***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: To determine whether prenatal corticosteroid therapy would reduce the incidence of neonatal necrotizing enterocolitis ( NEC ) , we assigned a total of 466 women admitted in premature labor either to receive placebo  ( group A , n = 256 ) , if delivery was expected to occur within 24 hours of admission , or to receive betamethasone ( group B , n = 210 ) if delivery was expected to take place more than 24 hours after admission . All women were free of severe medical complications or drug therapy ; cases of intrauterine growth retardation or premature rupture of the membranes were excluded . Their newborn infants , excluding malformed , congenitally infected , and growth-retarded infants , were enrolled in the study unless they had died before the age of 10 postnatal days . Babies born to group A mothers ( n = 248 ) were further assigned to a treatment group ( group A1 , n = 130 ) receiving dexamethasone , 2 mg/kg/day by intravenous injection during the first 7 days of life , or to a control group ( group A2 , n = 118 ) receiving 10 % dextrose solution placebo .  Group B infants ( prenatal betamethasone , n = 205 ) received neither treatment nor placebo . The incidence of NEC in group A1 was 6.9 % ( 9/130 ) , and in group A2 it was 14.4 % ( 17/118 ) ( p less than 0.05 ) . In group B the incidence was 3.4 % ( 7/205 ) ; this was much lower than in group A2 ( p less than 0.01 ) and lower than in group A combined ( 10.4 % ) ( p less than 0.01 ) . There was no death from NEC and no surgical intervention among group B patients . The mortality rate for group A1 ( 11 % ) was lower than for group A2 ( 56 % ) ( p less than 0.02 ) . There were fewer indications for surgical intervention for NEC in group A1 than in group A2 . Histologic studies confirmed bowel ischemia in all specimens analyzed . These data support the hypothesis that the incidence of NEC is significantly reduced after prenatal steroid treatment . Although postnatal therapy with steroids does not decrease the incidence as effectively as prenatal therapy , it improves clinical outcome of NEC Early postnatal use of dexamethasone has recently been shown to be effective in improving the pulmonary status in premature infants with respiratory distress syndrome ( RDS ) . To study the effect of dexamethasone on pulmonary inflammatory responses , we studied ten infants treated with dexamethasone and ten infants without this treatment . Serial tracheal aspirates were obtained for cell counts , neutrophil counts , total protein concentrations , and leukotriene B4 ( LTB4 ) and 6-keto prostagl and in (PG)F(1 alpha ) levels before and after starting the study . Infants in the dexamethasone-treated group required significantly lower mean airway pressures for ventilation and had lower PaCO2 values from day 3 to day 14 than infants in the control group , suggesting better pulmonary function . For infants in the dexamethasone group , the tracheal aspirates showed significantly lower cell and neutrophil counts , protein concentrations , and 6-keto-PGF(1 alpha ) and LTB4 levels than in the control group . We conclude that early postnatal dexamethasone therapy may lessen lung inflammation and improve pulmonary function in infants with RDS Dexamethasone was compared with placebo in a double-blind , crossover , r and omised study of infants with severe bronchopulmonary dysplasia who had required mechanical ventilation for at least four weeks , despite treatment with diuretics , methylxanthines , bronchodilators , fluid restriction , nutritional supplementation , and ligation of the patent ductus arteriosus when indicated . Gestational age ranged from 27 to 33 weeks and birth weight from 800 to 1730 g. Patients received dexamethasone ( 0 . 5 mg/kg/day ) or normal saline for the first 3 days , then treatment was crossed over for the next 3 days . The study was terminated when sequential analysis showed that all six patients had improved during dexamethasone therapy . Significant improvements were seen in ventilator-determined respiratory rate , peak inspiratory pressure , fractional inspired oxygen concentration , and alveolar arterial oxygen gradients ( p less than 0 . 05 ) . Although dexamethasone hastened weaning from mechanical ventilation , infection occurred in a substantial proportion of patients Background . Although several trials of early dexamethasone therapy have been completed to determine if such therapy would reduce mortality and chronic lung disease ( CLD ) in infants with respiratory distress , optimal duration and side effects of such therapy remain unknown . Purpose . The purpose of this study was : 1 ) to determine if a 3-day course of early dexamethasone therapy would reduce CLD and increase survival without CLD in neonates who received surfactant therapy for respiratory distress syndrome and 2 ) to determine adverse effects associated with such therapy . Design . This was a prospect i ve multicenter r and omized trial comparing a 3-day course of dexamethasone therapy beginning at 24 to 48 hours of life to placebo therapy .  Two hundred forty-one neonates ( dexamethasone n = 118 , placebon = 123 ) , who weighed between 500 g and 1500 g , received surfactant therapy , and were at significant risk for CLD or death using a model to predict CLD or death at 24 hours of life , were enrolled in the trial . Infants r and omized to receive early dexamethasone  were given 6 doses of dexamethasone at 12-hour intervals beginning at 24 to 48 hours of life . The primary outcomes compared were survival without CLD and CLD . CLD was defined by the need for supplemental oxygen at the gestational age of 36 weeks . Complication rates and adverse effects of study drug therapy were also compared . Results . Neonates r and omized to early dexamethasone treatment were more likely to survive without CLD ( RR : 1.3 ; 95 % CI : 1.03 , 1.7 ) and were less likely to develop CLD ( RR : 0.6 ; CI : 0.3 , 0.98 ) . Mortality rates were not significantly different . Subsequent dexamethasone therapy use was less in early dexamethasone-treated neonates ( RR : 0.8 ; CI : 0.7 , 0.96 ) . Very early ( ≤7 days of life ) intestinal perforations were more common among dexamethasone-treated neonates ( 8 % vs 1 % ) . Conclusion . We conclude that an early 3-day course of dexamethasone therapy increases survival without CLD , reduces CLD , and reduces  late dexamethasone therapy in high-risk , low birth weight infants who receive surfactant therapy for respiratory distress syndrome . Potential benefits of early dexamethasone therapy at the dosing schedule used in this trial need to be weighed against the risk for early intestinal perforation Background : Dexamethasone treatment is associated with an increased risk of cerebral palsy ( CP ) . Early hydrocortisone ( HC ) treatment may decrease the incidence of bronchopulmonary dysplasia ; however , the long-term effects are still under evaluation . Follow-up of r and omized studies concerning early HC treatment is essential to confirm the long-term safety . Objective : We hypothesized that early HC treatment in very preterm infants does not impair the neurologic outcome . Methods : We report follow-up data from a r and omized trial of early HC given for 10 days . Before the HC or placebo treatment , serum cortisol levels were measured . Receiver-operating characteristic was defined . Values below the median were classified as low endogenous cortisol and those above the median as high endogenous cortisol . A meta- analysis was performed . Results : Altogether 98 % of the 46 surviving infants participated in a follow-up study at a corrected age of 2 years . The growth characteristics were similar between the study groups . The developmental quotients ( DQs ) of the children with high endogenous cortisol and placebo treatment shortly after birth ( 100 ± 13 ) and those with low endogenous cortisol and HC ( 97 ± 7 ) were not lower than the DQs of the children with high endogenous cortisol and HC ( 92 ± 3 ) or low cortisol and placebo ( 96 ± 2 ) . According to a meta- analysis of three available trials ( 411 children ) , the rate of CP and survival without neurosensory or cognitive impairment was not influenced by HC . Conclusion : Early low-dose HC administration had no adverse effects at 2 years of age . Further studies are required to define the target group for neonatal HC 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 . Low cortisol concentrations in premature infants have been correlated with increased severity of illness , hypotension , mortality , and development of bronchopulmonary dysplasia . A total of 360 mechanically ventilated infants with a birth weight of 500 to 999 g were enrolled in a r and omized , multicenter trial of prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia . Mortality and bronchopulmonary dysplasia were decreased in the hydrocortisone-treated  patients exposed to chorioamnionitis .  We now report outcomes at 18 to 22 months ' corrected age . PATIENTS AND METHODS . Surviving infants were evaluated with st and ardized neurologic examination and Bayley Scales of Infant Development-II . Neurodevelopmental impairment was defined as a Mental Developmental Index or Psychomotor Developmental Index of < 70 , cerebral palsy , blindness or deafness . RESULTS . A total of 252 ( 87 % ) of 291 survivors were evaluated .  Cerebral palsy was diagnosed in 13 % of hydrocortisone-treated versus 14 % of placebo-treated infants . Fewer hydrocortisone-treated infants had a Mental Development Index < 70 , and more of the hydrocortisone-treated infants showed evidence of awareness of object permanence . Incidence of neurodevelopmental impairment was not different ( 39 % [ hydrocortisone ] vs 44 % [ placebo ] ) . There were no differences in physical growth measures . Chorioamnionitis-exposed infants treated with hydrocortisone were shorter and weighed less than controls but had no evidence of neurodevelopmental impairment . Among infants not exposed to chorioamnionitis , hydrocortisone-treated patients were less likely to have a Mental Development Index of < 70 or to be receiving glucocorticoids at follow-up . CONCLUSIONS . Early , low-dose hydrocortisone treatment was not associated with increased cerebral palsy . Treated infants had indicators of improved developmental outcome . Together with the short-term benefit previously reported , these data support additional studies of hydrocortisone treatment of adrenal insufficiency in extremely premature infants BACKGROUND Early administration of high doses of dexamethasone may reduce the risk of  chronic lung disease in premature infants but can cause complications . Whether moderate doses would be as effective but safer is not known . METHODS We r and omly assigned 220 infants with a birth weight of 501 to 1000 g who were treated with mechanical vent 
    Output:
    
Late steroid treatment was associated with a reduction in neonatal mortality ( at 28 days ) but not mortality at discharge or latest reported age .
There was a trend towards an increase in risk of infection and GI bleeding but not NEC .
There was an increase in severe ROP ( overall and a trend in survivors ) but no significant increase in blindness .
The trends to an increase in cerebral palsy or abnormal neurological examination were partly offset by a trend in the opposite direction in death before late follow-up .
The combined rate of death or cerebral palsy was not significantly different between steroid and control groups .
Major neurosensory disability , and the combined rate of death or major neurosensory disability , were not significantly different between steroid and control groups .
There were no substantial differences between groups for other outcomes in later childhood , including respiratory health or function , blood pressure , or growth .
AUTHORS ' CONCLUSIONS The benefits of late corticosteroid therapy may not outweigh actual or potential adverse effects .
Although there continues to be concern about an increased incidence of adverse neurological outcomes in infants treated with postnatal steroids  ( see also review of " Early postnatal corticosteroids for preventing chronic lung disease in preterm infants " ) , this review of postnatal corticosteroid treatment for CLD initiated after seven days of age suggests that late therapy may reduce neonatal mortality without significantly increasing the risk of adverse long-term neurodevelopmental outcomes .