***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 To compare the effects of intravenously injected with inhaled salbutamol in ventilator dependent infants with chronic lung disease ( CLD ) . Design Prospect i ve r and omized study in which each patient served as his/her own control . Setting Multidisciplinary neonatal and pediatric ICU . Patients 8 ventilator dependent premature infants with CLD . Interventions Salbutamol , 10 μg/kg was given intravenously , and 10–19 h later , twice 100 μg as pressurized aerosol , or vice versa , sequence r and omized . The pressurized aerosol was delivered by a metered dose inhaler into a newly developed aerosol holding chamber , integrated into the inspiratory limb of the patient circuit . Respiratory system mechanics were assessed by the single breath occlusion method before and 10 and 60 min after drug administration . Measurements and results Compliance improved significantly after intravenous injection ( 0.48±0.18 to 0.67±0.16 , p<0.01 and 0.59±0.23 ml/cmH2O/kg , NS , ( mean±1 SD ) and after inhalation ( 0.46±0.19 to 0.64±0.32,p<0.01 and 0.56±0.31 ml/cmH2O/kg , NS ) . Resistance decreased after i.v . use ( 0.38±0.17 to 0.25±0.11,p<0.001 and 0.25±0.10 cmH2O/ml/s , NS ) and after inhalation ( 0.35±0.12 to 0.27±0.09,p<0.01 and 0.28±0.12 cmH2O/ml/s , NS ) . Heart rate increased significantly after both routes of application , whereas mean arterial pressure , respirator setting s , FIO2 , transcutaneous SO2 and capillary PCO2 did not change . Conclusions Inhaled and intravenous salbutamol improves pulmonary mechanics to the same extent with comparable side effects , and may therefore be used to facilitate weaning from respirators UNLABELLED Several studies have demonstrated that normal infants exhibit bronchoconstriction after inhalation of nonspecific agonists and that the induced airway narrowing can be reversed by the inhalation of a beta-agonist . However , there are very limited data on baseline airway tone and the airway response to a beta-agonist in this subject population . The purpose of our study was to evaluate in normal infants baseline airway responsiveness to the inhaled beta-agonist , albuterol , using changes in maximal expiratory flows . Forty-one healthy infant volunteers with no history of respiratory disease or recurrent wheezing ( ages 5.4 to 141.4 wk ) were studied . Maximal expiratory flow- volume curves were obtained at baseline and 10 min after inhalation of albuterol ( n = 28 ) or placebo ( n = 13 ) using a metered-dose inhaler with a spacer . The mean percent change was significantly greater ( p < 0.05 ) in the albuterol versus placebo group for FEV(0.5 ) ( 2.2 % versus -1.5 % ) , FEF(75 % ) ( 10.6 % versus -3.1 % ) , and FEF(85 % ) ( 12.9 % versus 0.5 % ) . Six of 28 albuterol-treated infants demonstrated increases in FEF(75 % ) greater than two st and ard deviations from the mean change in FEF(75 % ) seen in the placebo group . These infants were younger and more frequently exposed to maternal smoking during pregnancy . We conclude that normal healthy infants have overall levels of baseline airway tone that are similar to that reported in adults and older children ; however , among the infants we evaluated the response to an inhaled bronchodilator was greatest in the youngest infants and in those exposed to tobacco smoking . KEYWORDS airway responsiveness ; asthma ; tobacco smoke ; infant pulmonary function ; 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 .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 AIMS To compare the efficacy of salbutamol delivered by metered dose inhaler ( MDI ) , jet nebuliser , and ultrasonic nebuliser in ventilated infants with chronic lung disease . METHODS Twenty preterm ventilated infants with chronic lung disease were enrolled in two studies . In study 1 ( n=10 ) , each infant was given 200 μg of salbutamol at 4 hour intervals and in r and om sequence from a metered dose inhaler – spacer device , a jet nebuliser , and an ultrasonic nebuliser with a small medication cup . The infants were monitored for heart rate , transcutaneous pO2 , pCO2 , and oxygen saturation , respiratory system resistance and compliance before and after each treatment . Infants in study 2 ( n=10 ) were similarly studied except for the use of a different jet nebuliser . RESULTS The mean ( SEM ) maximum percentage decreases in respiratory system resistance , observed at 30 minutes after aerosol delivery were study 1 : MDI : 44.3 (4.3)% ; jet : 32.3 (3.4)% ; ultrasonic : 56.1 (3.2)% ; study 2 : MDI : 28.6 (1.0)% ; jet : 16.9 (1.4)% ; ultrasonic : 42.1 (1.6)% . During the first hour after treatment , a significantly faster heart rate and higher transcutaneous pO2 were associated with the use of the ultrasonic nebuliser or MDI than with the jet nebulisers in both studies . The use of the ultrasonic nebuliser but not the other devices also result ed in a lower transcutaneous pCO2 and improved respiratory system compliance in study 2 . CONCLUSIONS These findings suggest that among the devices tested , the delivery of salbutamol aerosol to the lower respiratory tract was greatest using the ultrasonic nebuliser , and least with the jet nebulisers Abstract Bronchodilators are often used in the treatment of patients with bronchopulmonary dysplasia ( BPD ) .  However , few studies evaluate their efficacy in patients with stable disease beyond the newborn period . Therefore , pulmonary function was measured before and after aerosol treatment with salbutamol ( 0.25 ml Ventolin 0.5 % ) and subsequently after aerosol with ipratropium bromide ( 0.25 ml Atrovent 0.025 % ) . Studies were performed at the corrected postnatal age of 52±2 weeks in 52 patients who had been ventilated after birth because of newborn lung disease . Twenty-two of these 52 patients had developed BPD . Pulmonary function was measured after sedation and using the PEDS system . Expiratory resistance ( median 52.1 versus 39.1 cmH2O/l/s ; P<.008 ) and inspiratory resistance ( median 42.5 vs 27.8 cmH2O/l/s ; P<.04 ) were significantly worse in BPD patients at the age of 1 year . Half of the BPD patients had a decrease in pulmonary resistance  after salbutamol . However , there was no statistically significant decrease in pulmonary resistance  after salbutamol or ipratropium in the BPD patients as a group . After salbutamol pulmonary resistance significantly worsened in the patients who did not develop BPD . Conclusion Although individual patients may benefit , routine administration of bron chodilators seems not warranted in stable BPD patients at the age of 1 year Objective : To identify factors associated with bronchodilator administration to infants with bronchopulmonary dysplasia ( BPD ) and evaluate inter-institutional prescribing patterns . Study Design : A retrospective cohort study of < 29-week-gestation infants with evolving BPD defined at age 28 days within the Pediatric Health Information System data base . Controlling for observed confounding with r and om-effects logistic regression , we determined demographic and clinical variables associated with bronchodilator use and evaluated between-hospital variation . Result : During the study period , 33 % ( N=469 ) of 1429 infants with BPD received bronchodilators . Lengthening mechanical ventilation duration increased the odds of receiving a bronchodilator ( odds ratio 19.6 ( 11 to 34.8 ) at ⩾54 days ) . There was profound between-hospital variation in use , ranging from 0 to 81 % . Conclusion : Bronchodilators are frequently administered to infants with BPD at US children ’s hospitals with increasing use during the first hospital month . Increasing positive pressure exposure best predicts bronchodilator use . Frequency and treatment duration vary markedly by institution even after adjustment for confounding variables 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 
    Output:
    
Whether inhaled bronchodilators and inhaled corticosteroids improve long-term outcomes in BPD remains unclear .
There appears to be heterogeneity in treatment responses , and may be related to varying modes of administration .