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Change in practice after the Surfactant, Positive Pressure and Oxygenation Randomised Trial
  1. Jaclyn M LeVan1,2,
  2. Luc P Brion1,
  3. Lisa A Wrage3,
  4. Marie G Gantz3,
  5. Myra H Wyckoff1,
  6. Pablo J Sánchez1,4,
  7. Roy Heyne1,
  8. Mambarambath Jaleel1,
  9. Neil N Finer5,
  10. Waldemar A Carlo6,
  11. Abhik Das3,
  12. Barbara J Stoll7,
  13. Rosemary D Higgins8
  14. on behalf of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Bethesda, MD
  1. 1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  2. 2Pediatrix Medical Group, San Antonio, Texas, USA
  3. 3Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA
  4. 4Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
  5. 5Division of Neonatology, University of California, San Diego, California, USA
  6. 6Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  7. 7Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
  8. 8Eunice Kennedy Shriver National Institute of Child, Health and Human Development, Bethesda, Maryland, USA
  1. Correspondence to Dr Luc P Brion, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, STOP 9063, Dallas, TX 75390-9063, USA; luc.brion{at}


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 240/7–276/7 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).

  • Neonatology
  • Respiratory
  • Clinical Procedures
  • Data Collection

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