Respiratory Outcomes of the Surfactant Positive Pressure and Oximetry Randomized Trial (SUPPORT)

• Published in: The Journal of pediatrics 2014-08, Vol.165 (2), p.240-249.e4
• Main Authors: Stevens, Timothy P., MD, MPH, Finer, Neil N., MD, Carlo, Waldemar A., MD, Szilagyi, Peter G., MD, Phelps, Dale L., MD, Walsh, Michele C., MD, MS, Gantz, Marie G., PhD, Laptook, Abbot R., MD, Yoder, Bradley A., MD, Faix, Roger G., MD, Newman, Jamie E., PhD, MPH, Das, Abhik, PhD, Do, Barbara T., MSPH, Schibler, Kurt, MD, Rich, Wade, RRT, Newman, Nancy S., RN, Ehrenkranz, Richard A., MD, Peralta-Carcelen, Myriam, MD, MPH, Vohr, Betty R., MD, Wilson-Costello, Deanne E., MD, Yolton, Kimberly, PhD, Heyne, Roy J., MD, Evans, Patricia W., MD, Vaucher, Yvonne E., MD, MPH, Adams-Chapman, Ira, MD, McGowan, Elisabeth C., MD, Bodnar, Anna, MD, Pappas, Athina, MD, Hintz, Susan R., MD, MS Epi, Acarregui, Michael J., MD, Fuller, Janell, MD, Goldstein, Ricki F., MD, Bauer, Charles R., MD, O’Shea, T. Michael, MD, MPH, Myers, Gary J., MD, Higgins, Rosemary D., MD
• Format: Article
• Language: English
• Subjects: Continuous Positive Airway Pressure - methods; Delivery Rooms; Female; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Infant, Premature; Male; Oximetry - methods; Oxygen - therapeutic use; Pediatrics; Prospective Studies; Pulmonary Surfactants - therapeutic use; Respiratory Distress Syndrome, Newborn - therapy; Surveys and Questionnaires; Treatment Outcome; United States
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2014.02.054

Objective To explore the early childhood pulmonary outcomes of infants who participated in the National Institute of Child Health and Human Development's Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial (SUPPORT), using a factorial design that randomized extremely preterm infants to lower vs higher oxygen saturation targets and delivery room continuous positive airway pressure (CPAP) vs intubation/surfactant. Study design The Breathing Outcomes Study, a prospective secondary study to the Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial, assessed respiratory morbidity at 6-month intervals from hospital discharge to 18-22 months corrected age (CA). Two prespecified primary outcomes—wheezing more than twice per week during the worst 2-week period and cough longer than 3 days without a cold—were compared for each randomized intervention. Results One or more interviews were completed for 918 of the 922 eligible infants. The incidences of wheezing and cough were 47.9% and 31.0%, respectively, and did not differ between the study arms of either randomized intervention. Infants randomized to lower vs higher oxygen saturation targets had a similar risk of death or respiratory morbidity (except for croup and treatment with oxygen or diuretics at home). Infants randomized to CPAP vs intubation/surfactant had fewer episodes of wheezing without a cold (28.9% vs 36.5%; P