Early CPAP versus surfactant in extremely preterm infants

Neil N Finer; Waldemar A Carlo; Michele C Walsh; Wade Rich; Marie G Gantz; Abbot R Laptook; Bradley A Yoder; Roger G Faix; Abhik Das; W Kenneth Poole; Edward F Donovan; Nancy S Newman; Namasivayam Ambalavanan; Ivan D Frantz III; Susie Buchter; Pablo J Sánchez; Kathleen A Kennedy; Nirupama Laroia; Brenda B Poindexter; C Michael Cotten; Krisa P Van Meurs; Shahnaz Duara; Vivek Narendran; Beena G Sood; T Michael O'Shea; Edward F Bell; Vineet Bhandari; Kristi L Watterberg; Rosemary D Higgins; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network

doi:10.1056/NEJMoa0911783

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Early CPAP versus surfactant in extremely preterm infants

Journal article

Open access

Peer reviewed

Early CPAP versus surfactant in extremely preterm infants

Neil N Finer, Waldemar A Carlo, Michele C Walsh, Wade Rich, Marie G Gantz, Abbot R Laptook, Bradley A Yoder, Roger G Faix, Abhik Das, W Kenneth Poole, …

The New England journal of medicine, Vol.362(21), pp.1970-1979

05/27/2010

DOI: 10.1056/NEJMoa0911783

PMCID: PMC3071534

PMID: 20472939

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Abstract

There are limited data to inform the choice between early treatment with continuous positive airway pressure (CPAP) and early surfactant treatment as the initial support for extremely-low-birth-weight infants. We performed a randomized, multicenter trial, with a 2-by-2 factorial design, involving infants who were born between 24 weeks 0 days and 27 weeks 6 days of gestation. Infants were randomly assigned to intubation and surfactant treatment (within 1 hour after birth) or to CPAP treatment initiated in the delivery room, with subsequent use of a protocol-driven limited ventilation strategy. Infants were also randomly assigned to one of two target ranges of oxygen saturation. The primary outcome was death or bronchopulmonary dysplasia as defined by the requirement for supplemental oxygen at 36 weeks (with an attempt at withdrawal of supplemental oxygen in neonates who were receiving less than 30% oxygen). A total of 1316 infants were enrolled in the study. The rates of the primary outcome did not differ significantly between the CPAP group and the surfactant group (47.8% and 51.0%, respectively; relative risk with CPAP, 0.95; 95% confidence interval [CI], 0.85 to 1.05) after adjustment for gestational age, center, and familial clustering. The results were similar when bronchopulmonary dysplasia was defined according to the need for any supplemental oxygen at 36 weeks (rates of primary outcome, 48.7% and 54.1%, respectively; relative risk with CPAP, 0.91; 95% CI, 0.83 to 1.01). Infants who received CPAP treatment, as compared with infants who received surfactant treatment, less frequently required intubation or postnatal corticosteroids for bronchopulmonary dysplasia (P<0.001), required fewer days of mechanical ventilation (P=0.03), and were more likely to be alive and free from the need for mechanical ventilation by day 7 (P=0.01). The rates of other adverse neonatal outcomes did not differ significantly between the two groups. The results of this study support consideration of CPAP as an alternative to intubation and surfactant in preterm infants. (ClinicalTrials.gov number, NCT00233324.)

Continuous Positive Airway Pressure

Infant, Extremely Low Birth Weight

Hospital Mortality

Infant Mortality

Humans

Oximetry

Male

Retinopathy of Prematurity - epidemiology

Pulmonary Surfactants - therapeutic use

Oxygen - blood

Bronchopulmonary Dysplasia - epidemiology

Oxygen - administration & dosage

Apgar Score

Infant, Premature

Intention to Treat Analysis

Female

Oxygen Inhalation Therapy - methods

Intubation, Intratracheal

Infant, Newborn

Details

Title: Subtitle: Early CPAP versus surfactant in extremely preterm infants
Creators: Neil N Finer
Waldemar A Carlo
Michele C Walsh
Wade Rich
Marie G Gantz
Abbot R Laptook
Bradley A Yoder
Roger G Faix
Abhik Das
W Kenneth Poole
Edward F Donovan
Nancy S Newman
Namasivayam Ambalavanan
Ivan D Frantz III
Susie Buchter
Pablo J Sánchez
Kathleen A Kennedy
Nirupama Laroia
Brenda B Poindexter
C Michael Cotten
Krisa P Van Meurs
Shahnaz Duara
Vivek Narendran
Beena G Sood
T Michael O'Shea
Edward F Bell
Vineet Bhandari
Kristi L Watterberg
Rosemary D Higgins
SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network
Resource Type: Journal article
Publication Details: The New England journal of medicine, Vol.362(21), pp.1970-1979
DOI: 10.1056/NEJMoa0911783
PMID: 20472939
PMCID: PMC3071534
ISSN: 0028-4793
eISSN: 1533-4406
Grant note: UG1 HD053089 / NICHD NIH HHS UG1 HD040492 / NICHD NIH HHS U10 HD53089 / NICHD NIH HHS U10 HD027871 / NICHD NIH HHS U10 HD040498 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS M01 RR39 / NCRR NIH HHS U10 HD053124-03 / NICHD NIH HHS U10 HD040521 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS M01 RR70 / NCRR NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD36790 / NICHD NIH HHS M01 RR8084 / NCRR NIH HHS U10 HD40498 / NICHD NIH HHS UL1 TR000454 / NCATS NIH HHS U10 HD021373-24 / NICHD NIH HHS UL1 RR25008 / NCRR NIH HHS U10 HD40492 / NICHD NIH HHS M01 RR007122 / NCRR NIH HHS U10 HD027880-18 / NICHD NIH HHS UG1 HD027851 / NICHD NIH HHS U10 HD34216 / NICHD NIH HHS U10 HD27851 / NICHD NIH HHS U10 HD053119 / NICHD NIH HHS M01 RR125 / NCRR NIH HHS M01 RR006022 / NCRR NIH HHS UG1 HD053109 / NICHD NIH HHS U10 HD053119-04 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS U10 HD27871 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD034216-13 / NICHD NIH HHS U10 HD40689 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS U10 HD21385 / NICHD NIH HHS U10 HD40461 / NICHD NIH HHS M01 RR633 / NCRR NIH HHS M01 RR6022 / NCRR NIH HHS U10 HD040492-08 / NICHD NIH HHS U01 HD036790 / NICHD NIH HHS M01 RR54 / NCRR NIH HHS U10 HD53124 / NICHD NIH HHS U10 HD27856 / NICHD NIH HHS M01 RR997 / NCRR NIH HHS U10 HD040498-05 / NICHD NIH HHS UL1 TR000041 / NCATS NIH HHS M01 RR16587 / NCRR NIH HHS U10 HD27880 / NICHD NIH HHS M01 RR008084 / NCRR NIH HHS UL1 RR24979 / NCRR NIH HHS UL1 RR25744 / NCRR NIH HHS M01 RR016587 / NCRR NIH HHS U10 HD27904 / NICHD NIH HHS U10 HD027856-18 / NICHD NIH HHS M01 RR32 / NCRR NIH HHS U10 HD027851-18 / NICHD NIH HHS M01 RR7122 / NCRR NIH HHS U10 HD027853-18 / NICHD NIH HHS U10 HD27853 / NICHD NIH HHS U10 HD021385-23 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS M01 RR64 / NCRR NIH HHS U10 HD021364-23 / NICHD NIH HHS M01 RR44 / NCRR NIH HHS UL1 RR24139 / NCRR NIH HHS U10 HD040521-05 / NICHD NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS U10 HD053109-04 / NICHD NIH HHS U10 HD040461 / NICHD NIH HHS UL1 RR024979 / NCRR NIH HHS U10 HD53119 / NICHD NIH HHS U10 HD053124 / NICHD NIH HHS M01 RR80 / NCRR NIH HHS M01 RR59 / NCRR NIH HHS M01 RR000030-45 / NCRR NIH HHS U10 HD53109 / NICHD NIH HHS U10 HD21397 / NICHD NIH HHS U10 HD021397 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS UL1 RR024139 / NCRR NIH HHS UL1 RR025008 / NCRR NIH HHS U10 HD21364 / NICHD NIH HHS U10 HD027871-18 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD040689-08 / NICHD NIH HHS U10 HD053089-04 / NICHD NIH HHS M01 RR750 / NCRR NIH HHS U10 HD034216 / NICHD NIH HHS U10 HD40521 / NICHD NIH HHS U10 HD040461-05 / NICHD NIH HHS UL1 RR025744 / NCRR NIH HHS U10 HD21373 / NICHD NIH HHS U10 HD027904-18 / NICHD NIH HHS U10 HD036790-12 / NICHD NIH HHS M01 RR30 / NCRR NIH HHS
Language: English
Date published: 05/27/2010
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093473202771

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