***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: 1 . Shackelford GD . Neurosonography of hydrocephalus in infants . Neuroradiology 1986;28:452 - 62 . 2 . Levene MI . Measurement of the growth of the lateral ventricles in preterm infants with real-time ultrasound . Arch Dis Child 1981 ; 56i900 - 4 . 3 . Johnson ML , Mack LA , Rumaek CM , et al. B-mode echoencephalography inthe normal and high risk infant . A JR Am J Roentgenol 1979;133:374 - 81 . 4 . Rumack CM , Johnson ML . Perinatal and infant brain imaging . Chicago : Year Book Medical Publishers , 1984:157 . 5 . Brann BS , Wofsy C , Wicks J , Brayer J. The quantification of neonatal cerebral ventricular volume by real-time ultrasonography : derivation and in vitro confirmation of a mathematical model . J Ultrasound Med 1990;9:1 - 8 . 6 . Brann BS , Wofsy C , Papile LA , Angelus P , Backstrom C. The quantification of neonatal cerebral ventricular volume by realtime ultrasonography : in vivo validation of the cylindrical coordinate method . J Ultrasound Med 1990;9:9 - 15 . 7 . Garrett W J , Kossoff G , Warren PS .  Cerebral ventricular size in children : a two-dimensional ultrasonic study . Radiology 1980 ; 136:711 - 5 . 8 . London DA , Carroll BA , Enzmann DR . Sonography of ventricular size and germinal matrix hemorrhage in premature infants . AJNR 1980;1:295 - 300 . 9 . Sauerbrei EE , Digney M , Harrison PB , Cooperberg PL . Ultrasonic evaluation of neonatal intracranial hemorrhage and its complications . Radiology 1981 ; 39:667 - 85 . 10 . Quisling RG , Reeder JD , Setzer ES , Kaude JV . Temporal comparative analysis of computed tomography with ultrasound  for intracranial hemorrhage in premature infants . Neuroradiology 1983;24:205 - 11 . 11 . Naidich TP , Epstein F , Lin JP , Kricheff II , Hochwald GM . Evaluation Of pediatric hydrocephalus by computed tomography . Radiology 1976;119:337 - 45 . 12 . Hertzberg BS , Bowie JD , Burger PC , Marshburn PB , Djang WT . The th?ee lines : origin of sonographic l and marks in the fetal head . A JR Am J Roentgenol 1987;149:1009 - 12 . 13 . Hakim S , Adams RD . The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure . J Neurol Sci 1965;2:307 - 27 . 14 . Geschwind N. The mechanism of  normal pressure hydrocephalus . J Neurol Sci 1968;7:481 - 93 . 15 . Nagashima T , Tamaki N , Matsumoto S , Horwitz B , Seguchi Y. Biomechanics of hydrocephalus : a new theoretical model . Neurosurgery 1987;21:898 - 904 As a result of r and omized assignment , 15 preterm infants weighing 1,500 gm or less at birth and who had a symptomatic PDA were treated according to a medical management protocol , and ten according to an early surgical closure protocol .  All infants required  mechanical ventilation  at the time of study entry , which was one week after birth . Birth weight , gestational age , age at onset of congestive failure , age at study entry , and the initial morbidity of members of the two groups were similar . The nine surviving infants managed according to the surgical closure protocol were weaned from mechanical ventilation sooner , had a decreased need for digoxin and furosemide , achieved gastrointestinal function sooner , and had a smaller hospital bill than the 12 survivors of the medical management group . These results indicate that infants with a symptomatic PDA still requiring mechanical ventilation  at one week after birth will benefit from surgical closure of the ductus at that time AIM To evaluate the efficiency and side effects of ibuprofen for the early treatment of patent ductus arteriosus ( PDA ) and compare it with indomethacin . METHODS Forty preterm infants with gestational ages of less than 33 weeks , with respiratory distress syndrome ( RDS ) and echocardiographically confirmed PDA , were r and omly assigned at days 2 to 3 of life to receive either intravenous indomethacin 3 × 0.2 mg/kg at 12 hour intervals or intravenous ibuprofen 1 × 10 mg/kg , followed by 5 mg/kg 24 and 48 hours later . RESULTS PDA closed in 15 of 20 patients from the indomethacin group ( 75 % ) and in 16 of 20 ( 80 % ) from the ibuprofen group . Seven patients ( three indomethacin , four ibuprofen ) required a second treatment with indomethacin and in five ( three in the indomethacin group and two in the ibuprofen group ) the duct was ultimately ligated . Ibuprofen patients had a better urinary output and showed no increase in serum creatinine concentrations compared with the indomethacin group . Ibuprofen was not associated with any other side effect . CONCLUSIONS Ibuprofen treatment seems to be as efficient as indomethacin in closing PDA on the third day of life in preterm infants with respiratory distress syndrome and seems to have fewer renal side effects We admitted 36 preterm neonates ( 600 to 1250 gm birth weight ) with normal 6-hour echoencephalograms to a r and omized , placebo-controlled prospect i ve trial to determine whether a low dose of indomethacin would prevent germinal matrix or intraventricular hemorrhage and permit adequate urinary output . Between the sixth and tenth postnatal hours , indomethacin ( 0.1 mg/kg ) or placebo was administered intravenously every 24 hours for a total of three doses . Cardiac ultrasound studies to assess the status of the ductus arteriosus were performed at 6 postnatal hours and on day 5 . Urinary output , serum electrolytes , serum indomethacin levels , and renal and clotting functions were monitored . No differences in birth weight , gestational age , or Apgar scores were noted between the two groups of infants . Two indomethacin-treated infants and three infants given placebo had significant urinary output difficulties , requiring that the study medication be withheld . Of 19 infants given indomethacin  , two had germinal matrix or intraventricular hemorrhage , in comparison with 8 of 17 infants given saline solution ( p = 0.02 ) . Of the infants who had a left-to-right patent ductus arteriosus shunt before treatment , 64 % of the indomethacin-treated and 33 % of the saline solution-treated infants no longer had a patent ductus arteriosus on day 5 . Ductal status appeared unrelated to the development of germinal matrix or intraventricular hemorrhage Objectives To determine patent ductus arteriosus ( PDA )  closure rates , and  indomethacin ( INDO ) toxicity rates in neonates dosed with INDO using an individualized pharmacokinetic/pharmacodynamic ( PK/PD ) dosing approach . In addition , develop PD curves evaluating dose-response and concentration-response relationships for closure and renal toxicity , especially in select subgroups historically known as “ poor responders ” ( < 1000 g and ≥10 days postnatal age ) . Design Prospect i ve , cohort study . Setting Level III neonatal intensive care unit . Subjects One hundred thirty-nine patients receiving 151 courses of INDO for PDA closure were evaluated . Interventions Patients initially received 0.25 mg/kg of INDO , followed immediately by 1 mg/kg of furosemide . INDO concentrations were obtained 2 hrs and 8 hrs after the dose and were assayed using high-performance liquid chromatography . Individualized PK parameters were calculated with subsequent INDO dosing based on the individualized PK variables to increase trough serum concentrations by 0.3–0.5 mg/L. Measurements and Main Results Ductal closure was successful in 127 patients ( 91 % ) . Renal toxicity occurred in 21 ( 15 % ) patients and was temporary and reversible . No significant differences in response rates based on treatment weight or postnatal age were observed . PD curves were similar for neonates < 1000 g vs. ≥1000 g. PD curves were also similar for neonates with postnatal age < 10 days vs. ≥10 days . Statistically significant differences were noted between neonates categorized for postnatal age < 10 days vs. ≥ 10 days in total days of therapy ( 1.8 vs. 2.3 days ) , total number of doses required to close PDA ( 3.5 vs. 5.6 doses ) , critical INDO dose ( 0.9 vs. 1.4 mg/kg ) , critical INDO concentration ( 1.9 vs. 1.4 mg/L ) , and critical dose/critical concentration ratio ( 0.52 vs. 2.2 ) . Conclusions These findings support the hypothesis that the poor PDA closure rates with INDO for neonates > 10 days postnatal age are the result of pharmacokinetic differences only and that weight does not impact response rates . Individualized pharmacokinetic/pharmacodynamic dosing of INDO continues to achieve higher closure rate than current dosing st and ards . Patients historically known as poor responders significantly benefit from this dosing approach In a r and omized study , indomethacin was administered either by an intravenous rapid infusion or by a 30-minute intravenous infusion to preterm infants . Ten infants were r and omly assigned to the rapid infusion group and nine to the other group .  Time-averaged mean systolic , mean flow velocity , and mean diastolic blood flow velocities were measured in the internal carotid artery with a pulsed Doppler . Blood flow velocities , arterial blood gases , intraarterial blood pressures , and transcutaneous PO2 and PCO2 were measured at 5 and 1 minutes before indomethacin and then at 5 , 10 , 20 , 30 , 35 , 40 , 50 , 60 , and 90 minutes after indomethacin administration . Intravenous indomethacin either by rapid or slow infusion caused a significant decrease in the blood flow velocities . The blood flow velocities were significantly lower 5 minutes after rapid infusion and by 30 minutes in the slow-infusion group . In both groups , the blood flow velocities remained depressed up to 90 minutes . The blood pressures increased concomitantly to the blood flow velocities in the rapid-administration group only . Because indomethacin given for 30 minutes does not avoid the decrease in the blood flow velocities , further studies are necessary to ascertain the safest method of administration Abstract . Indomethacin ( INDO ) and , more recently , ibuprofen ( IBU ) have been used to treat haemodynamically significant patent ductus arteriosus ( PDA ) in preterm infants . Both are cyclo-oxygenase blockers , but seem to have a different influence on regional circulation . In a prospect i ve , r and omised , controlled study , we compared INDO and IBU with regard to efficacy and safety for the early non-invasive treatment of PDA . Doppler echocardiography was used to study 232 preterm infants ( gestational age 23–34 weeks ) with respiratory distress syndrome of whom 175 had persistent , haemodynamically significant PDA at 48–72 h of life . They were r and omised to receive three intravenous doses of either INDO ( 0.2 mg/kg , at 12 h intervals ) or IBU ( a first 10 mg/kg dose followed by two doses of 5 mg/kg at 24 h intervals ) , recording rate of ductal closure , need for additional treatment , side-effects and clinical course . The efficacy of the pharmacological treatment was similar in the two groups ( 56/81 , 69 % INDO ; 69/94 , 73 % IBU ) . Patients treated with INDO showed a significant increase in serum creatinine ( 89±24 versus 82±20 mmol/l , P=0.03 ) and a near-significant tendency for a lower fractional excretion of sodium ( 3±3 versus 4±2 % , P=0.08 ) ; moreover , 12/81 ( 15 % ) INDO patients versus 1/94 ( 1 % ) IBU patients became oliguric ( < 1 ml/kg per h ) during treatment ( P=0.017 ) . Conclusion : our findings confirm that , by comparison with indomethacin , ibuprofen has fewer effects on renal function in terms of urine output and fluid retention , with much the same efficacy and safety in closing patent ductus arteriosus in preterm infants with respiratory distress syndrome . In particular , no increased incidence of intracranial haemorrhage was observed after ibupro 
    Output:
    
Analysis of these studies showed that , although the primary outcome of PDA closure on days two and five slightly favored bolus administration , there was no statistical difference between the two groups .
AUTHORS ' CONCLUSIONS Due to a paucity of events and lack of precision , the available data was found to be insufficient to draw conclusions regarding the efficacy of continuous indomethacin infusion versus bolus injections for the treatment of PDA .
Although continuous indomethacin seems to cause less alterations in cerebral , renal and mesenteric circulations , the clinical meaning of this effect is unclear .