±0.0 days , p=0.001 ) and duration of supplemental oxygen exposure ( 15±3.2 versus 8.2±3.3 days , p=0.04 ) were significantly shorter in the SNIPPV group . Furthermore , the duration of parenteral nutrition ( 12.1±1.6 versus 8.4±0.8 days , p=0.02 ) and length of stay ( 37.5±3.0 versus 29.1±3.3 days , p=0.04 ) were also significantly shorter in the SNIPPV group . There were no differences between the two groups in blood gas or OI values postsurfactant ( up to 48 hours ) . There was no statistical difference in the incidence of intraventricular hemorrhage grade I ( three ( 9 % ) in the CV group and two infants ( 8 % ) in the SNIPPV group ) . No infant died in either group or had patent ductus arteriosus , air leaks , necrotizing enterocolitis , periventricular leukomalacia , retinopathy of prematurity or bronchopulmonary dysplasia . CONCLUSIONS : Infants of 28 to 34 weeks GA with RDS requiring surfactant with early extubation to SNIPPV had a shorter duration of intubation , and decreased need for oxygen as compared to CV . There was also a significant decrease in the duration of parenteral 
    Output:
    
Conclusions NIPPV could be used to reduce endotracheal ventilation , increase successful extubation , decrease the rate of apnea of prematurity , and have better outcome indicated by fewer death and /or bronchopulmonary dysplasia in preterm and term newborn infants