Timothy P Stevens1, Neil N Finer2, Waldemar A Carlo3, Peter G Szilagyi4, Dale L Phelps4, Michele C Walsh5, Marie G Gantz6, Abbot R Laptook7, Bradley A Yoder8, Roger G Faix8, Jamie E Newman6, Abhik Das9, Barbara T Do6, Kurt Schibler10, Wade Rich2, Nancy S Newman5, Richard A Ehrenkranz11, Myriam Peralta-Carcelen3, Betty R Vohr7, Deanne E Wilson-Costello5, Kimberly Yolton10, Roy J Heyne12, Patricia W Evans13, Yvonne E Vaucher2, Ira Adams-Chapman14, Elisabeth C McGowan15, Anna Bodnar8, Athina Pappas16, Susan R Hintz17, Michael J Acarregui18, Janell Fuller19, Ricki F Goldstein20, Charles R Bauer21, T Michael O'Shea22, Gary J Myers4, Rosemary D Higgins23. 1. Department of Pediatrics, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY. Electronic address: timothy_stevens@urmc.rochester.edu. 2. Division of Neonatology, University of California at San Diego, San Diego, CA. 3. Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL. 4. Department of Pediatrics, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY. 5. Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH. 6. Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC. 7. Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI. 8. Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 9. Social, Statistical, and Environmental Sciences, RTI International, Rockville, MD. 10. Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH. 11. Department of Pediatrics, Yale University School of Medicine, New Haven, CT. 12. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. 13. Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX. 14. Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA. 15. Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA. 16. Department of Pediatrics, Wayne State University, Detroit, MI. 17. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA. 18. Department of Pediatrics, University of Iowa, Iowa City, IA. 19. Division of Neonatology, University of New Mexico Health Sciences Center, Albuquerque, NM. 20. Department of Pediatrics, Duke University, Durham, NC. 21. University of Miami Miller School of Medicine, Miami, FL. 22. Division of Neonatology, Wake Forest University School of Medicine, Winston-Salem, NC. 23. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Abstract
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.
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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