***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 The objective of the series was to study the effect of prenatal dexamethasone therapy on the growth and neurological development of preterm children until the age of 2 years . Eighty‐two children with a mean gestational age of 30 ( 24–33 ) weeks and a mean weight of 1291 ( 530–2360 ) g at birth , treated antenatally with either dexamethasone ( n= 50 ) or placebo ( n= 32 ) , were examined at the adjusted age of 24 months by a paediatric neurologist , a neuropsychologist and a speech therapist . Neurological development was defined as normal if all scores of neuropaediatric , neuropsychological and verbal tests were within the normal range . Normal neurological development was found in 52 % of the dexamethasone‐treated and in 34 % of the placebo‐treated children . The incidence of cerebral palsy was 10 % in the dexamethasone group and 22 % in the placebo group . Minor developmental delay was found in 42 % of dexamethasone‐treated and in 53 % of placebo‐treated children . Our follow‐up results indicate that the beneficial effect of prenatal glucocorticoid treatment on cerebral complications I intraventricular haemorrhage or periventricular leucomalacia ) demonstrated during the neonatal period may be followed by a lower incidence of cerebral palsy in surviving premature children BACKGROUND The efficacy and safety of repeat doses of prenatal corticosteroids remains uncertain . Our aim was to establish whether repeat prenatal corticosteroids given to women at risk of preterm birth can reduce neonatal morbidity without harm . METHODS In this hospital-based study , 982 women who remained at risk of preterm birth at less than 32 weeks ' gestation , 7 or more days after receiving a first course of prenatal corticosteroids  , were r and omly assigned to receive a repeat intramuscular dose of either 11.4 mg betamethasone ( as Celestone Chronodose ) , or saline placebo . This was repeated every week the woman remained undelivered , at less than 32 weeks ' gestation , and at risk of preterm birth . Primary outcomes were occurrence and severity of neonatal respiratory distress syndrome , use and duration of oxygen and mechanical ventilation , and weight , length , and head circumference at birth and hospital discharge . Statistical analyses were on an intention to treat basis . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N48656428 . FINDINGS Fewer babies exposed to repeat corticosteroids had respiratory distress syndrome ( 33%vs 41 % ; relative risk 0.82 , 95 % CI 0.71 - 0.95 , p=0.01 ) and fewer had severe lung disease ( 12%vs 20 % ; relative risk 0.60 , 95 % CI 0.46 - 0.79 , p=0.0003 ) than those in the placebo group . In keeping with these benefits , babies exposed to repeat corticosteroids needed less oxygen therapy ( p=0.03 ) , and shorter duration of mechanical ventilation ( p=0.01 ) . Mean weight , length , and head circumference at birth and hospital discharge did not differ between treatment groups . Z-scores for weight ( p=0.04 ) and head circumference ( p=0.03 ) at birth were lower in the babies who received repeat corticosteroids although at the time of hospital discharge Z-scores did not differ between treatment groups ( p=0.29 for weight , p=0.48 for head circumference ) . INTERPRETATION Exposure to repeat doses of antenatal corticosteroids reduces neonatal morbidity . Pending long-term outcome results , the short-term benefits for the babies in our study support the use of repeat doses of corticosteroids in women who remain at risk of very preterm birth 7 or more days after an initial course Objective To assess the efectiveness of corticosteroids in patients with preterm premature rupture of membranes ( PROM ) after treatment with a broad-spectrum antibiotic , ampicillin-sulbactam .  Methods A r and omized clinical trial of corticosteroids in patients with preterm PROM was undertaken after treating these patients for a minimum of 12 hours with ampicillin-sulbactam . No digital vaginal examinations were performed on these patients . Antbiotics were continued for 7 days and the steroids were repeated weekly . No tocolytics were used . The primary outcome measure was the incidence of respiratory distress syndrome ( RDS ) . Secondary outcome measures included latency period and neonatal and maternal infectious morbidity . Results Seventy-seven patients were enrolled and data about their pregnancies were analyzed . No statistically significant difference in latency period was noted ( 14.7 days in the steroid group , 15.8 days in the no-steroid group ) . Both neonatal and maternal infectious morbidity were similar . A significant reduction in the incidence of RDS ( 18.4 versus 43.6 % , P = .03 ) were observed in the steroid group . Conclusion These data suggest that treating preterm PROM patients with a broad-spectrum antibiotic before corticosteroids decreases RDS without apparent adverse sequelae OBJECTIVES To assess the benefits and risks of  antenatal corticosteroid therapy  for fetal maturation . OPTIONS To administer antenatal corticosteroids or not to women at risk of preterm birth . OUTCOMES Perinatal morbidity , including : respiratory distress syndrome , intraventricular hemorrhage , infection , adrenal suppression , somatic and brain growth ; perinatal mortality ; and maternal morbidity , including infection and adrenal suppression . EVIDENCE MEDLINE and PubMed search es 1996 to August 2002 for English- language articles related to  antenatal corticosteroid therapy for fetal maturation , the Cochrane Library , and national statements including that of the National Institutes of Health ( NIH ) , the American College of Obstetricians and Gynecologists , and the Royal College of Obstetricians and Gynaecologists . VALUES The evidence obtained was review ed and evaluated by the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada ( SOGC ) and recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Exam . BENEFITS AND HARMS : A single course of corticosteroids reduces perinatal mortality , respiratory distress syndrome , and intraventricular hemorrhage . Information regarding repeat courses of corticosteroids is limited and conflicting , with many studies being retrospective and non-r and omized . Some studies suggested a reduction in respiratory distress syndrome with repeat courses , but some found increased rates of neonatal and maternal infection ; fetal , neonatal , and maternal adrenal suppression ; decreased fetal or neonatal somatic and brain growth ; and increased perinatal mortality . RECOMMENDATIONS The SOGC supports the recommendations of the NIH Consensus Development Panel : 1 . All pregnant women between 24 and 34 weeks ' gestation who are at risk of preterm delivery within 7 days should be considered c and i date s for antenatal treatment with a single course of corticosteroids . ( I-A ) 2 . Treatment should consist of two 12 mg doses of betamethasone given IM 24 hours apart , or four 6 mg doses of dexamethasone given IM 12 hours apart ( I-A ) . There is no proof of efficacy for any other regimen . 3 . Because of insufficient scientific data from r and omized clinical trials regarding efficacy and safety , repeat courses of corticosteroids should not be used routinely ( II-2E ) but be reserved for women participating in r and omized controlled trials . VALIDATION This Committee Opinion has been review ed and approved by the Maternal-Fetal Medicine Committee of the SOGC and approved by SOGC Council 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 OBJECTIVE To evaluate the effect of dexamethasone administration on labor duration . METHOD In this controlled trial 122 nulliparous women with a full-term pregnancy and a Bishop score of 7 or greater were r and omly assigned to receive a single 8-mg dose of dexamethasone or placebo 6 hours before initiation of labor induction . RESULTS The interval between initiation of labor induction and beginning of the active phase of labor was shorter in the dexamethasone than in the control group ( 3.09+/-1.5 hours vs. 4.21+/-1.8 hours ; P=0.001 ) . The duration of the second stage of labor was also shorter in the dexamethasone group ( 22.23+/-16.09 minutes vs. 29.01+/-15.32 minutes ; P=0.014 ) . CONCLUSION The administration of dexamethasone was found to shorten labor duration Previous r and omized controlled studies of corticosteroids for the reduction of respiratory distress syndrome have failed to demonstrate benefit in very early premature gestational age groups . A r and omized , double-blind , placebo-controlled clinical trial of betamethasone given to mothers with intact membranes and threatened premature delivery between 24 and 28 weeks of pregnancy was conducted . Thirty-six patients were r and omized to receive betamethasone , two doses of 12 mg , 24 hours apart , and 41 received placebo . No difference was found in the overall incidence of respiratory distress syndrome between the two groups ( betamethasone vs placebo 0.55 vs 0.66 ) or in the incidence of respiratory distress syndrome in babies delivered between 1 and 7 days after the first dose of drug ( betamethasone vs placebo 0.78 vs 0.88 ) . Nor were there any differences observed in any measure of severity of respiratory distress syndrome between the groups . The neonatal death rates were also similar ( betamethasone vs placebo 0.25 vs 0.24 ) . The only difference seen was an unexpected reduction in the betamethasone group in the incidence of grade s 3 and 4 intraventricular hemorrhage  ( betamethasone vs placebo 1/31 vs 9/36 , p = 0.01 ) . Therefore this study was unable to demonstrate any beneficial effect of corticosteroids in reducing respiratory distress syndrome at less than 28 weeks ' gestation in spite of a sample size that had an 80 % likelihood of detecting a 50 % reduction in the incidence of respiratory distress syndrome with p = 0.05 , which is the minimum reduction seen in virtually all r and omized trials in other gestational age groups 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<0·0 
    Output:
    
Meta-analyses and meta-regression of trials including participants with a lower gestational age revealed no significant reduction of neonatal mortality and morbidity in the corticosteroid group as compared with nonintervention , in contrast to clear evidence of beneficial effects in trials including women given corticosteroids at a later gestational age .
A gestational age-dependent effect of antenatal corticosteroids on neonatal outcomes with lesser treatment benefits in patients < 26 weeks ' gestational age appears to exist .
There is no evidence from r and omized controlled trials to support or refute the recommendation of administrating antenatal corticosteroids to women at risk of preterm birth < 26 weeks ' gestation