title: Respiratory outcomes of the surfactant positive pressure and oximetry randomized trial (SUPPORT).
abstract: OBJECTIVE
  To explore the early childhood pulmonary outcomes of infants who participated in the National Institute of Child Health and Human Development's Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial (SUPPORT), using a factorial design that randomized extremely preterm infants to lower vs higher oxygen saturation targets and delivery room continuous positive airway pressure (CPAP) vs intubation/surfactant.
  
  
  METHODS
  The Breathing Outcomes Study, a prospective secondary study to the Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial, assessed respiratory morbidity at 6-month intervals from hospital discharge to 18-22 months corrected age (CA). Two prespecified primary outcomes-wheezing more than twice per week during the worst 2-week period and cough longer than 3 days without a cold-were compared for each randomized intervention.
  
  
  RESULTS
  One or more interviews were completed for 918 of the 922 eligible infants. The incidences of wheezing and cough were 47.9% and 31.0%, respectively, and did not differ between the study arms of either randomized intervention. Infants randomized to lower vs higher oxygen saturation targets had a similar risk of death or respiratory morbidity (except for croup and treatment with oxygen or diuretics at home). Infants randomized to CPAP vs intubation/surfactant had fewer episodes of wheezing without a cold (28.9% vs 36.5%; P<.05), respiratory illnesses diagnosed by a doctor (47.7% vs 55.2%; P<.05), and physician or emergency room visits for breathing problems (68.0% vs 72.9%; P<.05) by 18-22 months CA.
  
  
  CONCLUSIONS
  Treatment with early CPAP rather than intubation/surfactant is associated with less respiratory morbidity by 18-22 months CA. Longitudinal assessment of pulmonary morbidity is necessary to fully evaluate the potential benefits of respiratory interventions for neonates.
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY. Electronic address: timothy_stevens@urmc.rochester.edu.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Stevens
authors.affiliation: Division of Neonatology, University of California at San Diego, San Diego, CA.
authors.forename: Neil N
authors.initials: NN
authors.lastname: Finer
authors.affiliation: Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY.
authors.forename: Dale L
authors.initials: DL
authors.lastname: Phelps
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC.
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.affiliation: Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI.
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Yoder
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Faix
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Newman
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, Rockville, MD.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, NC.
authors.forename: Barbara T
authors.initials: BT
authors.lastname: Do
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH.
authors.forename: Kurt
authors.initials: K
authors.lastname: Schibler
authors.affiliation: Division of Neonatology, University of California at San Diego, San Diego, CA.
authors.forename: Wade
authors.initials: W
authors.lastname: Rich
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.affiliation: Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Myriam
authors.initials: M
authors.lastname: Peralta-Carcelen
authors.affiliation: Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI.
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH.
authors.forename: Deanne E
authors.initials: DE
authors.lastname: Wilson-Costello
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yolton
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Roy J
authors.initials: RJ
authors.lastname: Heyne
authors.affiliation: Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Evans
authors.affiliation: Division of Neonatology, University of California at San Diego, San Diego, CA.
authors.forename: Yvonne E
authors.initials: YE
authors.lastname: Vaucher
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Ira
authors.initials: I
authors.lastname: Adams-Chapman
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA.
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: McGowan
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Anna
authors.initials: A
authors.lastname: Bodnar
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, MI.
authors.forename: Athina
authors.initials: A
authors.lastname: Pappas
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.affiliation: Department of Pediatrics, University of Iowa, Iowa City, IA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Acarregui
authors.affiliation: Division of Neonatology, University of New Mexico Health Sciences Center, Albuquerque, NM.
authors.forename: Janell
authors.initials: J
authors.lastname: Fuller
authors.affiliation: Department of Pediatrics, Duke University, Durham, NC.
authors.forename: Ricki F
authors.initials: RF
authors.lastname: Goldstein
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.affiliation: Division of Neonatology, Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: T Michael
authors.initials: TM
authors.lastname: O'Shea
authors.affiliation: Department of Pediatrics, University of Rochester Medical Center and Golisano Children's Hospital, Rochester, NY.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Myers
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000627:therapeutic use*; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States
chemical_list: D011663:Pulmonary Surfactants; D010100:Oxygen
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