***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: OBJECTIVES High quality CPR skill retention is poor . We hypothesized that " just-in-time " and " just-in-place " training programs would be effective and well-accepted to maintain CPR skills among PICU staff . METHODS " Rolling Refreshers " , a portable manikin/defibrillator system with chest compression sensor providing automated corrective feedback to optimize CPR skills , were conducted daily in the PICU with multidisciplinary healthcare providers . Providers practice d CPR until skill success was attained , prospect ively defined as <3 corrective prompts within 30s targeting chest compression ( CC ) rate 90 - 120/min , CC depth > 38 mm during continuous CPR . Providers completing > or = 2 refreshers/month ( Frequent Refreshers [ FR ] ) were compared to providers completing < 2 refreshers/month ( Infrequent Refreshers [ IR ] ) for time to achieve CPR skill success . Univariate analysis performed using non-parametric methods . Following actual cardiac arrests , CPR providers were surveyed for subjective feedback on training approach efficacy ( 5-point Likert scale ; 1=poor to 5=excellent ) . RESULTS Over 15 weeks , 420 PICU staff were " refreshed " : 340 nurses , 34 physicians , 46 respiratory therapists . A consecutive sample of 20 PICU staff was assessed before subsequent refresher sessions ( FREQ n=10 , INFREQ n=10 ) . Time to achieve CPR skill success was significantly less in FREQ ( median 21s , IQR : 15.75 - 30s ) than in INFREQ ( median 67s , IQR : 41.5 - 84s ; p<0.001 ) . Following actual resuscitations , CPR providers ( n=9 ) rated " Rolling Refresher " training as effective ( mean=4.2 ; Likert scale 1 - 5 ; st and ard deviation 0.67 ) . CONCLUSIONS A novel " Rolling Refresher " CPR skill training approach using " just-in-time " and " just-in-place " simulation is effective and well received by PICU staff . More frequent refreshers result ed in significantly shorter times to achieve proficient CPR skills BACKGROUND : Studies suggest that giving newly born preterm infants sustained lung inflation ( SLI ) may decrease their need for  mechanical ventilation ( MV ) and improve their respiratory outcomes . METHODS : We r and omly assigned infants born at 25 weeks 0 days to 28 weeks 6 days of gestation to receive SLI ( 25 cm H2O for 15 seconds ) followed by nasal continuous positive airway pressure ( nCPAP ) or nCPAP alone in the delivery room . SLI and nCPAP were delivered by using a neonatal mask and a T-piece ventilator . The primary end point was the need for MV in the first 72 hours of life . The secondary end points included the need for respiratory supports and survival without bronchopulmonary dysplasia ( BPD ) . RESULTS : A total of 148 infants were enrolled in the SLI group and 143 in the control group . Significantly fewer infants were ventilated in the first 72 hours of life in the SLI group ( 79 of 148 [ 53 % ] ) than in the control group ( 93 of 143 [ 65 % ] ) ; unadjusted odds ratio : 0.62 [ 95 % confidence interval : 0.38–0.99 ] ; P = .04 ) . The need for respiratory support and survival without BPD did not differ between the groups . Pneumothorax occurred in 1 % ( n = 2 ) of infants in the control group compared with 6 % ( n = 9 ) in the SLI group , with an unadjusted odds ratio of 4.57 ( 95 % confidence interval : 0.97–21.50 ; P = .06 ) . CONCLUSIONS : SLI followed by nCPAP in the delivery room decreased the need for MV in the first 72 hours of life in preterm infants at high risk of respiratory distress syndrome compared with nCPAP alone but did not decrease the need for respiratory support and the occurrence of BPD This study evaluated the effects of brief monthly refresher training on CPR skill retention , confidence , and satisfaction with CPR skill level of 606 nursing students from ten different US schools . Students were r and omized to course type , HeartCode ™ Basic Life Support ( BLS ) or an  instructor-led ( IL ) course , and then r and omized to a practice group , six minutes of monthly practice or no further practice . End-of- study survey results were compiled and reported as percentages . Short answer data were grouped by category for reporting . Fewer HeartCode ™ BLS students were satisfied with their CPR training compared to the IL students . Students who practice d CPR monthly were more confident than students who did not practice . Monthly practice improved CPR confidence , but initial course type did not . Students were most satisfied when they participated in the IL courses and frequent practice of CPR skills 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 determine whether umbilical cord milking ( UCM ) improves systemic blood flow and reduces neonatal morbidities compared with immediate cord clamping ( ICC ) . STUDY DESIGN Women admitted to a tertiary care center and delivering before 32 weeks ' gestation were r and omized to receive UCM or ICC .  Three blinded serial echocardiograms were performed in the first 2 days of the infant 's life . The primary outcome was measured systemic blood flow ( superior vena cava flow ) at each time point . RESULTS Of the 60 neonates who were enrolled and r and omized , 30 were assigned to cord milking and 30 to ICC . Neonates r and omized to cord milking had greater measures of superior vena cava flow and right ventricular output in the first 6 hours and 30 hours of life . Neonates receiving UCM also had greater serum hemoglobin , received fewer blood transfusions , fewer days on oxygen therapy , and less frequent use of oxygen at 36 weeks ' corrected postmenstrual age . CONCLUSIONS We demonstrate greater systemic blood flow with UCM in preterm neonates compared with ICC . Future large prospect i ve trials are needed to determine whether UCM reduces intraventricular hemorrhage and other long-term morbidities OBJECTIVE To investigate whether infants < 29 weeks gestation who receive positive pressure ventilation ( PPV ) immediately after birth with  a T-piece have higher oxygen saturation ( SpO₂ ) measurements at 5 minutes than infants ventilated with a self inflating bag ( SIB ) . STUDY DESIGN R and omized , controlled trial of T-piece or SIB ventilation in which SpO₂ was recorded immediately after birth from the right h and /wrist with a Masimo Radical pulse oximeter , set at 2-second averaging and maximum sensitivity . All resuscitations started with air . RESULTS Forty-one infants received PPV with a T-piece and 39 infants received PPV with a SIB . At 5 minutes after birth , there was no significant difference between the median ( interquartile range ) SpO₂ in the T-piece and SIB groups ( 61 % [ 13 % to 72 % ] versus 55 % [ 42 % to 67 % ] ; P = .27 ) . More infants in the T-piece group received oxygen during delivery room resuscitation ( 41 [ 100 % ] versus 35 [ 90 % ] , P = .04 ) . There was no difference in the groups in the use of continuous positive airway pressure , endotracheal intubation , or administration of surfactant in the delivery room . CONCLUSION There was no significant difference in SpO₂ at 5 minutes after birth in infants < 29 weeks gestation given PPV with a T-piece or a SIB as used in this study OBJECTIVE To evaluate the effectiveness and safety of a T-piece resuscitator compared with a self-inflating bag for providing mask ventilation to newborns at birth . STUDY DESIGN Newborns at ≥26 weeks gestational age receiving positive-pressure ventilation at birth were included in this multicenter cluster-r and omized 2-period crossover trial . Positive-pressure ventilation was provided with either a self-inflating bag ( self-inflating bag group ) with or without a positive end-expiratory pressure valve or a T-piece with a positive end-expiratory pressure valve ( T-piece group ) . Delivery room management followed American Academy of Pediatrics and International Liaison Committee on Resuscitation guidelines . The primary outcome was the proportion of newborns with heart rate (HR)≥100 bpm at 2 minutes after birth . RESULTS A total of 1027 newborns were included . There was no statistically significant difference in the incidence of HR≥100 bpm at 2 minutes after birth between the T-piece and self-inflating bag groups : 94 % ( 479 of 511 ) and 90 % ( 466 of 516 ) , respectively ( OR , 0.65 ; 95 % CI , 0.41 - 1.05 ; P=.08 ) . A total of 86 newborns ( 17 % ) in the T-piece group and 134 newborns ( 26 % ) in the self-inflating bag group were intubated in the delivery room ( OR , 0.58 ; 95 % CI , 0.4 - 0.8 ; P=.002 ) . The mean±SD maximum positive inspiratory pressure was 26±2 cm H2O in the T-piece group vs 28±5 cm H2O in the self-inflating bag group ( P<.001 ) . Air leaks , use of drugs/chest compressions , mortality , and days on mechanical ventilation did not differ significantly between groups . CONCLUSION There was no difference between the T-piece resuscitator and a self-inflating bag in achieving an HR of ≥100 bpm at 2 minutes in newborns≥26 weeks gestational age resuscitated at birth . However , use of the T-piece decreased the intubation rate and the maximum pressures applied OBJECTIVE : To determine whether a limited oxygen strategy ( LOX ) versus a high oxygen strategy ( HOX ) during delivery room resuscitation decreases oxidative stress in preterm neonates . METHODS : A r and omized trial of neonates of 24 to 34 weeks ’ gestational age ( GA ) who received resuscitation was performed . LOX neonates received room air as the initial resuscitation gas , and fraction of inspired oxygen ( Fio2 ) was adjusted by 10 % every 30 seconds to achieve target preductal oxygen saturations ( Spo2 ) as 
    Output:
    
Although most newly born infants successfully transition from intrauterine to extrauterine life without special help , because of the large total number of births , a significant number will require some degree of resuscitation.3 Newly born infants who do not