***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 double-blind study was design ed to investigate the effects of  antenatal glucocorticoids on the incidence of respiratory distress syndrome ( RDS ) in 128 premature human infants . There was a significant reduction ( P<0.05 ) in the incidence of RDS in the betamethasone-treated infants to 8.7 % compared to an incidence of 22.6 % in the saline-treated controls and 25.0 % in infants whose mothers received methylprednisolone . The effectiveness of betamethasone in reducing RDS was limited to premature infants delivered to mothers with intact fetal membranes and with an initial L/S ratio less than 2.0 . The time between administration of the glucocorticoid and delivery did not significantly affect the incidence of RDS in this study . The failure of methylprednisolone to reduce the development of RDS in premature infants suggests its potential use in maternal therapy during pregnancy with minimal effects on fetal maturation At the Women 's Hospital of the Medical Academy of Erfurt we have examined the efficiency of dexamethasone on  fetal lungs maturation at imminent premature birth and planned untimely delivery .  Dexamethasone was given in a r and omized series at a dosage of 12-mg per day orally on three successive days . The effectiveness of induction was measured at the percentage of the total phospholipid fraction in the amniotic fluid and at the mortality of RDS in both groups . A successful induction with dexamethasone we can only reach after the 32nd week of pregnancy .-- Because this effect is not always continuous , we recommend to make the induction of fetal lungs maturation with dexamethasone and --if it necessary -- its repetition after one week conditional upon the content of total phospholipids in amniotic fluid The existence of a Register of Controlled Trials in Perinatal Medicine ( National Perinatal Epidemiology Unit , Oxford , Engl and ) has offered an opportunity to assess the efficacy of online search ing of MEDLINE , an example of a broad bibliographic data base . Retrieval of all relevant r and omized control trials ( RCTs ) in a given field is important in analyses in which results are pooled ( meta-analyses ) . Reports of RCTs of prevention and treatment of neonatal hyperbilirubinemia and prevention of intraventricular hemorrhage ( IVH ) for the years 1966 - 1983 were sought in both the Register and MEDLINE files . Comparison of subject search es revealed a number of unlisted papers in each file that were then found to be present by an author search . In the MEDLINE search ing an amateur was clearly less efficient than an expert , but the expert recovered only 29 % of the relevant hyperbilirubinemia papers available in MEDLINE , and only 56 % of the identified IVH RCTs . Some of the deficiencies in recovery have been corrected by indexing improvements , such as the capability of identifying text words in abstract s , and the addition of new medical subject heading terms ( MeSH ) such as R AND OM ALLOCATION . Efficiency will be best facilitated by authors and editors keeping the MeSH terms used by MEDLINE indexers in mind when they compose titles and abstract Potential side effects of antenatal administration of corticosteroids to prevent neonatal respiratory distress syndrome were studied in 10- to 12-year-old children whose mothers had participated in a r and omized , double-blind , placebo-controlled trial of betamethasone .  The children had a general physical examination ; parents were interviewed about the medical history of their child with special attention to infectious diseases ; growth data were collected ; and a developmental neurological examination , an ophthalmological examination , and a lung function test were conducted . In the corticosteroid group significantly more hospital admissions because of infectious diseases during the first years of life were reported . On the other variables no differences between the corticoid and the placebo groups were found The Medical Research Council has for some years encouraged collaborative clinical trials in leukaemia and other cancers , reporting the results in the medical literature . One unreported result which deserves such publication is the development of the expertise to design and analyse such trials . This report was prepared by a group of British and American statisticians , but it is intended for people without any statistical expertise . Part I , which appears in this issue , discusses the design of such trials ; Part II , which will appear separately in the January 1977 issue of the Journal , gives full instructions for the statistical analysis of such trials by means of life tables and the logrank test , including a worked example , and discusses the interpretation of trial results , including brief reports of 2 particular trials . Both parts of this report are relevant to all clinical trials which study time to death , and wound be equally relevant to clinical trials which study time to other particular classes of untoward event : first stroke , perhaps , or first relapse , metastasis , disease recurrence , thrombosis , transplant rejection , or death from a particular cause . Part I , in this issue , collects together ideas that have mostly already appeared in the medical literature , but Part II , next month , is the first simple account yet published for non-statistical physicians of how to analyse efficiently data from clinical trials of survival duration . Such trials include the majority of all clinical trials of cancer therapy ; in cancer trials , however , it may be preferable to use these statistical methods to study time to local recurrence of tumour , or to study time to detectable metastatic spread , in addition to study ing total survival . Solid tumours can be staged at diagnosis ; if this , or any other available information in some other disease is an important determinant of outcome , it can be used to make the overall logrank test for the whole heterogeneous trial population more sensitive , and more intuitively satisfactory , for it will then only be necessary to compare like with like , and not , by chance , Stage I with Stage III A prospect i ve double-blind r and omized clinical trial was carried out to determine whether glucocorticoid treatment reduces the risk of respiratory distress syndrome ( RDS ) in prematurely born infants . There were 127 infants born to 122 mothers who received either steroid ( dexamethasone phosphate ) or placebo .  No differences between groups occurred in risk factors for RDS ( eg , prepartum asphyxia , male sex , cesarean section ) . When those who received a full course of dexamethasone therapy were compared with those who received placebo , a significant reduction was found in risk , severity , and deaths due to RDS . An increased incidence of infection in mothers treated with steroid was evident , particularly after premature rupture of membranes . We conclude that steroids are effective in reducing risk of RDS , but safer and more efficacious approaches for the prevention of RDS should be sought In a prospect i ve , r and omized , double‐blind , multicentre trial the effect of antenatal treatment with betamethasone phosphate was compared with placebo in the prevention of the respiratory distress syndrome ( RDS )  in preterm infants . The dose of betamethasone was 4 mg every 8 h for six doses , unless delivery occurred . The 251 women who were enrolled gave birth to 262 liveborn infants , 130 in the betamethasone and 132 in the placebo group ; the two groups were evenly matched in most respects . The diagnosis of RDS in the newborn was confirmed by two independent assessors . Seven of the 130 infants in the betamethasone group and 16 of the 132 in the placebo  group developed RDS . In infants whose mothers had received at least three injections , RDS was also less frequent in the steroid group than in the placebo group ( 3/104 and 10/104 respectively ; P<0·05 ) . There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial ( 0/30 and 8/45 respectively ; P<0·05 ) . The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation , within 8 days of trial entry , and whose mothers had received at least three injections ( 0/27 steroid group and 7/32 placebo group ; P=0·03 ) , and there were also significantly fewer neonatal deaths ( 2/27 and 13/32 , respectively ; P<0·01 ) in this  subgroup . Betamethasone did not provoke earlier delivery . Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids : there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group . Neonatal jaundice was significantly less frequent in the steroid ( 55/129 ) than in the placebo group ( 81/127 ; P<0·01 ) but not in the subgroups born before 34 completed weeks gestation This study compares fetal corticoid response from conventional dose ( 12.0 mg ) intramuscular betamethasone to large dose ( 1,000 mg ) intravenous cortisol administered to women in premature labor for  acceleration of fetal lung maturity .  To compare these two regimens , 14 women selected at r and om were treated in groups of seven with either cortisol or betamethasone .  Peripheral levels of unconjugated estriol were measured by specific radioimmunoassay prior to the cortisol dose and at 1 , 4 , 8 , and 12 hours following the dose . The rate of corticoid delivery to the fetal hypothalamic-adrenal axis was estimated by the per cent suppression of unconjugated estriol at each post-treatment interval . Least-squares regression lines fitted ( P less than 0.01 ) for each regimen were compared for time saved ( delta t ) when cortisol was used . Mean delta t ( 1 , 4 , 8 , and 12 hours ) was 9.0 + /- 0.2 S.E.M. hours . It is concluded that : ( 1 ) Intravenous cortisol delivers a fetal corticoid effect that is significantly more rapid in onset and more profound in magnitude than does intramuscular betamethasone and that ( 2 ) the cortisol regimen is probably better suited to the acceleration of fetal lung maturation in premature labor when time is short and rapid action is essential Over the past 20 years at least 11 r and omised trials of the prevention with diuretics of pre-eclampsia and its sequelae have been undertaken . Nine of these were review ed . Reliable data from the remaining two were not available . The nine review ed had investigated a total of nearly 7000 people . Significant evidence of prevention of " pre-eclampsia " was overwhelming , even when oedema was not included as a diagnostic criterion . But as the definitions of pre-eclampsia that had been used depended heavily on increases in blood pressure this evidence may simply have reflected the well known ability of diuretics to reduce blood pressure . When the data on perinatal death were review ed a little difference was seen in postnatal survival . The incidence of stillbirths was reduced by about one third with treatment , but , perhaps owing to small numbers ( only 37 stillbirths ) , the difference was not significant . Thus these r and omised trials failed to provide reliable evidence of either the presence or the absence of any worthwhile effects of treatment with diuretics on perinatal mortality . The implication s of this for current and future trials of beta blockers and other agents in the prevention of  pre-eclampsia  and its sequelae are that extremely large , ultra simple r and omised trials are needed , of a size sufficient to permit direct assessment of the effects of treatment not on pre-eclampsia but on perinatal mortality itself . This may require the study of tens of thous and s of pregnancies One hundred forty-six pregnant women were enrolled in a prospect i ve double-blind study to assess the effectiveness and side-effects of antenatal administration of betamethasone in the prevention of respiratory distress syndrome ( RDS ) in potentially premature infants . On admission to the study , the women were given , at r and om , either 12 mg of betamethasone or placebo . The same dose was repeated 24 hours later and then weekly up to 34 weeks of gestation . Gestational age of the infants ranged from 25 to 34 weeks , and birth weights ranged between 730 and 2,650 gm . Statistically significant differences in favor of the infants in the betamethasone group were found in the incidence of RDS , 20.7 % in the betamethasone group compared with 59.5 % in the control group ( P less than .005 ) ; in the severity of RDS ( P less than .05 ) ; and in the death rate ( P less than .05 ) . A higher incidence of hypoglycemia was found among infants in the betamethasone group ( P less than .05 ) . Prolonged rupture of the membranes played no protective role against RDS , and the incidence of infection was similar in both groups A prospect i ve r and omized study involving patients with premature rupture of the membranes between the twenty-eighth week and the thirty-fourth week of pregnancy was conducted . Patients with chorioamnionitis , advanced labor , and fetal distress , as well as those with mature lecithin/sphingomyelin ratios and /or Gram stains positive for bacteria , were delivered immediately . The remaining patients were r and omized . One group received betamethasone . Tocolytic agents were used in this group when necessary . After 48 hours all patients given corticosteroids ( CS group ) were delivered ) . The second group was managed expectantly ( EM group ) and were delivered only when spontaneous labor or infection occurred . A total of 160 patients were r and omized , 80 in each group . Maternal outcome , including chorioamnionitis and cesarean section rates , was not different ; however , the endometritis 
    Output:
    
Data from 12 controlled trials , involving over 3000 participants , show that corticosteroids reduce the occurrence of respiratory distress syndrome overall and in all the subgroups of trial participants that we examined .
This reduction in respiratory morbidity was associated with reductions in the risk of intraventricular haemorrhage , necrotizing enterocolitis and neonatal death .
There is no strong evidence suggesting adverse effects of corticosteroids .
The risks of fetal and neonatal infection may be raised if they are administered after prolonged rupture of the membranes , but this possibility is not substantiated by the results of the available trials .
The available data on long-term follow-up suggest that the short-term beneficial effects of corticosteroids may be reflected in reduced neurological morbidity in the longer term