Change in practice after the Surfactant, Positive Pressure and Oxygenation Randomised Trial

• Type of Material: Article
• Authors: Jaclyn M LeVan, University of Texas Southwestern Medical Center Dallas; Luc P Brion, University of Texas Southwestern Medical Center Dallas; Lisa A Wrage, RTI International; Marie G Gantz, RTI International; Myra H Wyckoff, University of Texas Southwestern Medical Center Dallas; Pablo J Sanchez, University of Texas Southwestern Medical Center Dallas; Roy Heyne, University of Texas Southwestern Medical Center Dallas; Mambarambath Jaleel, University of Texas Southwestern Medical Center Dallas; Neil N Finer, University of California San Diego; Waldemar A Carlo, University of Alabama Birmingham; Abhik Das, RTI International; Barbara Stoll, Emory University; Rosemary D Higgins, Eunice Kennedy Shriver National Institute of Child Health & Human Development
• Language: English
• Date: 2014-09-01
• Publisher: BMJ Publishing Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014, The Author(s). Published by BMJ Publishing Group Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/archdischild-2014-306057
• Title of Journal or Parent Work: Archives of disease in childhood. Fetal and neonatal edition
• Volume: 99
• Issue: 5
• Start Page: F386
• End Page: F390
• Keywords: DEATH; Pediatrics; RISK-FACTORS; EXTREMELY PRETERM INFANTS; Science & Technology; Life Sciences & Biomedicine; BIRTH-WEIGHT INFANTS; LUNG-DISEASE; PREMATURITY; BRONCHOPULMONARY DYSPLASIA; CARE

Abstract

Objective: To test the hypothesis that the proportion of endotracheal intubation (ETI) in the delivery room (DR) decreased in Neonatal Research Network (NRN) centres after the National Institute of Child Health and Human Development NRN Surfactant, Positive Pressure, and Oxygenation Randomised Trial (SUPPORT). Design: Retrospective cohort study using the prospective NRN generic database. Setting: Eleven centres that participated in the SUPPORT trial and remained part of the NRN. Preterm neonates 240/7-276/7 weeks' gestational age enrolled in the SUPPORT trial were randomised to: (1) DR continuous positive airway pressure or DR ETI with early surfactant administration; and (2) oxygen saturation targets of 85-89% or 91-95%. The prior NRN feasibility trial had assessed the feasibility of randomisation to continuous positive airway pressure versus ETI. Patients: Infants 24 0/7-276/7 weeks' gestational age, excluding infants with syndromes or major malformations and those on comfort care only. Main outcome measure: Proportion of DR ETI. Results: The proportion of DR ETI decreased significantly in the group of infants from centres that had not participated in the feasibility trial (91% before vs 75% after SUPPORT, adjusted relative risk 0.86, 95% CI 0.83-0.89, p<0.0001) but not in the group of infants from the other centres, where the proportion of ETI was already lower prior to initiation of the SUPPORT trial (61% before vs 58% after SUPPORT, adjusted relative risk 0.96, 95% CI 0.89 to 1.05, p=0.40). Conclusion: This study shows that DR ETI changed after SUPPORT only in NRN centres that had not participated in a similar trial. Trial registration number: NCT00063063 (GDB) and NCT00233324 (SUPPORT).