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

Abstract

Objective To explore the early childhood pulmonary outcomes of infants who participated in the NICHD SUPPORT Trial, using a factorial design that randomized extremely preterm infants to lower vs. higher oxygen saturation targets and delivery room CPAP vs. intubation/surfactant, found no significant difference in the primary composite outcome of death or BPD. Study design The Breathing Outcomes Study, a prospective secondary to SUPPORT, assessed respiratory morbidity at 6 month intervals from hospital discharge to 18–22 months corrected age (CA). Two pre-specified 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 between each randomized intervention. Results One or more interviews were completed for 918 of 922 eligible infants. The incidence of wheezing and cough were 47.9% and 31.0%, respectively, and did not differ between study arms of either randomized intervention. Infants randomized to lower vs. higher oxygen saturation targets had similar risks of death or respiratory morbidities (except for croup, 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<0.05), respiratory illnesses diagnosed by a doctor (47.7% vs. 55.2%, p<0.05) and physician or emergency room visits for breathing problems (68.0% vs. 72.9%, p<0.05) 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.

Neurodevelopmental outcomes of extremely low birthweight infants randomised to different PCO 2 targets: the PHELBI follow-up study

“…Similarly to the trial reported here, neurodevelopmental outcomes did not differ between study groups 10. Respiratory morbidities, however, were significantly reduced in the CPAP group at 18–22 months,26 which might, given the experience of earlier trials, correlate with neurodevelopmental performance at school age 27…”

Short- and Long-Term Outcomes for Extremely Preterm Infants

“…In addition, data supports the early use of surfactant among infants requiring mechanical ventilation, compared to delaying treatment until the severity of RDS worsens 28 . In the delivery room, studies suggest that initial CPAP, rather than intubation and surfactant, is a potentially more favorable approach to reduce long-term respiratory morbidity in EPT infants with RDS 29 and is a recommended approach in EPT infants who are spontaneously breathing in the delivery room 30 .…”

Oxygen Saturation Targeting and Bronchopulmonary Dysplasia

“…Furthermore, in SUPPORT both those with and without BPD had ongoing respiratory morbidity at 2 years, although less respiratory morbidity in those randomized to initial CPAP versus intubation. 79 In addition, although rates of severe ROP were increased in the higher target group, severe visual impairment at 2 years was very low (for the lower and higher targets in SUPPORT 1.0% and 1.2%; in COT 1.0% and 0.6%; in BOOST-NZ 0% and 0.7%), [55][56][57] indicating that current detection and treatment of ROP in these infants was largely successful.…”