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Published on: April 7, 2021
Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT)
Timothy P Stevens1, Neil N Finer2, Waldemar A Carlo3
1Department of Pediatrics, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY.
Insights
Early continuous positive airway pressure (CPAP) in preterm infants reduced later respiratory issues compared to intubation/surfactant. Oxygen saturation targets did not significantly impact these early childhood pulmonary outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Trials
Background:
- Extremely preterm infants face significant risks of respiratory morbidity.
- The Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial (SUPPORT) investigated oxygen saturation targets and delivery room respiratory support.
- Understanding long-term pulmonary outcomes is crucial for optimizing neonatal care.
Purpose of the Study:
- To evaluate the early childhood pulmonary outcomes of infants from the SUPPORT trial.
- To compare respiratory morbidity based on randomized oxygen saturation targets and delivery room respiratory support methods (CPAP vs. intubation/surfactant).
Main Methods:
- The Breathing Outcomes Study prospectively followed 918 infants from the SUPPORT trial.
- Respiratory symptoms like wheezing and cough were assessed at 6-month intervals up to 18-22 months corrected age (CA).
- Outcomes were compared between infants randomized to different oxygen saturation levels and initial respiratory support.
Main Results:
- No significant differences in overall wheezing or cough incidence were found between oxygen saturation target groups.
- Infants receiving early continuous positive airway pressure (CPAP) showed reduced rates of wheezing without a cold, doctor-diagnosed respiratory illnesses, and breathing-related emergency visits by 18-22 months CA compared to intubation/surfactant.
- While some specific morbidities differed, the primary outcomes did not vary significantly between oxygen saturation arms.
Conclusions:
- Early delivery room CPAP is associated with decreased respiratory morbidity in extremely preterm infants by 18-22 months corrected age.
- The choice of respiratory support in the delivery room has a more significant impact on early childhood pulmonary outcomes than initial oxygen saturation targets.
- Longitudinal studies are essential for assessing the full benefits of neonatal respiratory interventions.
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<.05), respiratory illnesses diagnosed by a doctor (47.7% vs 55.2%; P<.05), and physician or emergency room visits for breathing problems (68.0% vs 72.9%; P<.05) by 18-22 months CA.
Conclusion:
Treatment with early CPAP rather than intubation/surfactant is associated with less respiratory morbidity by 18-22 months CA. Longitudinal assessment of pulmonary morbidity is necessary to fully evaluate the potential benefits of respiratory interventions for neonates.
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