There are no significant differences in death or neurodevelopmental impairment between toddlers who underwent early continuous positive airway pressure (CPAP) or early surfactant administration as extremely premature infants, research shows.
Moreover, there was no difference in the composite outcome of neurodevelopmental impairment and death according to whether infants had a low or high target range of oxygen saturation, report Neil Finer (University of California, San Diego, USA) and colleagues.
"This is the first study to compare surfactant treatment to CPAP in a large group of infants, and these results reassure us that CPAP is as good a choice in the first hour of life as traditional methods for very preterm babies who need help breathing," commented co-author Rosemary Higgins (Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland, USA) in a press statement.
The follow-up study extends earlier findings that showed infants born aged 24-27 weeks gestation were more likely to survive if they received higher oxygen levels, although they were also at an increased risk for severe retinopathy. The 2010 study also demonstrated that CPAP was as effective as standard therapy with a ventilator and surfactant administration.
All infants were either randomly assigned to early CPAP with a limited ventilation strategy or early surfactant administration and to lower or higher target ranges of oxygen saturation (85-89% or 91-95%).
The current study followed the infants at 18-22 months for the primary composite outcome of death before assessment or neurodevelopmental impairment.
As reported in the NEJM, the researchers determined the primary outcome in 1234 (93.8%) of 1316 enrolled infants; 990 (93.6%) of the 1058 surviving infants were evaluated at 18-22 months of corrected age.
Death or neurodevelopmental impairment occurred in 27.9% of those in the CPAP group, compared with 29.9% of those in the surfactant group, corresponding to a nonsignificant relative risk of 0.93.
Death or neurodevelopmental impairment also occurred in 30.2% of infants in the lower oxygen group versus 27.5% of those in the higher oxygen saturation group, corresponding to a nonsignificant relative risk of 1.12.
Mortality was significantly higher in infants with the lower oxygen saturation target than in those with a higher one, at 22.1% versus 18.2%, corresponding to a relative risk of 1.25.
"Although these findings can give delivery room practitioners confidence in a suitable approach, they can't help predict how these children will grow or how well they'll do in school," remarked Higgins. "Our group will continue to monitor the health of a subset of these children through childhood, to determine if there are any major differences between the groups."
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