human
***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: We sought to identify risk factors and neonatal outcomes associated with the failure of the INSURE method ( INtubation- SURfactant- Extubation )  during nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome . We used a retrospective analysis of the prenatal histories , clinical courses , and laboratory data of all inborn infants with gestational age 27 to 34 weeks and respiratory distress syndrome treated with INSURE method .  Infants were categorized into two groups : INSURE failure group and INSURE success group . One hundred nine infants were eligible to the study . INSURE failure was registered in 35 infants ( 32.1 % ) . After control for confounding variables , INSURE failure was significantly associated with arterial partial pressure of carbon dioxide ( adjusted odds ratio [ OR ] = 1.82 ; 95 % confidence interval [ CI ] = 1.76 to 90.56 ) , mean arterial-to-alveolar oxygen tension ratio ( adjusted OR = 1.13 ; 95 % CI = 1.06 to 85.34 ) and severe radiological grade ( adjusted OR = 1.31 ; 95 % CI = 1.15 to 70.16 ) . Positive predictive values of these variables were 70 , 75 , and 55 % , respectively . Patent ductus arteriosus and mortality rates were significantly higher in INSURE failure group . Arterial partial pressure of carbon dioxide , arterial-to-alveolar oxygen tension ratio , and severe radiological grade are predictors of the failure of INSURE method in preterm infants with respiratory distress syndrome . However , a prospect i ve r and omized controlled trial is needed to determine whether or not infants at risk for INSURE failure are better off being treated with mechanical ventilation OBJECTIVES : The aims of this study were to assess the efficacy and feasibility of a new , less invasive surfactant administration technique for beractant replacement using a specifically design ed cannula in preterm infants born at < 32 weeks of gestation and to compare short- and long-term outcomes between this approach and st and ard treatment , consisting of intubation , administration of surfactant and early extubation to nasal continuous positive airway pressure . METHOD : This was a single-center , prospect i ve , open-label , non-r and omized , controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the st and ard approach .  Beractant ( 4 ml/kg ) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30 % FiO2 . Clinical trials.gov : NCT02611284 . RESULTS : In the group with less invasive surfactant administration , beractant was successfully administered in all patients . Thirteen patients ( 43.3 % ) in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life , compared with 22 ( 73 % ) in the control group ( p<0.036 ) . The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups ( 46 % vs. 40 % , respectively ) . There were no differences in other outcomes . CONCLUSION : The administration of beractant ( 4 ml/kg ) using a less invasive surfactant administration technique with a specifically design ed cannula for administration is feasible . Moreover , early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation , surfactant administration and early extubation 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 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 IMPORTANCE Treatment of respiratory distress syndrome in premature infants with continuous positive airway pressure ( CPAP )  preserves surfactant and keeps the lung open but is insufficient in severe surfactant deficiency . Traditional surfactant administration is related to short periods of positive pressure ventilation and implies the risk of lung injury . CPAP with surfactant but without any positive pressure ventilation may work synergistically . This r and omized trial investigated a less invasive surfactant application protocol ( LISA ) . OBJECTIVE To test the hypothesis that LISA increases survival without bronchopulmonary dysplasia ( BPD ) at 36 weeks ' gestational age in extremely preterm infants . DESIGN , SETTING , AND PARTICIPANTS The Nonintubated Surfactant Application trial was a multicenter , r and omized , clinical , parallel-group study conducted between April 15 , 2009 , and March 25 , 2012 , in 13 level III neonatal intensive care units in Germany . The final follow-up date was June 21 , 2012 . Participants included 211 of 558 eligible ( 37.8 % ) spontaneously breathing preterm infants born between 23.0 and 26.8 weeks ' gestational age with signs of respiratory distress syndrome . In an intention-to-treat design , infants were r and omly assigned to receive surfactant either via a thin endotracheal catheter during CPAP-assisted spontaneous breathing ( intervention group ) or after conventional endotracheal intubation during mechanical ventilation ( control group ) . Analysis was conducted from September 6 , 2012 , to June 20 , 2013 . INTERVENTION LISA via a thin catheter . MAIN OUTCOMES AND MEASURES Survival without BPD at 36 weeks ' gestational age . RESULTS Of 211 infants who were r and omized , 104 were r and omized to the control group and 107 to the LISA group . Of the infants who received LISA , 72 ( 67.3 % ) survived without BPD compared with 61 ( 58.7 % ) of those in the control group . The reduction in absolute risk was 8.6 % ( 95 % CI , -5.0 % to 21.9 % ; P = .20 ) . Intervention group infants were less frequently intubated ( 80 infants [ 74.8 % ] vs 103 [ 99.0 % ] ; P < .001 ) and required fewer days of mechanical ventilation . Significant reductions were seen in pneumothorax ( 5 of 105 intervention group infants [ 4.8 % ] vs 13 of 103 12.6 % ] ; P = .04 ) and severe intraventricular hemorrhage ( 11 infants [ 10.3 % ] vs 23 [ 22.1 % ] ; P = .02 ) , and the combined survival without severe adverse events was increased in the intervention group ( 54 infants [ 50.5 % ] vs 37 [ 35.6 % ] ; P = .02 ; absolute risk reduction , 14.9 ; 95 % CI , 1.4 to 28.2 ) . CONCLUSIONS AND RELEVANCE LISA did not increase survival without BPD but was associated with increased survival without major complications . Because major complications are related to lifelong disabilities , LISA may be a promising therapy for extremely preterm infants . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N64011614 OBJECTIVE : Early surfactant followed by extubation to nasal continuous positive airway pressure ( nCPAP ) compared with later surfactant and mechanical ventilation ( MV ) reduce the need for MV , air leaks , and bronchopulmonary dysplasia . This r and omized , controlled trial investigated whether prophylactic surfactant followed by nCPAP compared with early nCPAP application with early selective surfactant would reduce the need for MV in the first 5 days of life . METHODS : A total of 208 inborn infants who were born at 25 to 28 weeks ' gestation and were not intubated at birth were r and omly assigned to prophylactic surfactant or nCPAP within 30 minutes of birth . Outcomes were assessed within the first 5 days of life and until death or discharge of the infants from hospital . RESULTS : Thirty-three ( 31.4 % ) infants in the prophylactic surfactant group needed MV in the first 5 days of life compared with 34 ( 33.0 % ) in the nCPAP group ( risk ratio : 0.95 [ 95 % confidence interval : 0.64–1.41 ] ; P = .80 ) . Death and type of survival at 28 days of life and 36 weeks ' postmenstrual age and incidence of main morbidities of prematurity ( secondary outcomes ) were similar in the 2 groups . A total of 78.1 % of infants in the prophylactic surfactant group and 78.6 % in the nCPAP group survived in room air at 36 weeks ' postmenstrual age . CONCLUSIONS : Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP Providing less invasive surfactant administration ( LISA ) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia ( BPD ) in r and omised controlled trials . This large cohort study compared these outcome measures between LISA‐treated  infants and controls Aim : To evaluate whether very preterm babies can be extubated successfully to nasal continuous positive airway pressure ( nCPAP ) within one hour of birth after receiving one dose of surfactant in the treatment of respiratory distress syndrome ( RDS ) . Methods : Forty‐two infants of 25 to 28 + 6 wk of gestation were intubated at birth and given one dose of surfactant . They were then r and omized within one hour of birth to either continue with conventional ventilation or to be extubated to nCPAP . Results : Eight out of 21 ( 38 % ) babies r and omized to nCPAP did not require subsequent reventilation . ( Ventilation rates of 62 % 
    Output:
    
agent
***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: We sought to identify risk factors and neonatal outcomes associated with the failure of the INSURE method ( INtubation- SURfactant- Extubation )  during nasal continuous positive airway pressure for preterm infants with respiratory distress syndrome . We used a retrospective analysis of the prenatal histories , clinical courses , and laboratory data of all inborn infants with gestational age 27 to 34 weeks and respiratory distress syndrome treated with INSURE method .  Infants were categorized into two groups : INSURE failure group and INSURE success group . One hundred nine infants were eligible to the study . INSURE failure was registered in 35 infants ( 32.1 % ) . After control for confounding variables , INSURE failure was significantly associated with arterial partial pressure of carbon dioxide ( adjusted odds ratio [ OR ] = 1.82 ; 95 % confidence interval [ CI ] = 1.76 to 90.56 ) , mean arterial-to-alveolar oxygen tension ratio ( adjusted OR = 1.13 ; 95 % CI = 1.06 to 85.34 ) and severe radiological grade ( adjusted OR = 1.31 ; 95 % CI = 1.15 to 70.16 ) . Positive predictive values of these variables were 70 , 75 , and 55 % , respectively . Patent ductus arteriosus and mortality rates were significantly higher in INSURE failure group . Arterial partial pressure of carbon dioxide , arterial-to-alveolar oxygen tension ratio , and severe radiological grade are predictors of the failure of INSURE method in preterm infants with respiratory distress syndrome . However , a prospect i ve r and omized controlled trial is needed to determine whether or not infants at risk for INSURE failure are better off being treated with mechanical ventilation OBJECTIVES : The aims of this study were to assess the efficacy and feasibility of a new , less invasive surfactant administration technique for beractant replacement using a specifically design ed cannula in preterm infants born at < 32 weeks of gestation and to compare short- and long-term outcomes between this approach and st and ard treatment , consisting of intubation , administration of surfactant and early extubation to nasal continuous positive airway pressure . METHOD : This was a single-center , prospect i ve , open-label , non-r and omized , controlled pilot study with an experimental cohort of 30 patients treated with less invasive surfactant administration and a retrospective control group comprising the 30 patients most recently treated with the st and ard approach .  Beractant ( 4 ml/kg ) was administered as an exogenous surfactant in both groups if patients on nasal continuous positive airway pressure during the first three days of life were in need of more than 30 % FiO2 . Clinical trials.gov : NCT02611284 . RESULTS : In the group with less invasive surfactant administration , beractant was successfully administered in all patients . Thirteen patients ( 43.3 % ) in the group with less invasive surfactant administration required invasive mechanical ventilation for more than 1 hour during the first 3 days of life , compared with 22 ( 73 % ) in the control group ( p<0.036 ) . The rate of requiring invasive mechanical ventilation for more than 48 hours was similar between the infants in the two groups ( 46 % vs. 40 % , respectively ) . There were no differences in other outcomes . CONCLUSION : The administration of beractant ( 4 ml/kg ) using a less invasive surfactant administration technique with a specifically design ed cannula for administration is feasible . Moreover , early invasive mechanical ventilation exposure is significantly reduced by this method compared with the strategy involving intubation , surfactant administration and early extubation 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 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 IMPORTANCE Treatment of respiratory distress syndrome in premature infants with continuous positive airway pressure ( CPAP )  preserves surfactant and keeps the lung open but is insufficient in severe surfactant deficiency . Traditional surfactant administration is related to short periods of positive pressure ventilation and implies the risk of lung injury . CPAP with surfactant but without any positive pressure ventilation may work synergistically . This r and omized trial investigated a less invasive surfactant application protocol ( LISA ) . OBJECTIVE To test the hypothesis that LISA increases survival without bronchopulmonary dysplasia ( BPD ) at 36 weeks ' gestational age in extremely preterm infants . DESIGN , SETTING , AND PARTICIPANTS The Nonintubated Surfactant Application trial was a multicenter , r and omized , clinical , parallel-group study conducted between April 15 , 2009 , and March 25 , 2012 , in 13 level III neonatal intensive care units in Germany . The final follow-up date was June 21 , 2012 . Participants included 211 of 558 eligible ( 37.8 % ) spontaneously breathing preterm infants born between 23.0 and 26.8 weeks ' gestational age with signs of respiratory distress syndrome . In an intention-to-treat design , infants were r and omly assigned to receive surfactant either via a thin endotracheal catheter during CPAP-assisted spontaneous breathing ( intervention group ) or after conventional endotracheal intubation during mechanical ventilation ( control group ) . Analysis was conducted from September 6 , 2012 , to June 20 , 2013 . INTERVENTION LISA via a thin catheter . MAIN OUTCOMES AND MEASURES Survival without BPD at 36 weeks ' gestational age . RESULTS Of 211 infants who were r and omized , 104 were r and omized to the control group and 107 to the LISA group . Of the infants who received LISA , 72 ( 67.3 % ) survived without BPD compared with 61 ( 58.7 % ) of those in the control group . The reduction in absolute risk was 8.6 % ( 95 % CI , -5.0 % to 21.9 % ; P = .20 ) . Intervention group infants were less frequently intubated ( 80 infants [ 74.8 % ] vs 103 [ 99.0 % ] ; P < .001 ) and required fewer days of mechanical ventilation . Significant reductions were seen in pneumothorax ( 5 of 105 intervention group infants [ 4.8 % ] vs 13 of 103 12.6 % ] ; P = .04 ) and severe intraventricular hemorrhage ( 11 infants [ 10.3 % ] vs 23 [ 22.1 % ] ; P = .02 ) , and the combined survival without severe adverse events was increased in the intervention group ( 54 infants [ 50.5 % ] vs 37 [ 35.6 % ] ; P = .02 ; absolute risk reduction , 14.9 ; 95 % CI , 1.4 to 28.2 ) . CONCLUSIONS AND RELEVANCE LISA did not increase survival without BPD but was associated with increased survival without major complications . Because major complications are related to lifelong disabilities , LISA may be a promising therapy for extremely preterm infants . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N64011614 OBJECTIVE : Early surfactant followed by extubation to nasal continuous positive airway pressure ( nCPAP ) compared with later surfactant and mechanical ventilation ( MV ) reduce the need for MV , air leaks , and bronchopulmonary dysplasia . This r and omized , controlled trial investigated whether prophylactic surfactant followed by nCPAP compared with early nCPAP application with early selective surfactant would reduce the need for MV in the first 5 days of life . METHODS : A total of 208 inborn infants who were born at 25 to 28 weeks ' gestation and were not intubated at birth were r and omly assigned to prophylactic surfactant or nCPAP within 30 minutes of birth . Outcomes were assessed within the first 5 days of life and until death or discharge of the infants from hospital . RESULTS : Thirty-three ( 31.4 % ) infants in the prophylactic surfactant group needed MV in the first 5 days of life compared with 34 ( 33.0 % ) in the nCPAP group ( risk ratio : 0.95 [ 95 % confidence interval : 0.64–1.41 ] ; P = .80 ) . Death and type of survival at 28 days of life and 36 weeks ' postmenstrual age and incidence of main morbidities of prematurity ( secondary outcomes ) were similar in the 2 groups . A total of 78.1 % of infants in the prophylactic surfactant group and 78.6 % in the nCPAP group survived in room air at 36 weeks ' postmenstrual age . CONCLUSIONS : Prophylactic surfactant was not superior to nCPAP and early selective surfactant in decreasing the need for MV in the first 5 days of life and the incidence of main morbidities of prematurity in spontaneously breathing very preterm infants on nCPAP Providing less invasive surfactant administration ( LISA ) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia ( BPD ) in r and omised controlled trials . This large cohort study compared these outcome measures between LISA‐treated  infants and controls Aim : To evaluate whether very preterm babies can be extubated successfully to nasal continuous positive airway pressure ( nCPAP ) within one hour of birth after receiving one dose of surfactant in the treatment of respiratory distress syndrome ( RDS ) . Methods : Forty‐two infants of 25 to 28 + 6 wk of gestation were intubated at birth and given one dose of surfactant . They were then r and omized within one hour of birth to either continue with conventional ventilation or to be extubated to nCPAP . Results : Eight out of 21 ( 38 % ) babies r and omized to nCPAP did not require subsequent reventilation . ( Ventilation rates of 62 % 
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