***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: Objective To determine survival and neonatal morbidity for babies born between 22 and 26 weeks ’ gestation in Engl and during 2006 , and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks ’ gestation . Design Prospect i ve national cohort studies . Setting Maternity and neonatal units in Engl and . Participants 3133 births between 22 and 26 weeks ’ gestation in 2006 ; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks ’ gestation . Main outcome measures Survival to discharge from hospital , pregnancy and delivery outcomes , infant morbidity until discharge . Results In 2006 , survival of live born babies was 2 % ( n=3 ) for those born at 22 weeks ’ gestation , 19 % ( n=66 ) at 23 weeks , 40 % ( n=178 ) at 24 weeks , 66 % ( n=346 ) at 25 weeks , and 77 % ( n=448 ) at 26 weeks ( P<0.001 ) . At discharge from hospital , 68 % ( n=705 ) of survivors had bronchopulmonary dysplasia ( receiving supplemental oxygen at 36 weeks postmenstrual age ) , 13 % ( n=135 ) had evidence of serious abnormality on cerebral ultrasonography , and 16 % ( n=166 ) had laser treatment for retinopathy of prematurity . For babies born between 22 and 25 weeks ’ gestation from March to December , the number of admissions for neonatal care increased by 44 % , from 666 in 1995 to 959 in 2006 . By 2006 adherence to evidence based practice associated with improved outcome had significantly increased . Survival increased from 40 % to 53 % ( P<0.001 ) overall and at each week of gestation : by 9.5 % ( confidence interval −0.1 % to 19 % ) at 23 weeks , 12 % ( 4 % to 20 % ) at 24 weeks , and 16 % ( 9 % to 23 % ) at 25 weeks . The proportions of babies surviving in 2006 with bronchopulmonary dysplasia , major cerebral scan abnormality , or weight and /or head circumference < −2 SD were similar to those in 1995 , but the proportion treated for retinopathy of prematurity had increased from 13 % to 22 % ( P=0.006 ) . Predictors of mortality and morbidity were similar in both cohorts . Conclusion Survival of babies born between 22 and 25 weeks ’ gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged . These observations reflect an important increase in the number of preterm survivors at risk of later health problems OBJECTIVE : To assess dexamethasone ( DEX ) and hydrocortisone ( HC ) use in premature infants over time and the association of steroid use with the incidence of  bronchopulmonary dysplasia ( BPD ) at 36 weeks ' postmenstrual age . METHODS : We analyzed data from the Pediatrix data base for neonates of 23 to 32 weeks ' gestation managed during 1997–2006 ( N = 77520 ) . We compared the use of  DEX , HC  and BPD ( defined by oxygen use at 36 weeks ' postmenstrual age ) according to year and estimated gestational age . Mantel-Haenszel χ2 was used to compare the trends in steroid use and BPD rates according to year . RESULTS : There were no differences by year in the proportion of births at each gestation or in early or late neonatal death . DEX  use decreased from a peak of 25.0 % in 1998 to 6.8 % in 2006 , but HC use increased from 1.1 % in 1997 to a peak of 6.5 % in 2006 . The median age at initiation of DEX use increased > 2 weeks from 1997 to 2006 . BPD rates increased from 19 % in 1997 to 25 % by 2006 . Rates for severe BPD ( defined by positive pressure support ) also increased significantly over time . Between 23 and 28 weeks , there was a significant increase in BPD rates associated with the decrease in DEX over time . CONCLUSIONS : Steroid use and preference have changed significantly over the past decade . Decreased use of DEX was associated with increased rates of BPD , any or severe , among very preterm infants . Well- design ed , r and omized , noncrossover trials with long-term outcome analysis of high-risk infants are needed We previously reported on a 7-day course of dexamethasone starting at 0.5 mg/kg/day in intubated very low birth weight ( VLBW ) infants , 7 - 14 days of age , with increased dynamic pulmonary compliance and decreased bronchopulmonary dysplasia ( BPD ) . The effect of low-dose dexamethasone on functional residual capacity ( FRC ) in VLBW infants is unknown . The objective of this study was to compare the effect of two regimens of moderately early dexamethasone on FRC and passive respiratory compliance ( Crs ) in VLBW infants at risk for BPD . Sixty-two intubated VLBW infants were r and omized ( double-blinded ) at 7 - 21 days of age ; 29 patients ( mean birth weight , 839 g ) received " high " dose dexamethasone ( 0.5 mg/kg/day for 3 days , 0.25 mg/kg/day for 3 days , and 0.1 mg/kg/day on day 7 , total dose of 2.35 mg/kg ) , and 33 infants ( mean birth weight , 830 g ) received " low-dose " dexamethasone ( 0.2 mg/kg/day for 3 days and 0.1 mg/kg/day for 4 days , total dose of 1 mg/kg ) . FRC and Crs were measured with the nitrogen washout technique and single breath occlusion technique , before and on days 2 , 5 , and 7 of therapy . Clinical outcome and early neurodevelopmental follow-up were evaluated . FRC significantly increased in the high-dose ( 19.3 ml/kg at baseline to 34 ml/kg on day 7 ; P < 0.001 ) and low-dose ( 18.1 ml/kg at baseline to 30.3 ml/kg on day 7 ; P < 0.001 ) dexamethasone groups when compared to baseline . There was a significant increase in Crs and a decrease in FiO2 within each group . The improvements in FRC and Crs were comparable between groups , and specific compliances ( Crs/FRC ) were not different . There were no significant differences in other clinical outcome parameters , including BPD and neurodevelopmental outcome . In conclusion , there are significant increases in FRC during a 7-day course of moderately early dexamethasone in VLBW infants . The lower total dose ( 1 mg/kg ) appears as effective as the higher total dose of dexamethasone ( 2.35 mg/kg ) in increasing FRC . Comparable significant increases in Crs were observed in both groups of infants . Additional long-term follow-up is underway OBJECTIVES To study whether early postnatal ( < 12 hours ) dexamethasone therapy reduces the incidence of chronic lung disease in preterm infants with respiratory distress syndrome . MATERIAL S AND METHODS A multicenter r and omized , double-blind clinical trial was undertaken on 262 ( saline placebo , 130 ; dexamethasone , 132 ) preterm infants ( < 2000 g ) who had respiratory distress syndrome and required mechanical ventilation shortly after birth . The sample size was calculated based on the 50 % reduction in the incidence of chronic lung disease when early dexamethasone is used , allowing a 5 % chance of a type I error and a 10 % chance of a type II error . For infants who received dexamethasone , the dosing schedules were : 0.25 mg/kg/dose every 12 hours intravenously on days 1 through 7 ; 0.12 mg/kg/dose every 12 hours intravenously on days 8 through 14 ; 0.05 mg/kg/dose every 12 hours intravenously on days 15 through 21 ; and 0 . 02 mg/kg/dose every 12 hours intravenously on days 22 through 28 . A st and ard protocol for respiratory care was followed by the participating hospitals . The protocol emphasized the criteria of initiation and weaning from mechanical ventilation . The diagnosis of chronic lung disease based on oxygen dependence and abnormal chest roentgenogram was made at 28 days of age . To assess the effect of dexamethasone on pulmonary inflammatory response , serial tracheal aspirates were assayed for cell counts , protein , leukotriene B4 , and 6-keto prostagl and in F1alpha . All infants were observed for possible side effects , including hypertension , hyperglycemia , sepsis , intraventricular hemorrhage , retinopathy of prematurity , cardiomyopathy , and alterations in calcium homeostasis , protein metabolism , and somatic growth . RESULTS Infants in the dexamethasone group had a significantly lower incidence of chronic lung disease than infants in the placebo group either judged at 28 postnatal days ( 21/132 vs 40/130 ) or at 36 postconceptional weeks ( 20/132 vs 37/130 ) . More infants in the dexamethasone group than in the placebo group were extubated during the study . There was no difference between the groups in mortality ( 39/130 vs 44/132 ) ; however , a higher proportion of infants in the dexamethasone group died in the late study period , probably attributable to infection or sepsis . There was no difference between the groups in duration of oxygen therapy and hospitalization . Early postnatal use of dexamethasone was associated with a significant decrease in tracheal aspirate cell counts , protein , leukotriene B4 , and 6-keto prostagl and in F1alpha , suggesting a suppression of pulmonary inflammatory response . Significantly more infants in the dexamethasone group than in the placebo group had either bacteremia or clinical sepsis ( 43/132 vs 27/130 ) . Other immediate , but transient , side effects observed in the dexamethasone group are : an increase in blood glucose and blood pressure , cardiac hypertrophy , hyperparathyroidism , and a transient delay in the rate of growth . CONCLUSIONS In preterm infants with severe respiratory distress syndrome requiring assisted ventilation shortly after birth , early postnatal dexamethasone therapy reduces the incidence of chronic lung disease , probably on the basis of decreasing the pulmonary inflammatory process during the early neonatal period . Infection or sepsis is the major side effect that may affect the immediate outcome . Other observable side effects are transient . In view of the significant side effects and the lack of overall improvement in outcome and mortality , and the lack of long term follow-up data , the routine use of early dexamethasone therapy is not yet recommended OBJECTIVE We hypothesized that a pulsed course of dexamethasone would result in better linear growth than a 42-day reducing course in preterm infants at risk for chronic lung disease of prematurity . STUDY DESIGN Forty infants with a birth weight of < or = 1,250 g who required mechanical ventilation at 7 days of age were r and omly assigned to a repeatable 3-day pulse course of dexamethasone commencing immediately or a 42-day ( long ) course commencing at 14 days of age if they still required mechanical ventilation and supplemental oxygen . The primary outcome measure was linear growth at 36 weeks ' postmenstrual age measured by knemometry . RESULTS There was no difference in lower leg length at 36 weeks ' postmenstrual age . Infants receiving the pulse course had lower rises in blood pressure , less myocardial hypertrophy , and less adrenal suppression . However , more infants required supplemental oxygen at 28 days ' postnatal age ( 14/18 vs 8/21 , P < .05 ) and 36 weeks ' PMA ( 8/16 vs 5/20 , P = .12 ) . CONCLUSION In preterm infants at risk for chronic lung disease , a pulsed course of dexamethasone has fewer side effects than a long course but may be less effective at preventing chronic lung disease AIM To compare early ( <3 days ) with late ( > 15 days ) steroid therapy and dexamethasone with inhaled budesonide in very preterm infants at risk of developing chronic lung disease . METHODS Five hundred seventy infants from 47 neonatal intensive care units were enrolled . Criteria for enrollment included gestational age < 30 weeks , postnatal age < 72 hours , and need for mechanical ventilation and inspired oxygen concentration > 30 % . Infants 
    Output:
    
The composite outcomes of death or BPD and death or abnormal neurodevelopmental outcome showed similar results although the former only reached borderline significance .There were no differences in outcomes between a moderate- and a low-dosage regimen .