***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: Abstract Fluid overload worsens respiratory failure ; conversely , fluid restriction has been associated with a higher survival rate without chronic lung disease . We therefore hypothesised that fluid restriction in the perinatal period might improve lung function in ventilated , prematurely born infants of very low birthweight . As a consequence , we compared in a r and omised trial the effect of two fluid regimes on perinatal lung function . On one regime infants were to receive 60 ml/kg on day 1 , increasing to 150 ml/kg by day 7 , and on the other regime approximately 25 % less fluid was to be prescribed . Lung function was assessed by measurement of functional residual capacity ( FRC ) and compliance . Measurements were made daily on days 1 to 5 and then on day 7 . Ninety infants , median gestational age 28 weeks ( range 23–33 ) , were included in the study . There were no significant differences between the two groups regarding their gestational age or birthweight  , or in the proportions who received antenatal steroids or postnatal surfactant .  The infants on the restricted regime received significantly less fluid ( P < 0.01 ) . The only significant differences in lung function between the two groups , however , were that the infants on the restricted regime had a higher mean compliance on day 3 , but thereafter the difference was reversed . Colloid intake , however , unfavourably affected lung function , total colloid intake being negatively correlated with both the area under the curve of birth-adjusted FRC ( P=0.003 ) and compliance ( P=0.001 ) . Conclusion We conclude that early fluid restriction appears to have very little impact on perinatal lung function BACKGROUND Fluid restriction has been reported to improve survival of infants without chronic lung disease ( CLD )  , but it remains unknown whether it reduces CLD in a population at high risk of CLD routinely exposed to antenatal steroids and postnatal surfactant without increasing other adverse outcomes . AIM To investigate the impact of fluid restriction on the outcome of ventilated , very low birthweight infants . STUDY DESIGN A r and omised trial of two fluid input levels in the perinatal period was performed . A total of 168 ventilated infants ( median gestational age 27 weeks ( range 23–33 ) ) were r and omly assigned to receive st and ard volumes of fluid ( 60 ml/kg on day 1 progressing to 150 ml/kg on day 7 ) or be restricted to about 80 % of st and ard input . RESULTS Similar proportions of infants on the two regimens had CLD beyond 28 days ( 56%v 51 % ) and 36 weeks post conceptional age ( 26 % v 25 % ) , survived without oxygen dependency at 28 days ( 31 % v 27 % ) and 36 weeks post conceptional age ( 58 % v 52 % ) , and developed acute renal failure . There were no statistically significant differences between other outcomes , except that fewer of the restricted group ( 19 % v 43 % ) required postnatal steroids ( p < 0.01 ) . In the trial population overall , duration of oxygen dependency related significantly to the colloid ( p < 0.01 ) , but not crystalloid , input level ; after adjustment for specified covariates , the hazard ratio was 1.07 ( 95 % confidence interval 1.02 to 1.13 ) . CONCLUSIONS In ventilated , very low birthweight infants , fluid restriction in the perinatal period neither reduces CLD nor increases other adverse outcomes . Colloid infusion , however , is associated with increased duration of oxygen dependency . Key messages High fluid volumes increase the likelihood of a PDA , a risk factor for CLD development One of four previous r and omised trials showed that fluid restriction improved outcome —that is , a lower mortality in a relatively mature population We now show in ventilated VLBW infants that fluid restriction in the perinatal period does not reduce CLD ; colloid infusion , however , increases duration of oxygen The clinical effects of fluid therapy design ed to maintain different degrees of negative water balance during the first five days of life were determined prospect ively in 88 very low-birth-weight infants . Infants with birth weights of 750 to 1,500 gm were matched for birth weight in 250 gm increments . RDS or no RDS , asphyxiated or not , and inborn or outborn . Each infant was r and omized to either Group 1 - -fluids managed to allow 1 to 2 % loss of BW per day to a maximum loss of 8 to 10 % , or Group 2 - -fluids managed to allow 3 to 5 % loss of BW per day to a maximum loss of 13 to 15 % . The mean five-day cumulative fluid input in Group 2 was 220 ml/kg less than in Group 1 , yet Group 2 lost only 41 gm/kg more than did Group 1 ( 8.8 % of BW lost in Group 1 vs 12.9 % of BW lost in Group 2 , P less than 0.001 ) . There were no statistically significant differences between the groups in incidence of clinical ly significant patent ductus arteriosus , intracranial hemorrhage , bronchopulmonary dysplasia , necrotizing enterocolitis , dehydration , acute renal failure , or metabolic disturbances . There was no difference in duration of respiratory support required , in time to regain BW , or in time to discharge . There was no difference in the neonatal mortality rate . Fluid input in VLBW infants can be flexible to allow the gradual loss of 5 to 15 % of birth weight during the first week of life without adversely affecting outcome Under st and ardized conditions two r and om groups of 28 premature and newborn infants , each mostly suffering from a respiratory distress syndrome , were given infusions of either 60 or 150 ml/kg per day on the first three days of life . On each of the three days an increase of the infusion quantity result ed in a 2 - -3 times larger urine flow , the osmolal clearance increasing significantly at the same time . This was mainly due to a higher loss of NaCl , whereas there were no significant or only small differences in the excretion of all other electrolytes , acids , and nitrogenous metabolites . There was no clear evidence that a larger fluid intake had an influence on the endogenous creatinine clearance . Considerably negative effects of an increased infusion quantity were not observed in these investigations , yet one should use extreme caution as ductus arteriosus persistens as well as bronchopulmonal dysplasia are attributed to large fluid intakes during the first days of life We studied 170 premature infants with birth weights between 751 and 2000 g in a r and omized sequential trial comparing " high " and " low " volumes of fluid intake . Beginning on the third day of life , the low-volume group received only enough water to meet average estimated requirements , and the high-volume group received an excess of at least 20 ml per kilogram of body weight per day ( mean excess , 47 ml per kilogram per day ) . Sequential analysis showed that the risk of patent ductus arteriosus with congestive heart failure was greater in infants receiving the high-volume regimen . Thirty-five of 85 infants in the high-volume group acquired murmurs consistent with patent ductus arteriosus , and 11 of these 35 had congestive heart failure . Only nine of 85 infants in the low-volume group had murmurs consistent with patent ductus arteriosus , and two of these nine had congestive heart failure . More cases of necrotizing enterocolitis also occurred in the high-volume group . We conclude that limitation of fluid intake to amounts estimated to meet requirements for excretion , insensible loss , and growth can reduce the risks of patent ductus arteriosus and congestive heart failure in premature infants One hundred consecutive low‐birth‐weight infants ( < 1751 g ) were r and omized equally into “ dry ” and “ control ” groups . Fluid administration in the dry group followed the schema 50 , 60 , 70 , 80 , 90 , 100 and 120 ml/kg/day during the first week and 150 ml/kg/day until aged four weeks and that of the control group 80 , 100 , 120 and 150 ml/kg/day during the first week and 200 ml/kg afterwards . The diagnosis of bronchopulmonary dysplasia was based on typical roentgenographic findings , clinical symptoms and a supplemental oxygen requirement at age one month . Mean weight loss was greater in the dry group than in the control group ( 8.8 vs 6.2 % ) , but there was no difference in weight between the groups at the age of four weeks . Twelve of the patients died , one in the dry group and 11 in the control group ( five died during the first 24 h and the remaining six between three days and three months ) . Twenty‐seven subjects in the dry group and 15 in the control group were alive and had no signs of bronchopulmonary dysplasia at age 28 days ( p < 0.05 ) , the numbers at term being 28 and 14 , respectively ( p < 0.01 ) . These results suggest that fluid restrictions can reduce the mortality and morbidity of low‐birth‐weight infants . Infants of this kind , with respiratory distress , show poor tolerance to fluids , especially during the first weeks of life 
    Output:
    
MAIN RESULTS The analysis of the four studies taken together indicates that restricted water intake significantly increases postnatal weight loss and significantly reduces the risks of patent ductus arteriosus , necrotizing enterocolitis , and death .
With restricted water intake , there are trends toward increased risk of dehydration and reduced risk of bronchopulmonary dysplasia , but these trends are not statistically significant .
REVIEW ER 'S CONCLUSIONS Based on this analysis , the most prudent prescription for water intake to premature infants would seem to be careful restriction of water intake so that physiological needs are met without allowing significant dehydration .
This practice could be expected to decrease the risks of patent ductus arteriosus and necrotizing enterocolitis-- and perhaps the overall risk of death -- without significantly increased risk of adverse consequences