***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: Background : Oral propranolol reduces retinopathy of prematurity (  ROP )  progression , although not safely . This study evaluated safety and efficacy of propranolol eye micro-drops in preterm newborns with ROP . Methods : A multicenter open-label trial , planned according to the Simon optimal two-stage design , was performed to analyze safety and efficacy of propranolol micro-drops in newborns with stage 2 ROP . To this end , hemodynamic and respiratory parameters were monitored , and blood sample s were collected weekly , for 3 wk . Propranolol  plasma levels were also monitored . The progression of the disease was evaluated with serial ophthalmologic examinations . Results : Twenty-three newborns were enrolled . Since the fourth of the first 19 newborns enrolled in the first stage of the study showed a progression to stage 2 or 3 with plus , the second stage was prematurely discontinued . Even though the objective to complete the second stage was not achieved , the percentage of ROP progression ( 26 % ) was similar to that obtained previously with oral propranolol administration . However , no adverse effects were observed and propranolol  plasma levels were significantly lower than those measured after oral administration . Conclusion : Propranolol 0.1 % eye micro-drops are well tolerated , but not sufficiently effective . Further studies are required to identify the optimal dose and administration schedule Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES Our goals were to determine the mortality risk for infants weighing 501 to 1500 gm according to gestational age , birth weight , and gender and to document birth weight-related changes in mortality and morbidity over a 5-year time period . STUDY DESIGN In this observational study perinatal data were prospect ively collected by the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network from May 1991 through December 1992 and compared with the corresponding data from 1987 through 1990 . St and ard definitions were used to record sociodemographic factors , perinatal events , and the neonatal course to 120 days of life , discharge , or death . RESULTS The 1991 and 1992 cohort included 4279 in-born infants . Among their mothers 10 % were < 18 years old ; 55 % were black , 31 % were white , and 11 % were Hispanic ; 14 % had received no prenatal care ; and 20 % had received antenatal corticosteroids .  Multiple gestations accounted for 20 % of the births . Fifty percent of the infants were delivered by cesarean section . During 1991 and 1992 the overall survival for infants weighing 501 to 1500 gm at birth was 81 % , compared with 74 % in 1987 and 1988 . Survival at birth weight 501 to 750 gm was 44 % ; it was 81 % at 751 to 1000 gm , 92 % at 1001 to 1250 gm , and 95 % between 1251 and 1500 gm . Female infants had a significantly greater chance of surviving than male infants at similar birth weights and gestational ages . At any given gestational age , smaller infants were less likely to survive . Survival in all birth weight categories increased between 1987 and 1992 , without accompanying increases in medical morbidity . Major morbidity increased with decreasing birth weight and included late-onset septicemia 22 % , chronic lung disease ( oxygen dependence at 36 weeks ' corrected age ) 18 % , severe intraventricular hemorrhage ( grade s III and IV ) 11 % , and necrotizing enterocolitis 5 % . Twelve percent of all infants were treated with corticosteroids for chronic lung disease , including 36 % of infants who were oxygen dependent at age 28 days . The mean length of hospital stay was 69 days for survivors and 18 days for infants who died . CONCLUSIONS Mortality for infants between 501 and 1500 gm at birth has declined over the past 5 years . There are interactions between birth weight , gestational age , gender , and survival rate . This increase in survival was not accompanied by an increase in medical morbidity PURPOSE To examine the relationship between the intake of sugar inositol , serum inositol levels , and ROP in three groups of low birthweight infants receiving feedings containing various concentrations of inositol .  METHODS Infants with a birthweight < 1500 g , with severe lung disease , were eligible for the study when they began enteral feedings . Infant formulas contained three different inositol concentrations : 2500 , 710 , and 242 micromol/L. Serum inositol concentrations were averaged over specific time intervals . A logistic regression model was used to investigate the confounding effect of duration of mechanical ventilation and oxygen therapy , birthweight , Apgar score , and serum inositol concentration on development of ROP . RESULTS Infants receiving high inositol formula and with higher serum inositol concentrations at birth and after 30 days had a statistically significant lower incidence of severe ROP than those receiving the lower inositol formula and with lower serum concentrations ( P<.05 ) . The effective serum inositol concentration ( EC90 ) associated with lesser disease was > 215 micromol/L. By logistic regression , the odds of developing severe ROP were greater among infants with low serum inositol concentration ( odds ratio=4.7 , 95 % confidence interval 0.90 - 24.8 , P=.017 ) . CONCLUSION Inositol supplementation may help prevent the most severe form of ROP According to preliminary results inositol ( INO ) is an important nutrient to immature preterm infants ( J Pediatr 1987 ; 110:604 ) . However , it is absent in nutrition of critically ill very low birth weight infants . In a present r and omized double blind trial INO or glucose ( 70–100 mg/kg/day ) was given to altogether 230 preterm infants ( gestation 24 to 31 w , mean 27.8 w , mean BW 1,106 g ) with RDS during 5 neonatal days . Two more courses during the first month were given , if the infant remained respirator-dependent and did not tolerate breast milk . INO-supplemented infants tended to have a milder respiratory course during the first week than those on glucose . The surviving INO-treated infants had a lower incidence of bronchopulmonary dysplasia ( BPD ) than the controls ( p<0.01 ) . No infant receiving INO  had severe retinopathy ( gr 4 ) , whereas of the surviving placebo treated infants 8.8 % became blind ( p<0.005 ) . Inositol  promotes endothelial cell growth , enhances glucocorticoid-mediated lung epithelial cell differentiation , and may serve as an antioxidant .  INO should be seriously considered as a nutrient during compromised neonatal transition of very low birth weight infants Background : Preterm infants with respiratory distress syndrome ( RDS ) given  inositol had reduced bronchopulmonary dysplasia ( BPD ) , death and severe retinopathy of prematurity ( ROP ) . We assessed the safety and pharmacokinetics of daily inositol to select a dose providing serum levels previously associated with benefit , and to learn if accumulation occurred when administered throughout the normal period of retinal vascularization . Methods : Infants ≤ 29 wk GA ( n = 122 , 14 centers ) were r and omized and treated with placebo or inositol at 10 , 40 , or 80 mg/kg/d . Intravenous administration converted to enteral when feedings were established , and continued to the first of 10 wk , 34 wk postmenstrual age ( PMA ) or discharge . Serum collection employed a sparse sampling population pharmacokinetics design . Inositol urine losses and feeding intakes were measured . Safety was prospect ively monitored . Results : At 80 mg/kg/d mean serum levels reached 140 mg/l , similar to Hallman ’s findings . Levels declined after 2 wk , converging in all groups by 6 wk . Analyses showed a mean volume of distribution 0.657 l/kg , clearance 0.058 l/kg/h , and half-life 7.90 h. Adverse events and comorbidities were fewer in the inositol groups , but not significantly so . Conclusion : Multiple dose inositol at 80 mg/kg/d was not associated with increased adverse events , achieves previously effective serum levels , and is appropriate for investigation in a phase III trial OBJECTIVES Our purpose was to determine the mortality and morbidity rates for infants weighing 501 to 1500 g according to gestational age , birth weight , and gender . STUDY DESIGN Perinatal data were collected prospect ively on an inborn cohort from January 1993 through December 1994 by 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network and were compared with the corresponding data from previous reports . Sociodemographic factors , perinatal events , and the neonatal course to 120 days of life , discharge , or death were evaluated . RESULTS Eighty-three percent of infants survived until discharge to home or to a long- term care facility ( compared with 74 % in 1988 ) . Survival to discharge was 49 % for infants weighing 501 to 750 g at birth , 85 % for those 751 to 1000 g , 93 % for those 1001 to 1250 g , and 96 % for those 1251 to 1500 g. The majority of deaths occurred within the first 3 days of life . Mortality rates were greater for male than for female infants . Respiratory distress syndrome was the most frequent pulmonary disease ( 52 % ) . Chronic lung disease ( defined as an oxygen requirement at 36 weeks after conception ) developed in 19 % . Thirty-two percent of infants had evidence of intracranial hemorrhage . Periventricular leukomalacia was noted in 6 % of infants who had ultrasonography after 2 weeks . The average duration of hospitalization for survivors was 68 days ( 122 days for surviving infants weighing 501 to 750 g , compared with an average of 43 days for surviving infants 1251 to 1500 g ) . Among infants who died , the average length of stay was 19 days . CONCLUSIONS The mortality rate for infants weighing between 501 and 1500 g at birth continues to decline . This increase in survival is not accompanied by an increase in medical morbidity . There are interactions between birth weight , gestational age , sex , and survival rates Objectives To evaluate the implementation of four high evidence practice s for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity . Design Prospect i ve multinational population based observational study . Setting 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE ( Effective Perinatal Intensive Care in Europe for very preterm births ) project . Participants 7336 infants born between 24 + 0 and 31 + 6 weeks ’ gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission . Main outcome measures Combined use of four evidence based practice s for infants born before 28 weeks ’ gestation using an “ all or none ” approach : delivery in a maternity unit with appropriate level of neonatal care ; administration of antenatal corticosteroids ; prevention of hypothermia  ( temperature on admission to neonatal unit ≥36 ° C ) ; surfactant used within two hours of birth or early nasal continuous positive airway pressure . Infant outcomes were in-hospital mortality , severe neonatal morbidity at discharge , and a composite measure of death or severe morbidity , or both . We modelled associations using risk ratios , with propensity score weighting to account for potential confounding bias . Analyses were adjusted for clustering within delivery hospital . Results Only 58.3 % ( n=4275 ) of infants received all evidence based practice s for which they were eligible . Infants with low gestational age , growth restriction , low Apgar scores , and who were born on the day of maternal admission to hospital were less likely to receive evidence based care . After adjustment , evidence based care was associated with lower in-hospital mortality ( risk ratio 0.72 , 95 % confidence interval 0.60 to 0.87 ) and in-hospital mortality or severe morbidity , or both ( 0.82 , 0.73 to 0.92 ) , corresponding to an estimated 18 % decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants . Conclusions More comprehensive use of evidence based practice s in perinatal medicine could result in considerable gains for very preterm infants , in terms of increased survival without severe morbidity PURPOSE To analyze the incidence and severity of  retinopathy of prematurity ( ROP ) in China , and to explore 
    Output:
    
Conclusions Based on current evidence , inositol supplementation showed no significant effect on preventing severe ROP , and exploratory sensitivity analysis showed a trend toward an increase on mortality