***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: A prospect i ve r and omized controlled trial was performed to compare the effects of ibuprofen with indomethacin on cerebral hemodynamics measured using near infrared spectroscopy in preterm infants during treatment for patent ductus arteriosus . Infants were r and omly assigned to three intravenous doses of either indomethacin ( 0.20–0.25 mg/kg , 12 hourly ) or ibuprofen ( 5–10 mg/kg , 24 hourly ) and also received a dose of saline . The primary end points of the study were the effects of the first dose on cerebral blood flow ( CBF ) and cerebral blood volume . Fifteen infants received indomethacin and 18 received ibuprofen .  The group mean ( SD ) values for CBF ( mL·100 g−1·min−1 ) before and after the first dose of indomethacin were 13.6 ( 4.1 ) and 8.3 ( 3.1 ) , respectively , the change being significant ( p < 0.001 ) . In contrast , no significant changes in CBF were observed with the first dose of ibuprofen , the respective before and after values being 13.3 ( 3.2 ) and 14.9 ( 4.7 ) mL·100 g−1·min−1 . The median ( interquartile range ) value for change in cerebral blood volume ( mL/100 g ) after the first dose in the indomethacin group was −0.4 ( −0.3 to −0.6 ) and in the ibuprofen group was 0.0 ( 0.1 to −0.1 ) , the difference between the two groups being significant ( p < 0.001 ) . Cerebral oxygen delivery changed significantly after the first dose in the indomethacin group but not in the ibuprofen group . Significant reductions in CBF , cerebral blood volume , and cerebral oxygen delivery also occurred after the 24-h dose of indomethacin , but there were no significant changes after the 48-h dose of saline in the indomethacin group or after the 24- and 48-h doses of ibuprofen . The patent ductus arteriosus closure rates after indomethacin and ibuprofen were 93 and 78 % , respectively . We conclude that ibuprofen , unlike indomethacin , has no adverse effects on cerebral hemodynamics and appears to mediate patent ductus arteriosus closure The effect of repeated doses of indomethacin on mean peak velocity ( MPV ) and time-averaged mean velocity in the middle cerebral artery was assessed in 10 ventilated neonates with a patent ductus arteriosus using colour/duplex Doppler technique prior to , and 10 , 30 , and 120 min after the first and the third dose . Velocities were significantly reduced up to 120 min after the first dose . The third dose result ed in a significant reduction in MPV at 10 and 30 min following treatment . This reduction was half of that observed after the first dose . Systemic blood pressure ( BP ) and heart rate did not change significantly after each separate dose . However , by the third dose , mean and diastolic BP were significantly increased from pretreatment levels . The attenuated response of cerebral blood flow ( CBF ) velocities to the third dose of indomethacin compared with the first dose is probably related to altered haemodynamics . Indomethacin should be used cautiously in infants with other conditions which are known to decrease CBF such as hypotension , hypocarbia and polycythaemia OBJECTIVE To determine whether a course of low-dose indomethacin therapy , when initiated within 24 hours of birth , would decrease ductal shunting in premature infants who received prophylactic surfactant in the delivery room . DESIGN Ninety infants , with birth weights of 600 to 1250 gm , were entered into a prospect i ve , r and omized , controlled trial to receive either indomethacin , 0.1 mg/kg per dose , or placebo less than 24 hours and again every 24 hours for six doses . Echocardiography was performed on day 1 before treatment and on day 7 , 24 hours after treatment . A hemodynamically significant patent ductus arteriosus ( PDA ) was confirmed with an out-of- study echocardiogram , and the nonresponders were treated with st and ard indomethacin or ligation . RESULTS Forty-three infants received indomethacin ( birth weight , 915 + /- 209 gm ; gestational age , 26.4 + /- 1.6 weeks ; 25 boys ) , and 47 received placebo ( birth weight , 879 + /- 202 gm ; gestational age , 26.4 + /- 1.8 weeks ; 22 boys ) ( P = not significant ) . Of 90 infants , 77 ( 86 % ) had a  PDA by echocardiogram on the first day of life before study treatment ; 84 % of these PDAs were moderate or large in size in the indomethacin-treated group compared with 93 % in the placebo group . Nine of forty indomethacin-treated infants ( 21 % ) were study -dose nonresponders compared with 22 ( 47 % ) of 47 placebo-treated infants ( p < 0.018 ) . There were no significant differences between both groups in any of the long-term outcome variables , including intraventricular hemorrhage , duration of oxygen therapy , endotracheal intubation , duration of stay in neonatal intensive care unit , time to regain birth weight or reach full caloric intake , incidence of bronchopulmonary dysplasia , and survival . No significant differences were noted in the incidence of oliguria , elevated plasma creatinine concentration , thrombocytopenia , pulmonary hemorrhage , or necrotizing enterocolitis . CONCLUSION The prophylactic use of low doses of indomethacin , when initiated in the first 24 hours of life in low birth weight infants who receive prophylactic surfactant in the delivery room , decreases the incidence of left-to-right shunting at the level of the ductus arteriosus OBJECTIVE The authors evaluated the risk of necrotizing enterocolitis ( NEC ) in very low birth weight infants receiving indomethacin ( INDO ) to close patent ductus arteriosus ( PDA ) . BACKGROUND DATA Controversy exists regarding the best method of managing very low birth weight infants with PDA and whether to employ medical management using INDO or surgical ligation of the ductus . METHODS Two hundred fifty-two premature infants with symptomatic PDA were given intravenously INDO 0.2 mg/kg every 12 hours x 3 in an attempt to close the ductus . Patients were evaluated for sex , birth weight , gestational age , ductus closure , occurrence of NEC , bowel perforation , and mortality . RESULTS There were 135 boys and 117 girls . The PDA closed or became asymptomatic in 224 cases ( 89 % ) , whereas 28 ( 11 % ) required surgical ligation . Ninety infants ( 35 % ) developed evidence of NEC after INDO therapy . Fifty-six were managed medically ; surgical intervention was required in 34 of 90 cases ( 37.8 % ) or 13 % of the entire PDA/INDO study group . Bowel perforation was noted in 27 cases ( 30 % ) . Factors associated with the onset of NEC included gestational age < 28 weeks , birth weight < 1 kg , and prolonged ventilator support . The overall mortality rate was 25.5 % , but was higher in infants with NEC versus those without . The highest mortality was noted in perforated NEC cases . The PDA/INDO patients were compared with a control group of 764 infants with similar sex distribution , birth weights , and gestational ages without PDA who did not receive INDO .  Necrotizing enterocolitis occurred in 105 of 764 control patients ( 13.7 % ) , including 13 ( 12.3 % ) with perforation . The overall mortality rate of controls was 25 % , which was similar to the overall 25.5 % mortality rate in the PDA/INDO study group . CONCLUSION These data indicate that there is increased risk of NEC and bowel perforation in premature infants with PDA receiving INDO  .  Mortality was higher in the PDA/INDO group with NEC than those PDA/INDO infants without NEC In the course of a double-blind trial of intravenous indomethacin therapy in premature infants with patent ductus arteriosus , renal function and urinary kallikrein were studied in 21 infants following one dose of either saline placebo or indomethacin . Ten infants were assigned to the control group and 11 were in the indomethacin group . Significantly lower urine output , fraction excretion of sodium , fraction excretion of chloride , and urinary kallikrein were noted by 45 % , 59 % , 63 % , and 51 % , respectively , in the indomethacin group as compared to the control group . There was a concomitant decrease in serum sodium concentration ( P less than .05 ) at 24 hours following indomethacin therapy . No significant difference in glomerular filtration rate was seen between the control group and the indomethacin-treated infants Near infrared spectroscopy was used to investigate the effects of intravenously administered indomethacin ( 0.1 - 0.2 mg/kg ) on cerebral haemodynamics and oxygen delivery in 13 very preterm infants treated for patent ductus arteriosus . 7 infants received indomethacin by rapid injection ( 30 s ) and 6 by slow infusion ( 20 - 30 min ) . In all the infants cerebral blood flow , oxygen delivery , blood volume , and the reactivity of blood volume to changes in arterial carbon dioxide tension fell sharply after indomethacin . There were no differences in the effects of rapid and slow infusion . These falls in cerebral oxygen delivery and the disruption of cerebrovascular control might compromise cellular oxygen availability , particularly in regions of the brain where the arterial supply is precarious . Care should be taken to ensure that oxygen delivery is optimum before the administration of indomethacin to preterm infants OBJECTIVE To evaluate the effect of intravenous ibuprofen and indomethacin for treatment of patent ductus arteriosus ( PDA ) on mesenteric and renal blood flow velocity in preterm infants . STUDY DESIGN Seventeen mechanically ventilated preterm infants ( <33 weeks ' gestation ) with PDA received either 0.2 mg/kg indomethacin ( n = 8) or 10 mg/kg ibuprofen ( n = 9 ) , infused over 15 minutes . Mesenteric and renal blood flow velocity were measured by using Doppler ultrasonography . RESULTS Indomethacin caused a significant reduction in mesenteric and renal blood flow velocity 30 minutes after drug administration ; mesenteric and renal blood flow velocity did not return to the pretreatment values by 120 minutes . Ibuprofen did not alter blood flow 30 minutes after treatment , and blood flow increased 120 minutes after treatment . Mesenteric and renal blood flow velocity changes were significantly different between the 2 treatment groups . CONCLUSIONS Compared with indomethacin , ibuprofen did not significantly reduce mesenteric and renal blood flow velocity 
    Output:
    
Ibuprofen reduces urine output .
Prophylactic use of ibuprofen reduces the incidence of PDA , the need for rescue treatment with cyclo-oxygenase inhibitors and surgical closure .
Prophylactic treatment therefore exposes a large proportion of infants unnecessarily to a drug that has important side effects ( mainly involving the kidneys ) without conferring any important short term benefits .