***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 : The primary aim of this r and omized study was to describe the feasibility of early administration of surfactant via a thin catheter during spontaneous breathing ( Take Care ) and compare early mechanical ventilation ( MV ) requirement with the InSurE ( Intubate , Surfactant , Extubate ) procedure . METHODS : Preterm infants , who were < 32 weeks and stabilized with nasal continuous positive airway pressure ( nCPAP ) in the delivery room , were r and omized to receive  early surfactant treatment  either by the Take Care or InSurE technique . Tracheal instillation of 100 mg/kg poractant α via 5-F catheter during spontaneous breathing under nCPAP was performed in the intervention group . In the InSurE procedure , infants were intubated , received positive pressure ventilation for 30 seconds after surfactant instillation , and placed on nCPAP immediately . RESULTS : One hundred infants in each group were analyzed .  The MV requirement in the first 72 hours of life was significantly lower in the Take Care group when compared with the InSurE group ( 30 % vs 45 % , P = .02 , odds ratio –0.52 , 95 % confidence interval –0.94 to –0.29 ) . Mean duration of both nCPAP and MV were significantly shorter in the Take Care group ( P values .006 and .002 , respectively ) . Bronchopulmonary dysplasia rate was significantly lower among the infants treated with the Take Care technique ( relative risk –0.27 , 95 % confidence interval –0.1 to –0.72 ) CONCLUSIONS : The Take Care technique is feasible for the treatment of respiratory distress syndrome in infants with very low birth weight . It significantly reduces both the need and duration of MV , and thus the bronchopulmonary dysplasia rate in preterm infants The cost of surfactant replacement therapy ( SRT ) will restrict its use under conditions of limited health re sources . Before the local advent of SRT , infants ventilated for hyaline membrane disease ( HMD ) had an overall survival rate of 87 % and an incidence of bronchopulmonary dysplasia of 6.4 % . This , together with the cost of SRT , prompted a study to identify those infants who would benefit the most from SRT .  Twenty-two infants assessed as having severe HMD were r and omised to receive SRT at 3 - 4 hours ( 9 ) or at 6 - 8 hours ( 13 ) after birth . Two infants ( 15 % ) in the latter group did not require SRT . The outcome of these two groups was the same . Of 56 infants assessed as having moderate HMD , only 24 ( 43 % ) qualified for SRT from 6 hours of age . The outcome of the SRT and non-SRT infants was comparable . The group of infants with moderate HMD had a significantly better outcome than those with severe HMD . A limited period of observation to assess the severity of illness did not compromise outcome in this group of 78 infants with moderate to severe HMD BACKGROUND There are limited data to inform the choice between early treatment with continuous positive airway pressure ( CPAP ) and early surfactant treatment as the initial support for extremely-low-birth-weight infants . METHODS We performed a r and omized , multicenter trial , with a 2-by-2 factorial design , involving infants who were born between 24 weeks 0 days and 27 weeks 6 days of gestation . Infants were r and omly assigned to intubation and surfactant treatment ( within 1 hour after birth ) or to CPAP treatment initiated in the delivery room , with subsequent use of a protocol -driven limited ventilation strategy . Infants were also r and omly assigned to one of two target ranges of oxygen saturation . The primary outcome was death or bronchopulmonary dysplasia as defined by the requirement for supplemental oxygen at 36 weeks ( with an attempt at withdrawal of supplemental oxygen in neonates who were receiving less than 30 % oxygen ) . RESULTS A total of 1316 infants were enrolled in the study . The rates of the primary outcome did not differ significantly between the CPAP group and the surfactant group ( 47.8 % and 51.0 % , respectively ; relative risk with CPAP , 0.95 ; 95 % confidence interval [ CI ] , 0.85 to 1.05 ) after adjustment for gestational age , center , and familial clustering . The results were similar when bronchopulmonary dysplasia was defined according to the need for any supplemental oxygen at 36 weeks ( rates of primary outcome , 48.7 % and 54.1 % , respectively ; relative risk with CPAP , 0.91 ; 95 % CI , 0.83 to 1.01 ) . Infants who received CPAP treatment , as compared with infants who received surfactant treatment , less frequently required intubation or postnatal corticosteroids for bronchopulmonary dysplasia ( P<0.001 ) , required fewer days of mechanical ventilation ( P=0.03 ) , and were more likely to be alive and free from the need for mechanical ventilation by day 7 ( P=0.01 ) . The rates of other adverse neonatal outcomes did not differ significantly between the two groups . CONCLUSIONS The results of this study support consideration of CPAP as an alternative to intubation and surfactant in preterm infants . ( Clinical Trials.gov number , NCT00233324 . Thirty preterm infants weighing > or = 800 g with clinical and radiological evidence of respiratory distress syndrome ( RDS ) requiring mechanical ventilation with FiO2 of > or = 40 % were given modified bovine surfactant ( Survanta ) . They were compared with equal number of historical controls . Infants who received surfactant showed prompt and highly significant improvement in FiO2 , mean airway pressure , arterial/alveolar oxygen tension ratio and ventilatory index . There was significant improvement in mortality rate ( 10 % vs 33 % ; p = 0.03 ) . Among the survivors , surfactant-treated infants required shorter duration of continuous positive airway pressure ( CPAP ) ( 3.4 vs 9.6 days ; p = 0.04 ) . For survivors with birthweight of > 1000 g , surfactant-treated infants required shorter duration of ventilatory support ( intermittent positive pressure ventilation + CPAP ) ( 7.5 vs 18.9 days , p = 0.02 ) . Overall , surfactant-treated infants achieved full enteral feeds sooner ( 15.7 days vs 24.6 days ; p = 0.03 ) and required shorter duration of total parenteral nutrition ( 13.9 days vs 25.6 days ; p = 0.02 ) . We concluded that surfactant replacement therapy was effective in the treatment of preterm infants with RDS BACKGROUND We conducted a prospect i ve , multicenter investigation of incidence , management and outcome of neonatal acute respiratory disorders ( NARD ) , and evaluated related perinatal risk factors and efficacy of respiratory therapies in neonatal intensive care units ( NICUs ) in a Chinese neonatal network . METHODS Data were prospect ively collected in 2004 - 2005 from infants with NARD defined as presence of respiratory distress and oxygen requirement during the first 3 days of life . RESULTS A total of 2677 NARD was classified ( 20.5 % of NICU admissions ) . There were 711 ( 5.44 % ) with respiratory distress syndrome ( RDS ) , 589 ( 4.51 % ) pulmonary infection , 409 ( 3.13 % ) meconium aspiration syndrome , 658 ( 5.03 % ) aspiration of amniotic fluid  and 239 ( 1.83 % ) transient tachypnoea . Meconium aspiration syndrome had the highest rate with fetal distress , transient tachypnoea from cesarean section , and RDS with maternal disorders .  Assisted mechanical ventilation  was applied in 53.4 % of NARD , and in above five disorders with 84.7 % , 52.3 % , 39.8 % , 24.5 % , and 53.6 % , respectively . Corresponding mortality in these disorders was 31.4 % , 13.6 % , 17.8 % , 4.1 % and 5.0 % , respectively . Surfactant was provided to 33.9 % of RDS . In all RDS infants , the survival rate was 78.8 % if receiving surfactant , and 63.4 % if not ( P < 0.001 ) . CONCLUSIONS This study provided NICU admission-based incidence and mortality of NARD , reflecting efficiency of advanced respiratory therapies , which should be a reference for current development of respiratory support in NICU at provincial and sub-provincial levels , justifying efforts in upgrading st and ard of care in emerging regions through a collaborative manner A protein free artificial surfactant ( artificial lung exp and ing compound ; ALEC ) composed of dipalmitoylphosphatidylcholine and phosphatidylglycerol was assessed for its effect on the main complications of prematurity in a prospect i ve two stage r and omised trial of 328 unselected babies delivered at between 25 and 29 weeks of gestation . Babies were r and omised to receive approximately 100 mg artificial surfactant suspension or 1 ml saline . This was given at birth into the pharynx with up to three more endotracheal doses if the baby was intubated during the first day . Treatment with artificial surfactant reduced the neonatal mortality from 27 % to 14 % , the incidence of parenchymal brain haemorrhages from 24 % to 16 % , and the severity of the respiratory distress syndrome . In the first 10 days babies treated with artificial surfactant who survived averaged 19 hours less in greater than 30 % oxygen , 20 hours less ventilation , and 17 hours less supplemental oxygen . Artificial surfactant had no effect on the incidence of pneumothoraces , pulmonary interstitial emphysema , patent ductus arteriosus , or postnatal infections and no serious side effects .  Artificial surfactant ( ALEC ) given to very premature babies at birth significantly reduces their mortality and the respiratory support needed and should prove a valuable addition to treatment Objective To evaluate the applicability and potential effectiveness of a technique of minimally-invasive surfactant therapy ( MIST ) in preterm infants on continuous positive airway pressure ( CPAP ) . Methods An open feasibility study of MIST was conducted at two sites . Infants were eligible for MIST if needing CPAP pressure ≥7 cm H2O and FiO2 ≥0.3 ( 25–28 weeks gestation , n=38 ) or ≥0.35 ( 29–32 weeks , n=23 ) . Without premedication , a narrow-bore catheter was inserted through the vocal cords under direct vision . Surfactant ( 100 or 200 mg/kg Curosurf ) was then instilled , followed by reinstitution of CPAP . Outcomes were compared between surfactant-treated infants and historical controls achieving the same CPAP and FiO2 thresholds . Results Surfactant was successfully administered via MIST in all cases , with a rapid and sustained reduction in FiO2 thereafter . For infants at 25–28 weeks gestation , need for intubation < 72 h was diminished after MIST compared with controls ( 32 % vs 68 % ; OR 0.21 , 95 % CI 0.083 to 0.55 ) , with a similar trend at 29–32 weeks ( 22 % vs 45 % ; OR 0.34 , 95 % CI 0.11 to 1.1 ) . Duration of ventilation and incidence of bronchopulmonary dysplasia were similar , but infants receiving MIST had a shorter duration of oxygen therapy . Conclusion Surfactant delivery via a narrow-bore tracheal catheter is feasible and potentially effective , and deserves further investigation in clinical trials INTRODUCTION Although many therapeutic interventions have proven efficacy through r and omized control trials ( RCT ) with extensive use in Neonatal Intensive Care Units ( NICU ) for Very Low Birth Weight Infants ( VLBWI ) , doubts remain about its overall effectiveness . OBJECTIVE To determine changes in the effectiveness of NICU practice s on VLBWI over 14 years in the quality of neonatal survival in a General Hospital , with emphasis in the change in reanimation practice s by the introduction of the spread use of surfactant . METHODS We included all consecutive VLBWI admitted in our NICU during a period of 14 years : 1989 - 1992 ( n= 145 ) ; 1993 - 2002 ( n= 342 ) . All survivors were included in our follow-up program ; 80 % and 85 % were available for assessment at two years of corrected age . The patients were assigned to 4 groups by weight in 250 g categories , between 500 and 1500 g. OUTCOME MEASURES Survival and adjusted quality of survival ( QS ) . The QS was expressed in life-years gained . We create categories for the estimation of disabilities . We also analyzed time of NICU stay by weight and mortality categories during the 2 periods . RESULTS The survival rate improved significantly between the 2 periods ( 23 % ) from 52 % to 75 % . The actuarial survival showed a significant increase in all weight groups ( p < 0.001 ) , especially between 50 
    Output:
    
One RCT and twelve observational studies reported the risk of bronchopulmonary dysplasia ( BPD ) with contrasting results ; while the RCT and most before-after/cohort studies showed a significant reduction or no effect , the majority of the case-control studies demonstrated significantly higher odds of receiving SRT in neonates who developed BPD .
Available evidence suggests that SRT is effective , safe and feasible in level-3 neonatal units and has the potential to reduce neonatal mortality and air leaks in low-re source setting s as well .