***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: Abstract Early inflammatory lesions and bronchial hyperresponsiveness are characteristics of the respiratory distress in premature neonates and are susceptible to aggravation by assisted ventilation . We hypothesized that treatment with inhaled salbutamol and beclomethasone might be of clinical value in the prevention of bronchopulmonary dysplasia ( BPD ) in ventilator-dependent premature neonates . The study was double-blinded and placebo controlled . We studied 173 infants of less than 31 weeks of gestational age , who needed ventilatory support at the 10th postnatal day . They were r and omised to four groups and received either placebo + placebo , placebo + salbutamol , placebo + beclomethasone or beclomethasone + salbutomol , respectively for 28 days . The major criteria for efficacy were : diagnosis of BPD ( with score of severity ) , mortality , duration of ventilatory support and oxygen therapy . The trial groups were similar with respect to age at entry ( 9.8–10.1 days ) , gestational age ( 27.6–27.8 weeks ) , birth weight and oxygen dependence . We did not observe any significant effect of treatment on survival , diagnosis and severity of BPD , duration of ventilatory support or oxygen therapy . For instance , the odds-ratio ( 95 % confidence interval ) for severe or moderate BPD were 1.04 ( 0.52–2.06 ) for inhaled beclomethasone and 1.54 ( 0.78–3.05 ) for inhaled salbutamol . Conclusion This r and omised prospect i ve trial does not support the use of treatment with inhaled beclomethasone , salbutamol or their combination in the prevention of BPD in premature ventilated neonates OBJECTIVE : To assess dexamethasone ( DEX ) and hydrocortisone ( HC ) use in premature infants over time and the association of steroid use with the incidence of  bronchopulmonary dysplasia ( BPD ) at 36 weeks ' postmenstrual age . METHODS : We analyzed data from the Pediatrix data base for neonates of 23 to 32 weeks ' gestation managed during 1997–2006 ( N = 77520 ) . We compared the use of  DEX , HC  and BPD ( defined by oxygen use at 36 weeks ' postmenstrual age ) according to year and estimated gestational age . Mantel-Haenszel χ2 was used to compare the trends in steroid use and BPD rates according to year . RESULTS : There were no differences by year in the proportion of births at each gestation or in early or late neonatal death . DEX  use decreased from a peak of 25.0 % in 1998 to 6.8 % in 2006 , but HC use increased from 1.1 % in 1997 to a peak of 6.5 % in 2006 . The median age at initiation of DEX use increased > 2 weeks from 1997 to 2006 . BPD rates increased from 19 % in 1997 to 25 % by 2006 . Rates for severe BPD ( defined by positive pressure support ) also increased significantly over time . Between 23 and 28 weeks , there was a significant increase in BPD rates associated with the decrease in DEX over time . CONCLUSIONS : Steroid use and preference have changed significantly over the past decade . Decreased use of DEX was associated with increased rates of BPD , any or severe , among very preterm infants . Well- design ed , r and omized , noncrossover trials with long-term outcome analysis of high-risk infants are needed Objective .This r and omized , controlled trial was design ed to determine the efficacy of inhaled fluticasone propionate on oxygen therapy weaning in a population of preterm infants who were born at < 32 weeks of gestation and experienced moderate bronchopulmonary dysplasia ( BPD ) . Methods .Thirty-two infants who were ≤32 weeks of gestation , had moderate BPD that required supplemental oxygen ( fraction of inspired oxygen ≥0.25 ) , and were aged between 28 and 60 days were r and omized . Fluticasone propionate 125 μg twice daily for 3 weeks and once daily for a fourth week was delivered to infants who weighed between 500 and 1200 g. The dosage was doubled for infants who weighed ≥1200 g. Results .Compared with placebo , treatment had no effect on either duration of supplemental O2 therapy or ventilatory support as assessed by survival analysis . At 28 days , a trend toward a lower cortisol/creatinine ratio in the treatment group was noted compared with placebo ( 25.1 ± 18.9 vs 43 ± 14.4 ) . In the fluticasone group at 28 days , the systolic arterial pressure ( 78 ± 3 vs 68 ± 3 mm Hg ) and diastolic arterial pressure ( 43 ± 3.4 mm Hg vs 38 ± 2.0 mm Hg ) were higher compared with baseline fluticasone values . The chest radiograph score was lower than baseline ( 2.8 ± 1.4 vs 3.7 ± 2.2 ) in the fluticasone group at 28 days . This study has a statistical power of 1.0 to detect a significant difference in the duration of oxygen supplementation of > 21 days between the study groups . Conclusion .We conclude that fluticasone propionate reduces neither supplemental O2 use nor the need for ventilatory support in this patient population . However , fluticasone does have a positive radiologic effect in lowering chest radiograph scores . In addition , our data point to a possible association among inhaled fluticasone treatment and higher arterial blood pressure . Thus , the results of this investigation do not support the use of inhaled corticosteroids in the treatment of oxygen-dependent infants who have established moderate BPD Objective : The efficacy of inhaled steroids in spontaneously breathing infants with established bronchopulmonary dysplasia ( BPD ) is debatable . The inhaled steroid hydrofluoalkane-beclomethasone dipropionate ( QVAR ) is unique in its small particle size that results in higher lung deposition . Our objective was to determine if inhaled QVAR could decrease respiratory rehospitalizations of infants with established BPD . Study Design : Double-blind , r and omized placebo-controlled , multicenter pilot study . Preterm infants with moderate-to-severe BPD were r and omized to inhaled QVAR 100 μg per dose or placebo twice daily via Aerochamber with face mask . Treatment was administered daily from recruitment at 36 weeks post menstrual age until 3 months post discharge . Analysis was carried out by intention to treat . Results : The QVAR ( n=18 ) and placebo ( n=20 ) groups were comparable in birth and recruitment characteristics . Length of stay ( 108.5±26.3 vs 108.7±36.0 days ) and infants requiring oxygen at discharge ( 5/17 vs 6/19 ) or at study end ( 0/17 vs 2/19 ) were comparable . Respiratory rehospitalizations/infant ( 0.1±0.5 vs 0.4±0.6 ) , rehospitalization days ( 0.5±1.5 vs 4.1±10.3 ) , and post-discharge additive inhaled ( 0.3±0.9 vs 6.4±21.5 days ) , systemic ( 0.7±2.8 vs 1.0±1.4 days ) and combined ( inhaled/systemic ) steroids ( 1.0±2.9 vs 7.8±25.8 days ) tended to be lower in the QVAR compared with the placebo group . Blood pressure , height and weight gain , and urine cortisol/creatinine ratio at study end were comparable between groups . Conclusions : Our study was unable to detect a significant effect of inhaled QVAR on the respiratory course of established BPD . The study was underpowered . Possible benefits of QVAR could be masked by a tendency toward higher use of additional steroids in the placebo group Parenteral glucocorticoids have been shown to be effective in the treatment of oxygen- and ventilator-dependent bronchopulmonary dysplasia . We conducted a r and omized , prospect i ve study using a nebulized , water-soluble form of beclomethasone dipropionate for the treatment of infants with oxygen- and ventilator-dependent lung disease . Newborn infants with chest x-ray changes consistent with bronchopulmonary dysplasia at 14 days of age were r and omly assigned , in a paired sequential fashion by birth weight , to treatment ( beclomethasone ) or placebo ( saline solution ) groups . Treatment included three nebulized doses of beclomethasone ( 50 micrograms ) or saline solution per day for 28 days . Measured variables included tidal volume , total dynamic compliance , and airway resistance . Weight gain , gender , and incidence of infection during therapy were also recorded . Pulmonary functions were measured before initiation of therapy and weekly thereafter . Thirteen infants , seven in the saline solution group and six in the beclomethasone group , met study criteria and completed treatment . Infants treated with beclomethasone had reductions in airway resistance that were significant in weeks 2 , 3 , and 4 ( p < 0.05 , p < 0.02 , and p < 0.001 , respectively ) . Dynamic lung compliance increased at weeks 3 and 4 ( p < 0.01 and p < 0.05 , respectively ) . As expected , tidal volume increased with weight and time , but there were no significant differences between groups . There were no differences between the groups in weight gain , gender , or infection . This study demonstrates that beclomethasone by nebulization ( 1 ) reduced airway resistance in oxygen-dependent neonates with bronchopulmonary dysplasia , ( 2 ) improved dynamic lung compliance , as reported with parenterally administered glucocorticoids , and ( 3 ) produced no apparent increase in the incidence of infection BACKGROUND Chronic lung disease ( CLD ) is one of the most severely disabling conditions of extremely low-birth-weight infants .  Systemic corticosteroids are effective but cause many adverse effects . Targeted therapy with inhaled corticosteroids may be an effective and less toxic alternative . STUDY OBJECTIVE To evaluate the additive effect of inhaled corticosteroids on markers of lung inflammation in infants receiving a 7-day course of systemic steroids . METHODS Preterm neonates weighing 1 kg or less and aged 12 to 28 days who were prescribed a 7-day course of systemic corticosteroids for evolving CLD were studied prospect ively and r and omized to receive either a tapering 4-week course of beclomethasone metered-dose inhaler ( MDI ) ( n = 5 ) or placebo MDI ( n = 6 ) . Primary outcome variables were the levels of pro- and anti-inflammatory cytokines , IL-8 , TNF-alpha , IL-1alpha , and sIL-2R . RESULTS This study was terminated early following literature reports of the adverse neurodevelopmental effects of dexamethasone . Measurements of respiratory and serum IL-8 , IL-1alpha and TNF-alpha were similar between the study group taking inhaled and systemic corticosteroids and the study group taking systemic steroids alone . No differences were found between the two groups in relation to dynamic compliance or resistance . CONCLUSIONS The addition of inhaled corticosteroids to a 7-day systemic course of corticosteroids did not alter cytokine response or improve pulmonary function Abstract The speed of action and side-effects of systemic versus inhaled steroids was compared in infants with mild-moderate oxygen dependency . Forty infants ( median gestational age 27 weeks ) were r and omized to receive either 10 days of dexamethasone ( systemic group ) or budesonide ( 100 μg qds ) ( inhaled group ) . At r and omization , there was no significant difference in the gestational or postnatal age , inspired oxygen requirements or compliance of the respiratory system of the two groups . After 36 h of treatment , there were significant changes ( P < 0.01 ) in both the inspired oxygen concentration and compliance of the respiratory system in the systemic but not the inhaled group . Only after 1 week of inhaled therapy were improvements in respiratory status noted but , even at that time , the inspired oxygen requirement was significantly lower in the systemic versus the inhaled group . In the systemic group only , however , were there significant increases in blood pressure . Conclusion Systemically administered rather than inhaled steroids appear to have a faster onset of action OBJECTIVE To compare duration of ventilation to mortality and adverse neurodevelopmental outcomes among extremely low birth weight ( ELBW ; 501 - 1000 g ) infants . STUDY DESIGN Retrospective analysis of prospect ively collected data from 5364 infants with a birthweight of 501 to 1000 g born at National Institute of Child Health and Human Development ( NICHD ) Neonatal Research Network centers from 1995 to 1998 . The main outcome measures were : survival , duration of mechanical ventilation , and neurodevelopmental outcome . RESULTS Overall survival was 71 % . The median duration of ventilation for survivors was 23 days ; 75 % were free of mechanical ventilation by 39 days , and 7 % were ventilated for > or 
    Output:
    
Inhalation corticosteroids did not reduce the separate or combined outcomes of death or BPD .
Furthermore , inhalation steroids did not impact total duration of mechanical ventilation or oxygen dependency .
There was a paucity of data on short- and long-term adverse effects .
Based on the results of the currently available evidence , inhalation corticosteroids initiated at ≥ 7 days of life for preterm infants at high risk of developing BPD can not be recommended at this point in time .