***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 To evaluate the clinical course , respiratory outcomes and markers of inflammation in preterm infants with moderate respiratory distress syndrome ( RDS ) assigned from birth to nasal continuous positive airway pressure ( NCPAP ) or bi-level NCPAP . Methods A total of 40 infants with a gestational age ( GA ) of 28–34 weeks ( < 35 weeks ' GA ) , affected by moderate RDS , were considered eligible and were r and omised to NCPAP ( group A ; n=20 , CPAP level=6 cm H2O ) or to  bi-level NCPAP ( group B ; n=20 , lower CPAP level=4.5 cm H2O , higher CPAP level=8 cm H2O ) , provided with variable flow devices . Inflammatory response was the primary outcome ; serum cytokines were measured on days 1 and 7 of life . Length of ventilation , oxygen dependency , need for intubation and occurrence of air leaks were considered as secondary outcomes . Results Infants showed similar characteristics at birth ( group A vs group B : GA 30.3±2 vs 30.2±2 weeks , birth weight 1429±545 vs 1411±560 g ) and showed similar serum cytokine levels at all times . Group A underwent longer respiratory support ( 6.2±2 days vs 3.8±1 days , p=0.025 ) , longer O2 dependency ( 13.8±8 days vs 6.5±4 days , p=0.027 ) and was discharged later ( GA at discharge 36.7±2.5 weeks vs 35.6±1.2 weeks , p=0.02 ) . All infants survived . No bronchopulmonary dysplasia ( BPD ) or neurological disorders occurred . Conclusions Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP , and allowed earlier discharge , inducing the same changes in the cytokine levels . It was found to be well tolerated and safe in the study population A prospect i ve , r and omized , cross-over trial was performed to compare the efficacy of nasal intermittent positive-pressure ventilation with nasal continuous positive airway pressure in infants of less than 32 weeks of gestation .  Continuous positive airway pressure was delivered at end-expiratory pressures of 4 cm H2O , while peak pressures of 20 cm H2O and end-expiratory pressures of 4 cm H2O were used during nasal intermittent positive-pressure ventilation at ventilatory rates of 20 breaths per minute . The frequency and extent of apnea and bradycardia during a 6-hour period in a patient receiving nasal continuous positive airway pressure  were compared with a similar crossover period of nasal intermittent positive-pressure ventilation . Although the infants had slightly less frequent episodes of apnea per hour ( 0.6 + /- 0.7 vs 0.5 + /- 0.7 ) and bradycardia per hour ( 1.2 + /- 1.3 vs 0.9 + /- 1.0 ) during nasal intermittent positive-pressure ventilation , these differences were not significant . There were no significant differences in the severity of these events as assessed by the duration and fall in transcutaneous oxygen pressure during apnea and heart rate during bradycardia . There were no significant changes in blood gases throughout the study . Nasal intermittent positive-pressure ventilation appears to have no advantages over nasal continuous positive airway pressure in preventing apnea and does not alter gas exchange in infants of less than 32 weeks of gestation Abstract Objective The Cox model is the dominant tool in clinical trials to compare treatment options . This model does not specify any specific form to the hazard function . On the other h and , parametric models allow the research er to consider an appropriate shape of hazard function for the event of interest . The aim of this article is to compare performance of Cox and parametric models . Methods We used data collected in a prospect i ve clinical trial that aim ed to compare performance of nasal intermittent positive pressure ventilation ( NIPPV ) and nasal continuous positive airway pressure ( NCPAP ) treatments in terms of survival of newborn infants who had respiratory distress syndrome ( RDS ) . Performance of Cox , exponential , Weibull , and log-logistic models were compared in terms of goodness of fit . Findings Fitting the Cox model , we have seen that infants who received NCPAP were 4.23 ( Hazard Ratio= 4.23 , 95 % Confidence Interval : 1.87–9.59 ) times more likely to fail than those received NIPPV ( P=0.001 ) . Adequacy of the exponential model was rejected . We have seen a decreasing hazard rate over time , in both treatment groups . This decrease was sharper in NCPAP group . Akiake information criterion corresponded to the log-logistic model and was lower than all other models followed by Weibull model . Conclusion Our results demonstrate the benefit of parametric survival models over traditional Cox regression model in terms of modeling of shape of hazard function . We saw a decreasing hazard that confirms the flexibility of parametric models in terms of the modeling of hazard rate CONTEXT : Strategies for reducing exposure to endotracheal ventilation through the use of early noninvasive ventilation has proven to be safe and effective , but the option with the greatest benefits needs to be determined . OBJECTIVE : To determine , in infants with respiratory distress syndrome , if early nasal intermittent positive-pressure ventilation ( NIPPV ) compared with nasal continuous positive airway pressure ( NCPAP ) decreases the need for mechanical ventilation . PATIENTS AND METHODS : In this single-center , r and omized controlled trial , infants ( gestational ages 26 to 3367 weeks ) with respiratory distress syndrome were r and omly assigned to receive early NIPPV or NCPAP . Surfactant was administered as rescue therapy . The primary outcome was the need for mechanical ventilation within the first 72 hours of life . RESULTS : A total of 200 infants , 100 in each arm , were r and omly assigned . Rates of the primary outcome did not differ significantly between the NIPPV ( 25 % ) and NCPAP ( 34 % ) groups ( relative risk [ RR ] : 0.71 [ 95 % confidence interval ( CI ) : 0.48–1.14 ] ) . In posthoc analysis , from 24 to 72 hours of life , significantly more infants in the NIPPV group remained extubated compared with those in the NCPAP groups ( 10 vs 22 % ; RR : 0.45 [ 95 % CI : 0.22–0.91 ] ) . This difference was also noted in the group of infants who received surfactant therapy , NIPPV ( 10.9 % ) , and NCPAP ( 27.1 % ) ( RR : 0.40 [ 95 % CI : 0.18–0.86 ] ) . CONCLUSIONS : Early NIPPV did not decrease the need for mechanical ventilation compared with NCPAP , overall , in the first 72 hours of life . However , further studies to assess the potential benefits of noninvasive ventilation are warranted , especially for the most vulnerable or preterm infants Objective : Comparison of outcomes of infants with respiratory distress syndrome ( RDS ) , post-surfactant , extubated to synchronized nasal intermittent positive pressure ventilation ( SNIPPV ) or continued on conventional ventilation ( CV ) .  Study Design : Prospect i ve post-surfactant r and omized controlled trial of primary mode SNIPPV compared with CV  in infants ( born from July 2000 to March 2005 ) with birth weights ( BW ) of 600 to 1250 g. Primary mode SNIPPV was defined as its use in the acute phase of RDS , following the administration of the first dose of surfactant . Result : There were no significant differences in the maternal demographics , antenatal steroid use , mode of delivery , BW , gestational age , gender or Apgar at 5 min between infants continued on CV ( n=21 ) and those extubated to primary mode SNIPPV ( n=20 ) . Significantly , more babies in the CV group had the primary outcome of bronchopulmonary dysplasia (BPD)/death , compared to the SNIPPV group ( 52 versus 20 % , P=0.03 ) . There was no difference in the incidence of other common neonatal morbidities . There were no differences in the Mental or Psychomotor Developmental Index scores on follow-up between the two groups . Conclusion : Infants of BW 600 to 1250 g with RDS receiving surfactant with early extubation to SNIPPV had a significantly lower incidence of BPD/death . Primary mode SNIPPV is a feasible method of ventilation in small premature infants OBJECTIVE To determine whether early application of Duo positive airway pressure ( DuoPAP ) , in comparison with nasal continuous positive airway pressure ( NCPAP ) , can reduce the need for endotracheal intubation and mechanical ventilation and decrease the incidence of bronchopulmonary dysplasia ( BPD ) in preterm neonates with respiratory distress syndrome ( RDS ) . METHODS In a single-center , r and omized controlled trial , preterm neonates ( gestational ages 30 - 35 weeks ) with RDS were r and omly assigned to receive DuoPAP ( n=34 ) or NCPAP ( n=33 ) within 6 hours of birth . If the two noninvasive ventilations were not effective , endotracheal intubation and mechanical ventilation were used , and pulmonary surfactant was administered as rescue therapy . The total invasive respiratory support rate and incidence of BPD within 24 , 48 and 72 hours of birth were observed . The two groups were compared in terms of PaCO2 , PaO2 and oxygenation index ( OI ) at 1 , 12 , 24 , 48 and 72 hours after using the noninvasive respiratory support . RESULTS The total invasive respiratory support rates within 48 and 72 hours after birth were significantly lower in the DuoPAP group than in the NCPAP group ( P<0.05 ) . There was no difference in the incidence of BPD between the two groups ( P>0.05 ) . The OI in the DuoPAP group was significantly higher than in the NCPAP group at 1 , 12 , 24 , 48 and 72 hours after noninlasive respiratory support ( P<0.05 ) . The DuoPAP group showed significantly lower PaCO2 than the NCPAP group at 1 , 12 , and 24 hours after noninvasive respiratory support ( P<0.05 ) . PaO2 was significantly higher in the DuoPAP group than in the NCPAP group at 1 and 12 hours after noninvasive respiratory support ( P<0.05 ) . CONCLUSIONS Compared with NCPAP , early application of DuoPAP can decrease the need for endotracheal intubation and mechanical ventilation in preterm neonates with RDS , showing promise for broad use OBJECTIVE To compare the rate of reintubation within 7 days after extubation and study the complications in premature infants who were r and omized in the immediate postextubation period to either nsNIMV or NCPAP . MATERIAL AND METHOD This study was conducted in the neonatal unit of Queen Sirikit National Institute of Child Health between June 1 and November 30 , 2006 . Intubated premature infants born at GA < or = 34 weeks or with birth weight < or = 1500 gm , ready to be extubated before 4 weeks of age were recruited . Infants were r and omized to either nsNIMV or NCPAP after extubation . Non-synchronized NIMV setting was the same as ventilator setting before extubation and NCPAP pressure was set at the same mean airway pressure of pre extubation ventilator value . Extubation was performed after intravenous loading dose of aminophylline . Primary outcome measurement was reintubation within 7 days of initial extubation and the secondary outcome was possible complications such as apnea , abdominal distension , gastrointestinal ( GI ) perforation , necrotizing enterocolitis ( NEC ) , sepsis and death . RESULTS A total of 70 VLBW infants were admitted to the neonatal unit during the study period . A total of 57 infants were intubated of which 48 infants were recruited for the study ; 24 were in the nsNIMV group and 24 were in the  NCPAP group . Infants in the nsNIMV group had mean birth weight and body weight at the start of study less than that in the NCPAP group ( 984.8 + /- 218 vs. 1067 + /- 214 and 1185 + /- 219 vs. 1205 + /-191 , p = 0.003 , 0.02 ) . The nsNIMV group also had a higher rate of RDS and antenatal steroid used when compared to the NCPAP group ( 19/24 vs. 12/24 and 17/24 vs. 8/24 , p = 0.03 , 0.01 ) . The nsNIMV group had fewer males than in the NCPAP group ( 8/24 vs. 17/24 , p = 0.01 ) . Reintubation was similar in both groups but atelectasis and sepsis were statistically significant risk factor for reintubation in NCPAP group . There were no significant differences in treatment related complications between the two groups , with respect to incidence of apnea ( 41.7 % in nsNIMV vs. 62.5 % in NCPAP ) , abdominal distensions ( 8.3 % in nsN 
    Output:
    
Early NIPPV does appear to be superior to NCPAP alone for decreasing respiratory failure and the need for intubation and endotracheal tube ventilation among preterm infants with respiratory distress syndrome .