***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 Our purpose was to evaluate the efficacy and safety of ambroxol for the prenatal prophylaxis of  infant respiratory distress syndrome ( IRDS ) .  STUDY DESIGN This was a prospect i ve study with 2 groups of pregnant patients with premature labor or with premature rupture of membranes at an estimated gestation between 27 to 34 completed weeks .  Ambroxol treatment group consisted of 39 subjects in whom 1,000 mg of ambroxol diluted in 500 ml of 5 % glucose solution was given intravenously for 4 hours once a day for 3 days , while the control group consisted of 41 subjects in whom ambroxol was not administered .  Main measures included Apgar scores , clinical signs of one or more of the following : respiratory rate of > 60/min , intercostal retraction , alar flaring , expiratory grunting , cyanosis on room air and radiological evidence of IRDS . Chi-square test was used to determine the statistical significance of the results . RESULTS Tolerable maternal side effects were noted . Profile of newborns delivered were similar in both groups . Incidence of IRDS was significantly less in the treatment group ( p < 0.01 ) . CONCLUSIONS Antenatal administration of ambroxol result ed in a significant decrease in the incidence of IRDS as well as perinatal morbidity and mortality . Due to the efficacy and safety of this drug , it might be useful for the prevention of IRDS OBJECTIVE To determine whether synchronized nasal intermittent positive pressure ventilation ( SNIPPV ) would decrease extubation failure compared with nasal continuous positive airway pressure ( NCPAP ) in preterm infants being ventilated for respiratory distress syndrome ( RDS ) . METHODS Infants who were < /=34 weeks ' gestational age and who were ventilated for RDS were r and omized to either SNIPPV or NCPAP  after extubation . The criteria for extubation were peak inspiratory pressure of < /=16 cm H(2)O , positive end expiratory pressure of < /=5 cm H(2)O , intermittent m and atory ventilation rate of 15 to 25 , and fraction of inspired oxygen < /=0.35 . Pulmonary function tests ( PFT ) were obtained before extubation . After extubation , blood gases were monitored for a minimum of 72 hours . Success was defined as remaining in the selected mode of treatment or demonstrating improvement ( switching to oxyhood/nasal cannula/room air ) by 72 hours . RESULTS Thirty-two ( 94 % ) of 34 infants were extubated successfully with the use of SNIPPV versus 18 ( 60 % ) of 30 with the use of NCPAP ( P < .01 ) . There was no difference in apnea/bradycardia episodes in the 2 groups during the 72-hour study period . Among 55 infants who had PFT , 80 % ( 8 of 10 ) with dynamic lung compliance of > /=0.5 mL/kg/cm H(2)O and expiratory airway resistance of < /=70 cm H(2)O/L/s were extubated successfully . In infants with poor lung function ( dynamic lung compliance : < 0.5 mL/kg/cm H(2)O ; expiratory airway resistance : > 70 cm H(2)O/L/s ) , successful extubation was seen in 93 % ( 27 of 29 ) in the SNIPPV group and 60 % ( 15 of 25 ) in the NCPAP group . When weight was controlled for at the time of extubation , the odds of success in the SNIPPV group were 21.1 times higher ( 95 % confidence interval : 3.4 , 130.1 ) than that of the NCPAP group . CONCLUSIONS SNIPPV is more effective than NCPAP in weaning infants with RDS from the ventilator . PFT may be useful in predicting successful extubation Although glucocorticoids have been universally implemented to stimulate fetal lung maturity , their effectiveness and side effects are still widely contested . In search of alternative drugs a double-blind study was conducted between June 1981 and June 1984 comparing betamethasone , a conventional corticoid , and ambroxol , a bromhexine metabolite for efficacy and tolerance in prenatal prevention of the respiratory distress syndrome ( RDS ) in premature infants and full-term neonates . The therapeutic efficacies of betamethasone and ambroxol for this indication proved to be comparable . Since the possible risks of corticoid therapy in abnormal pregnancies are repeatedly discussed in the literature and in daily clinical practice . 137 patients with EPH gestosis , placental insufficiency , diabetes mellitus , and premature rupture of the membranes were selected from the original group of 308 patients . Only minor side effects ( e.g. nausea ) were present in a few of the 137 cases undergoing treatment with the 2 test substances . No side effects were observed in the neonates . The incidence of fetal RDS was comparable in both groups ( 2.9 % with ambroxol , 2.2 % with betamethasone ) . Transient and mild RDS cases were slightly more frequent in the ambroxol group than in the betamethasone group . To date , contraindications to ambroxol treatment in abnormal pregnancies are unknown and since generally the rate of potential side effects is considered to be lower in comparison with corticoid treatment , the use of ambroxol especially in abnormal pregnancies corresponding indication can be recommended The results are reported of a multicenter r and omized study of the effectiveness of maternal administration of betamethasone versus ambroxol , a substance of the group of the benzylamines , for prevention of RDS in preterm infants . Women of 27 to 34 weeks gestation with threatened premature delivery or planned premature delivery were admitted to the trial . Between September 1981 and November 1984 a total of 288 r and omized patients delivered 315 neonates . The incidence of RDS was assessed in 169 viable neonates born before the 37th week . Of these 86 were born of 76 mothers treated with beta-methasone and 83 of 76 mothers treated with ambroxol .  The overall incidence of RDS was significantly ( P less than 0.05 ) higher in the betamethasone group ( 31 % ) than the ambroxol group ( 13 % ) . Ambroxol was significantly more effective than betamethasone in twin births , in infants born before the 31st week , when ROM to delivery time was more than 48 hours , when treatment to delivery time was between 2 and 7 days and in female infants . The neonatal infection rate was significantly higher ( P less than 0.05 ) in the group of betamethasone treated infants ( 18 % with four fatalities ) than in the group of ambroxol treated infants ( 9 % with one fatality ) . These results suggest that ambroxol may be a valid alternative to steroids for prevention of RDS Abstract The effectiveness of ambroxol in the prevention of neonatal respiratory distress syndrome and in reducing the need for intermittent m and atory ventilation  and oxygen therapy was studied in 88 mothers whose infants was born between 24 and 34 weeks of gestation and who were r and omized either for treatment with ambroxol ( group A = 42 ) or served as control ( group B = 46 ) . There were no significant differences in the mean gestational age , birth weight or Apgar score between the two groups . We found no significant differences in occurrence of respiratory distress syndrome ( 55 % vs 45 % ) , in support by intermittent m and atory ventilation ( 71 % vs 72 % ) or oxygen therapy ( 74 % vs 75 % ) at 12 h of age between groups A and B. Conclusion This study does not suggest the efficacy of antenatal ambroxol treatment both for the prevention of neonatal respiratory distress syndrome and for the reduction of its severity In a multicenter , r and omized double-blind study , the effect of Betamethasone and Ambroxol , both used for prenatal prevention of RDS in premature and newborn infants , is compared in a total of 185 patients with premature labour or an induced termination of pregnancy between the 28 and 36th week of gestation . The Ambroxol group of 93 patients is reduced to 77 due to a break up of therapy in 16 patients . The Betamethasone group is likewise reduced from 92 to 85 due to a break up of therapy in 7 patients . The main reason for breaking up therapy in these patients is the impossibility of stopping labour and delivery within 72 hours after admission to the hospital . Both treatment groups show no significant differences with regard to age , weight , history , rate of premature rupture of membranes , gestational age at beginning of therapy and at time of delivery , mode of delivery , rate of tocolytic therapy and prematurity . RDS morbidity , established by a st and ardized evaluation of the infants considering X-ray , clinical and blood-gas analyses findings , is 9 % ( 7 out of 79 infants ) in the Ambroxol group , and 6 % ( 5 out of 86 infants ) in the Betamethasone group . Statistically seen , the difference between the two groups is insignificant . Amniotic fluid analyses carried out in a total of 46 patients of both groups show increased surfactant parameters after therapy as compared to initial values before therapy . A significant difference between the two groups is not manifest . The objections against corticosteroids regarding there indications and side effects are generally known . The results of this study indicate that Ambroxol compared to Betamethasone can be considered as an effective drug for prevention of neonatal respiratory distress syndrome Stimulation of the surfactant production in fetal cells by ambroxol ( metabolite VIII of bromhexine ) has been investigated in human and animal experiments . There are no contraindications for the prenatal use of ambroxol , which is also well tolerated in high dose . Therefore the 1st Department of Obstetrics and Gynecology in Vienna took part in a multicentric clinical trial , where the allocation between cortisone and ambroxol was r and omised in a double blind fashion . The 1st Department included 34 women between 30 and 36 weeks of pregnancy with premature labour or indicated premature induction . Amniotic fluid sample s were taken by amniocentesis before therapy to prove lung immaturity by measurement of the L/S ratio and the dynamic surface tension . Following doses were used for this clinical trial group A : 1,000 mg ambroxol in 500 ml 5 % glucose infusion i.v . daily from day 1 to day 5 and 2 ml placebo-injection i.m . on day 1 and day 2 , group B : 8 mg Betamethasone i.m . on day 1 and day 2 and 500 ml 5 % glucose infusion with a placebo daily from day 1 to day 5 . The patients were treated at least 3 days ; in all cases amniotic fluid sample s were taken after therapy , to examine the L/S ratio and the dynamic surface tension .  29 women of the 34 fulfilled the above criteria , 15 in group A and 14 in group B ( 1 twin pregnancy ) . With the pretreatment parameters of lung maturity being similar in both groups ambroxol was found to lead to a marked but not significant improvement of the L/S ratio and the surface tension . ( ABSTRACT TRUNCATED AT 250 WORDS A controlled trial of betamethasone therapy was carried out in 282 mothers in whom premature delivery threatened or was planned before 37 weeks9 gestation , in the hope of reducing the incidence of  neonatal respiratory distress syndrome  by accelerating functional maturation of the fetal lung . Two hundred and thirteen mothers were in spontaneous premature labor . When necessary , ethanol or salbutamol infusions were used to delay delivery while steroid or placebo therapy was given . Delay for at least 24 hours was achieved in 77 % of the mothers . In these unplanned deliveries , early neonatal mortality was 3.2 % in the treated group and 15.0 % in the controls ( p 0.01 ) . There were no deaths with hyaline membrane disease or intraventricular cerebral hemorrhage in infants of mothers who had received betamethasone  for at least 24 hours before delivery . The respiratory distress syndrome occurred less often in treated babies ( 9.0 % ) than in controls ( 25.8 % , p 0.003 ) , but the difference was confined to babies of under 32 weeks9 gestation who had been treated for at least 24 hours before delivery ( 11.8 % of the treated babies compared with 69.6 % of the control babies p. 0.02 ) . There may be an increased risk of fetal death in pregnancies complicated by severe hypertensionedema-proteinuria syndromes and treated with betamethasone , but no other hazard of steroid therapy was noted . We conclude that this preliminary evidence justifies further trials , but that further work is needed before any new routine procedure is established In a double-blind multicenter study versus placebo , the therapeutic effects of ambroxol ( 10 mg/kg , i.v . twice daily for 7 days ) were studied in an appropriately selected population with severe respiratory failure . Treatment was given to 28 neonates with birth weight less than or equal to 2,000 g , appropriate for gestational age with idiopathic respiratory 
    Output:
    
There is insufficient evidence to support or refute the practice of giving ambroxol to women at risk of preterm birth for preventing neonatal RDS , perinatal mortality and adverse effects .