***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: AIM To assess the role of etamsylate * in reducing the risk of haemorrhagic brain damage and its consequences . DESIGN Follow up of babies recruited into a r and omised controlled trial . METHODS A total of 334 infants born before 33 weeks gestation in France and Greece were r and omly allocated within the first four hours of birth either to receive etamsylate or to act as controls . The principal outcomes in the trial were death or impairment and /or disability at the age of 2 years . RESULTS Fifty nine children were lost to follow up . A total of 115 ( 34 % ) either died or had some impairment or disability , and 88 ( 26 % ) either died or had severe impairment or disability at 2 years of age . These outcomes did not differ significantly between the two r and omised groups : relative risks and 95 % confidence intervals 1.14 ( 0.78 to 1.4 ) and 1.17 ( 0.82 to 1.68 ) respectively . The findings were similar for all the prespecified subgroup analyses stratified by key prognostic factors at trial entry : country of birth , gestational age < or ⩾ 29 weeks , inborn or outborn , age < or ⩾ 1 hour , and with or without cerebral scan abnormality . CONCLUSION These findings do not support the use of etamsylate . Other strategies need to be evaluated for the prevention of mortality and morbidity in these vulnerable infants . Key messages The findings from the only published follow up of children from a r and omised controlled trial of etamsylate do not support its use when given within the first four hours of birth to infants born before 33 weeks gestation Centres in Greece and France recruited 334 infants into the trial , and did not find that etamsylate  reduced the risk of haemorrhagic brain damage or its consequences in terms of death or impairment and /or disability Other strategies need to be evaluated for the prevention of mortality and morbidity in these vulnerable Cerebral blood flow velocity and cardiac output were measured with ultrasound before and 30 minutes after the administration of ethamsylate in a double blind placebo controlled study of 19 very low birthweight infants . No differences were found before or after treatment in either group Objective : To compare neurodevelopmental outcome of survivors of the multicentre trial of etamsylate ( the iRNN for ethamsylate ) for prevention of periventricular haemorrhage in very low birthweight infants . Design : Double blind , single observer , prospect i ve follow up of placebo controlled study . Setting : Six neonatal intensive care units in the United Kingdom . Neurodevelopmental outcome was assessed in health premises or children ’s homes . Subjects : 268 of 276 survivors of the original study were seen between 3.5 and 4.2 years of age . All were inborn and weighed 1500 g or less at birth . Intervention : Etamsylate 12.5 mg/kg or placebo six hourly from within one hour of delivery for four days . Main outcome measures : McCarthy scales of children ’s abilities , st and ardised neurological examination , full physical examination , functional assessment , seven letter Stycar vision test , and audiometry . Results : There was no difference between the groups in neuromotor outcome ( cerebral palsy ) or in the general cognitive index ( GCI ) of the McCarthy scales ( mean GCI was 93.3 for the etamsylate group ( n = 133 ) and 89.7 for the placebo group ( n = 131 ) ; p = 0.10 ) . There were more children with GCI < 70 ( 9 v 19 ; p = 0.047 ) or ⩽ 50 ( 3 v 11 ; p = 0.03 ) in the placebo group . Fewer children in the etamsylate group had squints ( 17 v 30 ; p = 0.042 ) or required surgery for patent ductus arteriosus ( 1 v 8 ; p = 0.036 ) . Conclusions : Etamsylate was not associated with a reduction in cerebral palsy . Severe cognitive impairment was reduced , but more children died and the improvement may be because fewer survived with low GCI The effect of Dicynene on blood loss during and after  transurethral resection for benign enlargement of the prostate was studied in 76 patients .  Median loss of blood at operation was 17 ml in those given Dicynene compared with 72 ml in the placebo group ( p equals less than 0.001 ) . Median postoperative blood loss was 38 ml in the Dicynene group , and 103 ml in the placebo group ( p equals 0.05 ) . Clinical evidence of deep vein thrombosis was found in neither group . Dicynene helps to reduce blood loss in transurethral resection The effectiveness of ethamsylate in the prevention of periventricular haemorrhage ( PVH ) in very low birthweight infants was evaluated by means of a multicentre , placebo-controlled , double-blind trial . In 330 infants without evidence of PVH on initial cranial ultrasound examination there was little difference between ethamsylate and placebo groups with respect to subependymal haemorrhage , but intraventricular and parenchymal haemorrhages developed in 30/162 infants ( 18.5 % ) in the treated group , compared with 50/168 ( 29.8 % ) in the control group ( p less than 0.02 ) . The incidence of intraventricular and parenchymal haemorrhage in survivors was 20/137 ( 14.6 % ) in the ethamsylate group and 37/146 ( 25.3 % ) in the controls ( p less than 0.05 ) . In 30 infants with evidence of PVH on the initial scan , ethamsylate treatment seemed to limit parenchymal extension . Analysis of the total cohort of 360 infants showed that the proportion of infants in whom an increase of two or more grade s of severity of PVH was recorded during the trial was lower in the treated than in the placebo group ( p less than 0.01 ) . No adverse effects were attributed to ethamsylate therapy . The reported incidence of patent ductus arterious was lower in the treated than in the placebo group ( p less than 0.02 ) . Mortality was similar in the two groups 22 patients complaining of primary menorrhagia or menorrhagia associated with an intrauterine device ( I.U.C.D. ) were studied in a double blind trial with crossover of ethamsylate and placebo . Acutal menstrual blood-losses were calculated from the iron content of used sanitary material during one pre-trail menstrual period and four trial menstrual periods , during which patients received ethamsylate ( " Dicynene " ) treatment during two menstrual cycles and placebo during two cycles . During ethamsylate treatment the mean menstrual blood-loss was reduced by 50 % in patients with primary menorrhagia and by 19 % in patients with an I.U.C.D. This difference between the two groups is probably accounted for by the differing values of initial blood-loss which was significantly higher in the group with primary menorrhagia . Tampon usage and the duration of bleeding were not significantly altered by ethamsylate treatment . Reported side-effects , which were not serious , were equally common during ethamsylate and placebo treatment OBJECTIVE To determine the role of ethamsylate in prevention of PVH-IVH in premature infants < 34 weeks gestational age . DESIGN Prospect i ve , r and omized , controlled study . METHODS Infants less than 34 weeks gestational age were included in the trial . Neonates with congenital malformations , family history of bleeding disorders and with Apgar scores < 5 at 5 minutes were excluded . Subjects were r and omized into two groups -- Group A infants received intravenous ethamsylate ( 12.5 mg/kg ) six hourly for four days and Group B infants served as a control group . Regular cranial ultrasounds  to detect the presence of PVH-IVH were done between days 3 - 5 , 10 - 14 and 28 - 30 of post natal age , and before hospital discharge in all infants and weekly in infants detected to have PVH-IVH on earlier scans . Various antenatal and postnatal factors known to affect the incidence of PVH-IVH were recorded . RESULTS A total of 192 infants underwent the trial , 93 in Group A and 99 in Group B. Antenatal corticosteroids ( 1 or 2 doses ) were administered to 32 ( 34.4 % ) and 36 ( 36.3 % ) women in Group A and Group B , respectively . None of the mothers received phenobarbitone , vitamin K or indomethacin antenatally and none of the infants received phenobarbitone , vitamin E or indomethacin postnatally during the study period . PVH-IVH was seen in 26 infants in Group A , of which Grade I IVH occurred in 9 , Grade II in 14 , Grade III in 2 and Grade IV in one infant . Twenty-nine infants had PVH-IVH in Group B of which 11 had Grade I , 15 Grade II and 3 Grade III . None of the differences were statistically significant . CONCLUSION Postnatal administration of ethamsylate did not decrease the incidence of PVH-IVH in the study infants Some trials in premature infants with respiratory distress syndrome have shown an increased incidence of patent ductus arteriosus after exogenous surfactant therapy . The effect of prophylactic ethamsylate on patent ductus arteriosus after intratracheal administration of a single dose of porcine surfactant preparation ( Curosurf , 2.5 ml/kg ) was studied in a group of 20 preterm infants with severe respiratory distress syndrome . Gestational age of the patients was 29.2 + /- 2.5 weeks ( mean + /- SD ) , and birth weight was 1158 + /- 319 gm .  Ethamsylate ( 12.5 mg/kg ) was given prophylactically within the first 4 hours of life followed by 6-hourly doses for 4 days . Hemodynamically significant patent ductus arteriosus occurred more frequently in the untreated group ( 8 of 10 ) than in the ethamsylate group ( 2 of 10 ) ( p < 0.02 ) . No acute adverse effects were attributed to the therapy . This preliminary experience suggests that ethamsylate , an inhibitor of prostagl and in bio synthesis , could be useful in reducing the incidence of patent ductus arteriosus in very low birth weight infants treated with exogenous surfactant Abstract The effect of ethamsylate , a capillary-stabilising drug , in limiting or preventing periventricular haemorrhage ( PVH ) in 70 very low birth-weight babies was evaluated in a double-blind trial . PVH developed in 9 of the 35 infants on ethamsylate and 18 of the 35 infants who received placebo .  Mortality associated with PVH was similar in both groups , but the incidence of PVH of all grade s in survivors was reduced in the ethamsylate-treated group OBJECTIVES To determine whether the current incidence of intraventricular haemorrhage ( IVH ) of grade 2 or more is high enough in preterm infants born after 29 weeks gestation to justify the cost of screening with ultrasound and to explore clinical indicators for risk of IVH in the more mature preterm infant . METHODS This cohort study examined the incidence and severity of IVH in 800 preterm infants born between January 1992 and August 1996 , of whom 436 were born after 29 weeks . Demographic and clinical details were collected from a prospect ively maintained data base . The Medicare schedule charge rate for cerebral ultrasound was used to calculate costs . RESULTS 1.1 % of preterm babies born after 29 weeks gestation who had routine ultrasound scans had an IVH of grade 2 or 3 , no infant had a grade 4 IVH . Two infants had a grade 3 IVH , both of which were symptomatic . IVH was poorly predicted by other clinical criteria . Using the Medicare schedule to estimate costs , detecting the five grade 2 or 3 IVH cost A$ 42,000 . CONCLUSIONS The incidence of grade 2 - 4 IVH is low in infants born after 29 weeks gestation . Screening of this population is expensive and probably not justified . It may be most appropriate to scan these infants only if their condition raises concern Patent ductus arteriosus ( PDA ) is common in premature infants younger than 33 weeks ' gestational age ( GA ) , and its deleterious effects are increased by the presence of respiratory distress syndrome . A significant proportion of infants younger than 33 weeks ' GA have PDA . 12 Indomethacin has been used for the treatment of hemodynamically significant ductus , causing severe side effects , but even recently , it has been considered the only pharmacological approach to PDA . 3 In the early 1980s , Morgan et al 4 reported a reduction in the incidence of intraventricular hemorrhages in preterm neonates treated with ethamsylate , an inhibitor of prostagl and in bio synthesis . 4 - 6 Recently , ethamsylate has been reported to favor the closure of the ductus in preterm neonates with respiratory distress syndrome treated with exogenous surfactant . 7 In 1987 , we started prophyla 
    Output:
    
There was no significant difference detected in neonatal mortality or neurodevelopmental outcome at two years between infants treated with ethamsylate and controls .
There were no adverse effects of ethamsylate identified from this systematic review .
Preterm infants treated with ethamsylate showed no reductions in mortality or neurodevelopmental impairment despite the reduction in any grade of intraventricular haemorrhage seen in infants < 35 weeks gestation