title: Change in practice after the Surfactant, Positive Pressure and Oxygenation Randomised Trial.
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).
  
  
  METHODS
  Retrospective cohort study using the prospective NRN generic database.
  
  
  METHODS
  Eleven centres that participated in the SUPPORT trial and remained part of the NRN. Preterm neonates 24(0/7)-27(6/7) 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.
  
  
  METHODS
  Infants 24(0/7)-27(6/7) weeks' gestational age, excluding infants with syndromes or major malformations and those on comfort care only.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  This study shows that DR ETI changed after SUPPORT only in NRN centres that had not participated in a similar trial.
  
  
  BACKGROUND
  NCT00063063 (GDB) and NCT00233324 (SUPPORT).
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Pediatrix Medical Group, San Antonio, Texas, USA.
authors.forename: Jaclyn M
authors.initials: JM
authors.lastname: LeVan
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Luc P
authors.initials: LP
authors.lastname: Brion
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Wrage
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA.
authors.forename: Marie G
authors.initials: MG
authors.lastname: Gantz
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Myra H
authors.initials: MH
authors.lastname: Wyckoff
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Heyne
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Mambarambath
authors.initials: M
authors.lastname: Jaleel
authors.affiliation: Division of Neonatology, University of California, San Diego, California, USA.
authors.forename: Neil N
authors.initials: NN
authors.lastname: Finer
authors.affiliation: Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina, USA.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.affiliation: Eunice Kennedy Shriver National Institute of Child, Health and Human Development, Bethesda, Maryland, USA.
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure; D016208:Databases, Factual; D003696:Delivery Rooms; D004059:Diffusion of Innovation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000628:therapy*; D015931:Intensive Care, Neonatal / Q000379:methods; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D010102:Oxygen Inhalation Therapy; D011364:Professional Practice / Q000706:statistics & numerical data*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D011663:Pulmonary Surfactants
keywords: Clinical Procedures; Data Collection; Neonatology; Respiratory