RT Journal Article
SR Electronic
T1 Change in practice after the Surfactant, Positive Pressure and Oxygenation Randomised Trial
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F386
OP F390
DO 10.1136/archdischild-2014-306057
VO 99
IS 5
A1 Jaclyn M LeVan
A1 Luc P Brion
A1 Lisa A Wrage
A1 Marie G Gantz
A1 Myra H Wyckoff
A1 Pablo J Sánchez
A1 Roy Heyne
A1 Mambarambath Jaleel
A1 Neil N Finer
A1 Waldemar A Carlo
A1 Abhik Das
A1 Barbara J Stoll
A1 Rosemary D Higgins
YR 2014
UL http://fn.bmj.com/content/99/5/F386.abstract
AB 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).