Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT)

Timothy P. Stevens, Neil N. Finer, Waldemar A. Carlo, Peter G. Szilagyi, Dale L. Phelps, Michele C. Walsh, Marie G. Gantz, Abbot R. Laptook, Bradley A. Yoder, Roger G. Faix, Jamie E. Newman, Abhik Das, Barbara T. Do, Kurt Schibler, Wade Rich, Nancy S. Newman, Richard A. Ehrenkranz, Myriam Peralta-Carcelen, Betty R. Vohr, Deanne E. Wilson-Costello & 16 others Kimberly Yolton, Roy J. Heyne, Patricia W. Evans, Yvonne E. Vaucher, Ira Adams-Chapman, Elisabeth C. McGowan, Anna Bodnar, Athina Pappas, Susan R. Hintz, Michael J. Acarregui, Janell Fuller, Ricki F. Goldstein, Charles R Bauer, T. Michael O'Shea, Gary J. Myers, Rosemary D. Higgins

Research output: Contribution to journalArticle

51 Citations (Scopus)

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.

Original languageEnglish
JournalJournal of Pediatrics
Volume165
Issue number2
DOIs
StatePublished - Jan 1 2014

Fingerprint

Oximetry
Surface-Active Agents
Continuous Positive Airway Pressure
Respiratory Sounds
Pressure
Intubation
Morbidity
Oxygen
Cough
Respiration
National Institute of Child Health and Human Development (U.S.)
Extremely Premature Infants
Croup
Delivery Rooms
Lung
Diuretics
Hospital Emergency Service
Outcome Assessment (Health Care)
Newborn Infant
Prospective Studies

Keywords

  • BPD
  • Bronchopulmonary dysplasia
  • CA
  • Continuous positive airway pressure
  • Corrected age
  • CPAP
  • SUPPORT
  • Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Stevens, T. P., Finer, N. N., Carlo, W. A., Szilagyi, P. G., Phelps, D. L., Walsh, M. C., ... Higgins, R. D. (2014). Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT). Journal of Pediatrics, 165(2). https://doi.org/10.1016/j.jpeds.2014.02.054

Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT). / Stevens, Timothy P.; Finer, Neil N.; Carlo, Waldemar A.; Szilagyi, Peter G.; Phelps, Dale L.; Walsh, Michele C.; Gantz, Marie G.; Laptook, Abbot R.; Yoder, Bradley A.; Faix, Roger G.; Newman, Jamie E.; Das, Abhik; Do, Barbara T.; Schibler, Kurt; Rich, Wade; Newman, Nancy S.; Ehrenkranz, Richard A.; Peralta-Carcelen, Myriam; Vohr, Betty R.; Wilson-Costello, Deanne E.; Yolton, Kimberly; Heyne, Roy J.; Evans, Patricia W.; Vaucher, Yvonne E.; Adams-Chapman, Ira; McGowan, Elisabeth C.; Bodnar, Anna; Pappas, Athina; Hintz, Susan R.; Acarregui, Michael J.; Fuller, Janell; Goldstein, Ricki F.; Bauer, Charles R; O'Shea, T. Michael; Myers, Gary J.; Higgins, Rosemary D.

In: Journal of Pediatrics, Vol. 165, No. 2, 01.01.2014.

Research output: Contribution to journalArticle

Stevens, TP, Finer, NN, Carlo, WA, Szilagyi, PG, Phelps, DL, Walsh, MC, Gantz, MG, Laptook, AR, Yoder, BA, Faix, RG, Newman, JE, Das, A, Do, BT, Schibler, K, Rich, W, Newman, NS, Ehrenkranz, RA, Peralta-Carcelen, M, Vohr, BR, Wilson-Costello, DE, Yolton, K, Heyne, RJ, Evans, PW, Vaucher, YE, Adams-Chapman, I, McGowan, EC, Bodnar, A, Pappas, A, Hintz, SR, Acarregui, MJ, Fuller, J, Goldstein, RF, Bauer, CR, O'Shea, TM, Myers, GJ & Higgins, RD 2014, 'Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT)', Journal of Pediatrics, vol. 165, no. 2. https://doi.org/10.1016/j.jpeds.2014.02.054
Stevens, Timothy P. ; Finer, Neil N. ; Carlo, Waldemar A. ; Szilagyi, Peter G. ; Phelps, Dale L. ; Walsh, Michele C. ; Gantz, Marie G. ; Laptook, Abbot R. ; Yoder, Bradley A. ; Faix, Roger G. ; Newman, Jamie E. ; Das, Abhik ; Do, Barbara T. ; Schibler, Kurt ; Rich, Wade ; Newman, Nancy S. ; Ehrenkranz, Richard A. ; Peralta-Carcelen, Myriam ; Vohr, Betty R. ; Wilson-Costello, Deanne E. ; Yolton, Kimberly ; Heyne, Roy J. ; Evans, Patricia W. ; Vaucher, Yvonne E. ; Adams-Chapman, Ira ; McGowan, Elisabeth C. ; Bodnar, Anna ; Pappas, Athina ; Hintz, Susan R. ; Acarregui, Michael J. ; Fuller, Janell ; Goldstein, Ricki F. ; Bauer, Charles R ; O'Shea, T. Michael ; Myers, Gary J. ; Higgins, Rosemary D. / Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT). In: Journal of Pediatrics. 2014 ; Vol. 165, No. 2.
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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.",
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author = "Stevens, {Timothy P.} and Finer, {Neil N.} and Carlo, {Waldemar A.} and Szilagyi, {Peter G.} and Phelps, {Dale L.} and Walsh, {Michele C.} and Gantz, {Marie G.} and Laptook, {Abbot R.} and Yoder, {Bradley A.} and Faix, {Roger G.} and Newman, {Jamie E.} and Abhik Das and Do, {Barbara T.} and Kurt Schibler and Wade Rich and Newman, {Nancy S.} and Ehrenkranz, {Richard A.} and Myriam Peralta-Carcelen and Vohr, {Betty R.} and Wilson-Costello, {Deanne E.} and Kimberly Yolton and Heyne, {Roy J.} and Evans, {Patricia W.} and Vaucher, {Yvonne E.} and Ira Adams-Chapman and McGowan, {Elisabeth C.} and Anna Bodnar and Athina Pappas and Hintz, {Susan R.} and Acarregui, {Michael J.} and Janell Fuller and Goldstein, {Ricki F.} and Bauer, {Charles R} and O'Shea, {T. Michael} and Myers, {Gary J.} and Higgins, {Rosemary D.}",
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T1 - Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT)

AU - Stevens, Timothy P.

AU - Finer, Neil N.

AU - Carlo, Waldemar A.

AU - Szilagyi, Peter G.

AU - Phelps, Dale L.

AU - Walsh, Michele C.

AU - Gantz, Marie G.

AU - Laptook, Abbot R.

AU - Yoder, Bradley A.

AU - Faix, Roger G.

AU - Newman, Jamie E.

AU - Das, Abhik

AU - Do, Barbara T.

AU - Schibler, Kurt

AU - Rich, Wade

AU - Newman, Nancy S.

AU - Ehrenkranz, Richard A.

AU - Peralta-Carcelen, Myriam

AU - Vohr, Betty R.

AU - Wilson-Costello, Deanne E.

AU - Yolton, Kimberly

AU - Heyne, Roy J.

AU - Evans, Patricia W.

AU - Vaucher, Yvonne E.

AU - Adams-Chapman, Ira

AU - McGowan, Elisabeth C.

AU - Bodnar, Anna

AU - Pappas, Athina

AU - Hintz, Susan R.

AU - Acarregui, Michael J.

AU - Fuller, Janell

AU - Goldstein, Ricki F.

AU - Bauer, Charles R

AU - O'Shea, T. Michael

AU - Myers, Gary J.

AU - Higgins, Rosemary D.

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N2 - 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.

AB - 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.

KW - BPD

KW - Bronchopulmonary dysplasia

KW - CA

KW - Continuous positive airway pressure

KW - Corrected age

KW - CPAP

KW - SUPPORT

KW - Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial

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