Change in practice after the surfactant, positive pressure and oxygenation randomised trial

Jaclyn M. LeVan, Luc P. Brion, Lisa A. Wrage, Marie G. Gantz, Myra H. Wyckoff, Pablo J. Sánchez, Roy Heyne, Mambarambath Jaleel, Neil N. Finer, Waldemar A. Carlo, Abhik Das, Barbara J. Stoll, Rosemary D. Higgins

Research output: Contribution to journalArticle

7 Citations (Scopus)

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).

Original languageEnglish (US)
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume99
Issue number5
DOIs
StatePublished - 2014

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Surface-Active Agents
Delivery Rooms
Intratracheal Intubation
Pressure
Research
Continuous Positive Airway Pressure
Gestational Age
National Institute of Child Health and Human Development (U.S.)
Random Allocation
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Newborn Infant
Databases
Oxygen

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Change in practice after the surfactant, positive pressure and oxygenation randomised trial. / LeVan, Jaclyn M.; Brion, Luc P.; Wrage, Lisa A.; Gantz, Marie G.; Wyckoff, Myra H.; Sánchez, Pablo J.; Heyne, Roy; Jaleel, Mambarambath; Finer, Neil N.; Carlo, Waldemar A.; Das, Abhik; Stoll, Barbara J.; Higgins, Rosemary D.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 99, No. 5, 2014.

Research output: Contribution to journalArticle

LeVan, Jaclyn M. ; Brion, Luc P. ; Wrage, Lisa A. ; Gantz, Marie G. ; Wyckoff, Myra H. ; Sánchez, Pablo J. ; Heyne, Roy ; Jaleel, Mambarambath ; Finer, Neil N. ; Carlo, Waldemar A. ; Das, Abhik ; Stoll, Barbara J. ; Higgins, Rosemary D. / Change in practice after the surfactant, positive pressure and oxygenation randomised trial. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2014 ; Vol. 99, No. 5.
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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).",
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T1 - Change in practice after the surfactant, positive pressure and oxygenation randomised trial

AU - LeVan, Jaclyn M.

AU - Brion, Luc P.

AU - Wrage, Lisa A.

AU - Gantz, Marie G.

AU - Wyckoff, Myra H.

AU - Sánchez, Pablo J.

AU - Heyne, Roy

AU - Jaleel, Mambarambath

AU - Finer, Neil N.

AU - Carlo, Waldemar A.

AU - Das, Abhik

AU - Stoll, Barbara J.

AU - Higgins, Rosemary D.

PY - 2014

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N2 - 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).

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 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).

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