***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 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 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 Abstract . Hjalmarson O. ( Department of Pediatrics , University of Göteborg , Sweden ) . Epidemiology and classification of acute , neonatal respiratory disorders . A prospect i ve study . Acta Paediatr Sc and , 70 : 773 , 1981 . In a prospect i ve study a population of 32281 newborn infants in swenen was screened for signs of respiratory disease . All affected infants ( 2.9 % ) were investigated systematic ally and classified . Incidence and case fatality rates were calculated and related to gestational age , birth weight , sex and postnatal asphyxia , all of which strongly influenced one or both rates . The diagnostic system used was found suitable for future epidemiological research 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<0·05 ) . There was a significant reduction of RDS in those born between 24 h and 6 days after entry into the trial ( 0/30 and 8/45 respectively ; P<0·05 ) . The largest difference in frequency of RDS occurred in the subgroup of infants born before 34 weeks gestation , within 8 days of trial entry , and whose mothers had received at least three injections ( 0/27 steroid group and 7/32 placebo group ; P=0·03 ) , and there were also significantly fewer neonatal deaths ( 2/27 and 13/32 , respectively ; P<0·01 ) in this  subgroup . Betamethasone did not provoke earlier delivery . Premature rupture of the membranes and maternal hypertension did not seem to contraindicate the use of steroids : there was no increase in maternal or neonatal sepsis nor in stillbirth in hypertensive pregnancies in the steroid group . Neonatal jaundice was significantly less frequent in the steroid ( 55/129 ) than in the placebo group ( 81/127 ; P<0·01 ) but not in the subgroups born before 34 completed weeks gestation A double-blind controlled study on the prenatal use of betamethasone in the prevention of  respiratory distress syndrome ( RDS )  was carried out on 137 patients from 24 to 34 weeks ' gestation . The incidence of RDS was less in the treated group ( 5 % ) than in control group ( 17 % ) . The neonatal mortality rate was lower in the treated group ( 5 % ) than in the control group ( 18 % ) due to an excess of neonatal deaths in the placebo group OBJECTIVE To ascertain the role of low birth weight ( LBW ) in  neonatal mortality  in a periurban setting in Bangladesh . METHODS LBW neonates were recruited prospect ively and followed up at one month of age . The cohort of neonates were recruited after delivery in a hospital in Dhaka , Bangladesh , and 776 were successfully followed up either at home or , in the event of early death , in hospital . FINDINGS The neonatal mortality rate ( NMR ) for these infants was 133 per 1000 live births ( 95 % confidence interval : 110 - 159 ) . The corresponding NMRs ( and confidence intervals ) for early and late neonates were 112 ( 91 - 136 ) and 21 ( 12 - 33 ) per thous and live births , respectively . The NMR for infants born after fewer than 32 weeks of gestation was 769 ( 563 - 910 ) ; and was 780 ( 640 - 885 ) for infants whose birth weights were under 1500 g. Eighty-four per cent of neonatal deaths occurred in the first seven days ; half within 48 hours . Preterm delivery was implicated in three-quarters of neonatal deaths , but was associated with only one-third of LBW neonates . CONCLUSION Policy-relevant findings were : that LBW approximately doubles the NMR in a periurban setting in Bangladesh ; that neonatal mortality tends to occur early ; and that preterm delivery is the most important contributor to the NMR . The group of infants most likely to benefit from improvements in low-cost essential care for the newborn accounted for almost 61 % of neonatal mortalities in the cohort Objective To determine if an additive effect exists between antenatal corticosteroid administration and postnatal surfactant therapy in the prevention of  respiratory distress syndrome ( RDS ) in preterm infants . Methods A r and omized , double-blind trial was conducted from April 1990 to June 1994 , in which dexamethasone ( 5 mg every 12 hours for a total of four doses ) or saline was given to women at risk for delivery at 24–29 weeks ' gestation . At birth , prophylactic surfactant was administered to all study infants . Main outcome measures were RDS occurrence and severity . Secondary clinical end points included broncho-pulmonary dysplasia , pneumothorax , patent ductus arteriosus , necrotizing enterocolitis , retinopathy , intraventricular hemorrhage , and death . Results Seventy-five of the 124 r and omized subjects delivered 96 infants within the studied gestational age range ( dexamethasone , n = 54 ; placebo , n = 42 ) . Similar maternal demographics and obstetric complications were noted between study groups . A greater proportion of infants were delivered from multi-fetal gestations in the dexamethasone cohort ( 26 of 54 versus 12 of 42 newborns ; P = .05 ) . There were no significant differences in the occurrence or severity of RDS between the dexamethasone and placebo infants ( none or mild , 67 versus 67 % ; moderate , 24 versus 26 % severe , 9 versus 7 % , respectively ) , or differences in any of the secondary clinical outcomes . The study size was sufficient to exclude a 50 % reduction in RDS incidence as a consequence of dexamethasone exposure . An analysis restricted to singletons ( dexamethasone , n = 28 ; placebo , n = 30 ) revealed similar overall occurrence of intraventricular hemorrhage ( 12 of 28 versus ten of 30 ; P = .63 ) , but significantly fewer grade 3 and 4 intraventricular hemorrhages in dexamethasone-exposed neonates ( two of 12 versus six of ten ; P = .048 ) . Conclusion Antenatal dexamethasone does not appear to decrease the incidence or severity of RDS in surfactant-treated infants delivered at 24–29 weeks ' gestation , but may be associated with reduced severity of intraventricular hemorrhages in surfactant-treated singletons in this gestational age range In this study , 500 mg . of hydrocortisone were injected intravenously into 126 women every 12 hours for four doses in a double-blind , r and omized fashion . These 126 subjects were at risk for delivery of a premature infant because of premature labor of fetomaternal disease necessitating intervention . There were 67 patients in the treatment group and 59 in the placebo group . All patients had immature lecithin/sphingomyelin ratios and /or were at less than 34 weeks ' gestation . From these data , it appeared that there was a significant decrease in respiratory distress syndrome when the treatment group was compared to the placebo group . The neonatal survival rates also were improved significantly by steroid treatment . There was no demonstrable adverse steroid effect in mothers of fetuses in the long-term or short-term follow-up period , although a significant number of patients were lost to follow-up and the methodology of infant evaluation was imprecise . It would appear from these data that the injection of steroids is beneficial in moth 
    Output:
    
In low-income countries , many preterm babies currently receive little or no medical care .
It is plausible that antenatal steroids may be of even greater effect when tested in these setting s. Conclusions Based on high- grade evidence , antenatal steroid therapy is very effective in preventing neonatal mortality and morbidity , yet remains at low coverage in low/middle-income countries .
If fully scaled up , this intervention could save up to 500 000 neonatal lives annually