***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 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 One hundred forty-six pregnant women were enrolled in a prospect i ve double-blind study to assess the effectiveness and side-effects of antenatal administration of betamethasone in the prevention of respiratory distress syndrome ( RDS ) in potentially premature infants . On admission to the study , the women were given , at r and om , either 12 mg of betamethasone or placebo . The same dose was repeated 24 hours later and then weekly up to 34 weeks of gestation . Gestational age of the infants ranged from 25 to 34 weeks , and birth weights ranged between 730 and 2,650 gm . Statistically significant differences in favor of the infants in the betamethasone group were found in the incidence of RDS , 20.7 % in the betamethasone group compared with 59.5 % in the control group ( P less than .005 ) ; in the severity of RDS ( P less than .05 ) ; and in the death rate ( P less than .05 ) . A higher incidence of hypoglycemia was found among infants in the betamethasone group ( P less than .05 ) . Prolonged rupture of the membranes played no protective role against RDS , and the incidence of infection was similar in both groups A r and omized study was conducted to investigate the effects of antenatal corticosteroids and ampicillin in the management of preterm pregnancies under 34 weeks complicated by premature rupture of membranes . Patients with documented lecithin/sphingomyelin ( L/S ) ratios of less than 2.0 and a singleton gestation were eligible to participate in the study . One hundred sixty-five patients qualified and were r and omized , using sealed envelopes , to four study groups . All patients were followed expectantly . Group I ( 41 patients ) received neither ampicillin nor corticosteroids . Group II ( 43 patients ) received 24 mg of antenatal betamethasone . Group III ( 37 patients ) received 2 g of intravenous ampicillin every 6 hours , with discontinuation of antibiotic therapy if cultures were negative for pathogenic bacteria . Group IV ( 44 patients ) received both corticosteroids and ampicillin as described for groups II and III , respectively . Compared with patients not receiving corticosteroids , those administered antenatal corticosteroids experienced a reduction in the incidences of respiratory distress syndrome ( 53 versus 26 % ) , bronchopulmonary dysplasia ( 23 versus 9 % ) , severe grade s of intracranial hemorrhage ( 15 versus 3 % ) , and patent ductus arteriosus ( 18 versus 6 % ) , with no difference in the incidence of maternal or neonatal infection . Compared with patients not receiving antenatal antibiotics , the group of patients treated with ampicillin on admission had a lower incidence of clinical chorioamnionitis ( 4 versus 26 % ) and neonatal sepsis ( 5 versus 10 % ) . This reduction in infectious morbidity by antenatal ampicillin was restricted to those patients ( 28.4 % of the study population ) colonized with group B streptococci . This r and omized study suggests that the outcome of preterm pregnancies with premature rupture of membranes and an L/S ratio less than 2.0 can be improved by the concurrent use of corticosteroids and ampicillin A prospect i ve , r and omized study was conducted comparing the use of betamethasone and early delivery , early delivery alone , and expectant management in patients in the 28th to 34th week of pregnancy with premature rupture of the membranes ( PROM ) .  Tocolytic drugs were used to delay delivery until 24 hours had elapsed after the first dose of steroid or 24 to 48 hours of latent period had elapsed in the second group . There were ho significant differences in maternal age , gestation at PROM , maximum maternal temperature , birth weights , maternal hospital days , respiratory distress , maternal sepsis , or delivery routes in the three groups . Comparisons with one other similar prospect i ve , r and omized study support the concept that expectant management offers less risk from tocolytic side effects A prospect i ve r and omized study involving patients with premature rupture of the membranes between the twenty-eighth week and the thirty-fourth week of pregnancy was conducted . Patients with chorioamnionitis , advanced labor , and fetal distress , as well as those with mature lecithin/sphingomyelin ratios and /or Gram stains positive for bacteria , were delivered immediately . The remaining patients were r and omized . One group received betamethasone . Tocolytic agents were used in this group when necessary . After 48 hours all patients given corticosteroids ( CS group ) were delivered ) . The second group was managed expectantly ( EM group ) and were delivered only when spontaneous labor or infection occurred . A total of 160 patients were r and omized , 80 in each group . Maternal outcome , including chorioamnionitis and cesarean section rates , was not different ; however , the endometritis rate was significantly higher in the CS group ( p less than 0.05 ) . Neonatal outcome did not differ in mean birth weights , perinatal death rates , neonatal infections , or incidences of respiratory distress . The frequency of prolonged hospital stay ( greater than 4 weeks ) was higher in the neonates in the CS group ( p less than 0.01 ) . The conclusion is that corticosteroids and active management in patients with premature rupture of the membranes and premature gestations do not decrease the incidence of respiratory distress syndrome or perinatal mortality and may aggravate certain infectious complications OBJECTIVE To assess whether administration of dexamethasone in women with preterm premature rupture of membranes ( PPROM ) has an effect on the prevalence of maternal sepsis , neonatal respiratory distress syndrome ( RDS ) , perinatal mortality and neonatal sepsis in a developing country . SETTING Six public hospitals in South Africa that deal mainly with indigent women . METHOD A multicentre , double-blind , placebo-controlled , r and omised trial was performed on women with PPROM and fetuses of 28 - 34 weeks ' gestation or clinical ly estimated fetal weight between 1,000 and 2,000 g if the gestational age was unknown . Women were r and omised to receive either dexamethasone 24 mg intramuscularly or placebo in two divided doses 24 hours apart . All women received amoxycillin and metronidazole and were managed expectantly . Hexoprenaline was administered if contractions occurred within the first 24 hours after admission to the trial . OUTCOME MEASURES The maternal outcome measures were clinical chorio-amnionitis and postpartum sepsis . The outcome measures for infants were perinatal death , RDS , mechanical ventilation , necrotising enterocolitis , and neonatal infection within 72 hours . RESULTS One hundred and two women who delivered 105 babies were r and omised to the dexamethasone group and 102 women who delivered 103 babies , to the placebo group . The groups were well balanced with regard to clinical features . There was a trend towards fewer perinatal deaths in the dexamethasone group : 4 compared with 10 ( P = 0.16 , odds ratio 0.37 , 95 % confidence intervals 0.09 - 1.34 ) . A sub analysis of mothers who delivered more than 24 hours after admission to the study and their infants revealed a significant reduction in perinatal deaths ; 1 death in the dexamethasone group and 7 in the placebo group , P = 0.047 ( Fisher 's exact test ) . No woman in either group developed severe sepsis , and the incidence of sepsis in the women did not differ significantly . Eleven infants in each group developed sepsis . CONCLUSION This is the first r and omised trial in women with PPROM to compare the effects of the use of corticosteroids with placebo , where all women received prophylactic antibiotics concomitantly with the corticosteroids . A trend towards an improved perinatal outcome was demonstrated in the women who received dexamethasone . There was no increased risk of infection in the women or their infants where dexamethasone was administered . Administration of corticosteroids to women with PPROM has more advantages than disadvantages in developing countries The use of hydrocortisone and timed delivery was compared to expectant management of pregnancies complicated by preterm prematurely ruptured membranes in a prospect i ve r and omized trial of 73 patients . The incidence of maternal and neonatal complications was compared . There was no significant difference in the incidence of respiratory distress syndrome .  Steroid-treated mothers had an increased incidence of postpartum febrile morbidity . We conclude that treatment of women with preterm prematurely ruptured membranes with hydrocortisone and timed delivery offers no advantage over expectant management 
    Output:
    
the benefit of corticosteroids clearly outweighs their potential harmful effects .