***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 : Bronchopulmonary dysplasia ( BPD ) is the focus of many intervention trials , yet the outcome measure when based solely on oxygen administration may be confounded by differing criteria for oxygen administration between physicians . Thus , we wished to define BPD by a st and ardized oxygen saturation monitoring at 36 weeks corrected age , and compare this physiologic definition with the st and ard clinical definition of BPD based solely on oxygen administration . METHODOLOGY : A total of 199 consecutive very low birthweight infants ( VLBW , 501 to 1500 g birthweight ) were assessed prospect ively at 36±1 weeks corrected age . Neonates on positive pressure support or receiving > 30 % supplemental oxygen were assigned the outcome BPD . Those receiving ≤30 % oxygen underwent a stepwise 2 % reduction in supplemental oxygen to room air while under continuous observation and oxygen saturation monitoring . Outcomes of the test were “ no BPD ” ( saturations ≥88 % for 60 minutes ) or “ BPD ” ( saturation < 88 % ) . At the conclusion of the test , all infants were returned to their baseline oxygen . Safety ( apnea , bradycardia , increased oxygen use ) , inter-rater reliability , test – retest reliability , and validity of the physiologic definition vs the clinical definition were assessed . RESULTS : A total of 199 VLBW were assessed , of whom 45 ( 36 % ) were diagnosed with BPD by the clinical definition of oxygen use at 36 weeks corrected age . The physiologic definition identified 15 infants treated with oxygen who successfully passed the saturation monitoring test in room air . The physiologic definition diagnosed BPD in 30 ( 24 % ) of the cohort . All infants were safely studied . The test was highly reliable ( inter-rater reliability , κ=1.0 ; test – retest reliability , κ=0.83 ) and highly correlated with discharge home in oxygen , length of hospital stay , and hospital readmissions in the first year of life . CONCLUSIONS : The physiologic definition of BPD is safe , feasible , reliable , and valid and improves the precision of the diagnosis of BPD . This may be of benefit in future multicenter clinical trials OBJECTIVE To determine whether an earlier observation , that infants fed a casein-hydrolysate formula ( Nutramigen ) have lower neonatal jaundice levels than those fed st and ard formulas , would be repeated in a larger independent group of infants with more frequent measurements and more rigorous statistical analysis . DESIGN Newborn infants were fed human milk , a st and ard whey-predominant formula ( Enfamil ) , or Nutramigen  ( n = 20 for each group ) during the first 3 weeks of life . Transcutaneous jaundice index was measured daily for the first week of life and every 2 to 3 days thereafter , using a noninvasive jaundice meter . Linear regression models of the data were constructed , vali date d , and compared statistically . SETTING General community hospital with subsequent home visitation . PARTICIPANTS Healthy , term newborn infants selected by convenience , based on time of birth . INTERVENTION Infants were exclusively fed human milk , Enfamil , or Nutramigen . Formulas were r and omly assigned . MAIN OUTCOME MEASURE Jaundice index , a transcutaneous measurement of jaundice . RESULTS The jaundice index differed significantly among the 3 groups . Paired comparisons showed that the jaundice index of the Nutramigen group was significantly lower than that of the Enfamil group ( on days 6 - 16 ) and the human milk group ( on days 3 - 20 ) . The jaundice index of the Enfamil-fed group was significantly lower than that of the human milk group on days 13 to 19 . CONCLUSIONS Jaundice levels are lower in neonates fed Nutramigen rather than Enfamil and both these groups have lower jaundice levels than breast-fed infants OBJECTIVE To evaluate the effectiveness of fluid supplementation in decreasing the rate of exchange transfusion and the duration of phototherapy in term neonates with severe nonhemolytic hyperbilirubinemia . STUDY DESIGN This was a r and omized controlled trial conducted in a tertiary care referral unit in northern India . Seventy-four term neonates with severe nonhemolytic hyperbilirubinemia ( total serum bilirubin > 18 mg/dL [ 308 micromol/L ] to < 25 mg/dL [ 427 micromol/L ] ) . The subjects were r and omized to an " extra fluids " group ( intravenous fluid supplementation for 8 hours and oral supplementation for the duration of phototherapy ; n = 37 ) or a control group ( n = 37 ) . RESULTS At inclusion , 54 infants ( 73 % ) had high serum osmolality , including 28 ( 75 % ) in the extra fluids group and 26 ( 70 % ) in the control group . The proportion of infants who underwent exchange transfusion was lower in the extra fluids group than in the control group : 6 ( 16 % ) versus 20 (54%)(P = .001 ; relative risk = 0.30 ; 95 % confidence interval = 0.14 to 0.66 ) . The duration of phototherapy was also shorter in the extra fluids group : 52 + /- 18 hours versus 73 + /- 31 hours ( P = .004 ) . CONCLUSION  Fluid supplementation in term neonates presenting with severe hyperbilirubinemia decreased the rate of exchange transfusion and duration of phototherapy OBJECTIVE To compare the effectiveness of two methods of vascular access in newborns . DESIGN R and omized controlled trial . SETTING Neonatal intensive care unit in Regional Hospital of Valdivia , Chile . PARTICIPANTS Seventy-four high-risk newborns . INTERVENTIONS Peripherally inserted central catheter and peripheral intravenous catheter . MAIN OUTCOME MEASURES Length of neonatal intensive care unit stay and incidence of sepsis and phlebitis . RESULTS / DATA ANALYSIS : There were no statistically significant differences in the length of the neonatal intensive care unit stay and in the incidence of sepsis between groups . There was a significant higher incidence of phlebitis in the peripheral intravenous catheter group . CONCLUSIONS Although there was not a significant effect of the kind of catheter on length of neonatal intensive care unit stay , the peripherally inserted central catheter is recommended because of the decreased risk of phlebitis and the decreased number of venipuncture attempts and catheters needed to complete intravenous therapy Abstract Background : This study compared the rates of decrease in serum bilirubin levels in severely jaundiced healthy term infants given oral or intravenous fluid supplementation during phototherapy . Methods : A r and omized controlled study was carried out in the neonatal intensive care unit of Zeynep Kamil Maternity and Children Hospital ( Istanbul , Turkey ) over a 4-month period . Two hundred fifty healthy term infants with hyperbilirubinemia were r and omized to receive either solely breastmilk ( n=125 ) or both breastmilk and intravenous fluid ( n=125 ) during phototherapy . Results : There were no significant differences ( p>0.05 ) in the mean birth weight , mean gestastional age , modes of delivery , mean time of admission age , mean serum osmolality , and hematocrit and reticulocyte count between the two groups . Similarly , there was no significant difference ( p>0.05 ) in the mean indirect serum bilirubin level at the time of admission to the neonatal intensive care unit and at 4 , 8 , 12 , 24 , and 48 hours after commencement of phototherapy between the two groups . There was no significant difference ( p>0.05 ) in the mean duration of phototherapy or in the median duration of hospitalization between the two groups . Conclusions : Based on our results , intravenous fluid support has no effect on the rate of decrease in serum bilirubin and decrease in duration of phototherapy in healthy term newborns with no dehydratation . However , using the oral route avoided the need for intravenous cannulae and their attendant complications . Insensible fluid loss is increased during phototherapy , so protection of hydration status with oral feeding is important for newborns OBJECTIVE Our purpose was to evaluate the effect of breast-feeding frequency on serum bilirubin levels in the first 3 days after birth . STUDY DESIGN Two hundred seventy-five infants were r and omly assigned to a frequent or dem and breast-feeding schedule . RESULTS Infants in the frequent group ( n = 131 ) nursed nine ( 7.5 to 10.5 ) times per day ( median and inner 80 % ) , and the dem and group ( n = 143 ) fed 6.5 ( 5.5 to 8.0 ) times per day . The serum bilirubin level was measured in all infants between 48 and 80 hours ( median 53 hours , inner 80 % 48 to 68 hours ) and was 7.4 ( 1.8 to 10.7 ) mg/dl in the frequent group and 8.0 ( 2.9 to 11.2 ) mg/dl in the dem and group ( p = 0.103 ) . There was no correlation between the frequency of breast-feeding and the serum bilirubin level . CONCLUSION Within the range of the frequency of nursing observed in this study , we could not demonstrate a significant effect on serum bilirubin levels in the first 3 days after birth We measured the serum bilirubin concentrations in 2,416 consecutive infants admitted to our well-baby nursery . The maximum serum bilirubin concentration exceeded 12.9 mg/dL ( 221 mumol/L ) in 147 infants ( 6.1 % ) , and these infants were compared with 147 r and omly selected control infants with maximum serum bilirubin levels less than or equal to 12.9 mg/dL. In 66 infants ( 44.9 % ) , we identified an apparent cause for the jaundice , but in 81 ( 55 % ) , no cause was found . Of infants for whom no cause for hyperbilirubinemia was found , 82.7 % were breast-fed v 46.9 % in the control group ( P less than .0001 ) . Breast-feeding was significantly associated with hyperbilirubinemia , even in the first three days of life . The 95th percentile for bottle-fed infants is a serum bilirubin level of 11.4 mg/dL v 14.5 mg/dL for the breast-fed population , and the 97th percentiles are 12.4 and 14.8 mg/dL , respectively . Of the formula-fed infants , 2.24 % had serum bilirubin levels greater than 12.9 mg/dL v 8.97 % of breast-fed infants ( P less than .000001 ) . When compared with previous large studies , the incidence of " readily visible " jaundice ( serum bilirubin level greater than 8 mg/dL ) appears to be increasing . The dramatic increase in breast-feeding in the United States in the last 25 years may explain this observation . There is a strong association between breast-feeding and jaundice in the healthy newborn infant . Investigations for the cause of hyperbilirubinemia in healthy breast-fed infants may not be indicated unless the serum bilirubin level exceeds approximately 15 mg/dL , whereas in the bottle-fed infant , such investigations may be indicated if the serum bilirubin exceeds approximately 12 mg/dL. ( ABSTRACT TRUNCATED AT 250 WORDS Objectives : To determine the incidence of severe hyperbilirubinaemia in the newborn , and to identify associated clinical and demographic variables , and short-term outcomes . Design : Prospect i ve , population -based study . Setting : UK and Republic of Irel and , between 1 May 2003 and 31 May 2005 . Participants : Infants in the first month of life with severe hyperbilirubinaemia ( maximum unconjugated serum bilirubin ⩾510 & mgr;mol/l ) . Results : 108 infants met the case definition , 106 from the UK and 2 from the Republic of Irel and . The UK incidence of severe hyperbilirubinaemia was 7.1/100 000 live births ( 95 % CI 5.8 to 8.6 ) . Only 20 cases presented in hospital ; 88 were admitted with  severe jaundice  . 64 ( 60.4 % ) cases were male , and 56 ( 51.8 % ) were of ethnic minority origin . 87 ( 80.5 % ) cases were exclusively breast fed . Co-morbidity included haemolysis , dehydration , infection and bruising . 14 infants showed evidence of bilirubin encephalopathy , of whom 3 died . The UK incidence of bilirubin encephalopathy was 0.9/100 000 live births ( 95 % CI 0.46 to 1.5 ) . Conclusions : This is the first large , prospect i ve , population -based study of the incidence of severe hyperbilirubinaemia in the newborn . The clinical and demographic associations , and short-term outcomes identified , are the same as those reported recently in North America and Europe Thirty to 50 % of very low-b 
    Output:
    
Beyond eight hours postintervention , serum bilirubin was similar between the two groups .
AUTHORS ' CONCLUSIONS There is no evidence that IV fluid supplementation affects important clinical outcomes such as bilirubin encephalopathy , kernicterus , or cerebral palsy in healthy , term newborn infants with unconjugated hyperbilirubinaemia requiring phototherapy .
In this review , no infant developed these bilirubin-associated clinical complications .
Low- to moderate- quality evidence shows that there are differences in total serum bilirubin levels between fluid-supplemented and control groups at some time points but not at others , the clinical significance of which is uncertain .
There is no evidence of a difference between the effectiveness of IV and oral fluid supplementations  in reducing serum bilirubin .
Similarly , no infant developed adverse events or complications from fluid supplementation such as vomiting or abdominal distension .