Early CPAP Versus Surfactant in Extremely Preterm Infants

Abstract

Abstract The benefit of intubation for prophylactic surfactant was questioned as respiratory techniques evolved. The SUPPORT trial randomized 1316 extremely preterm infants born 24 to 27 weeks’ gestation to either early CPAP or intubation in the delivery room. This was in a 2×2 factorial trial, where oxygen saturation was also tested. After adjustment, the rate of the primary outcome of death or BPD did not differ significantly (CPAP 47.8% versus intubation 51.0%; RR 0.95, 95% CI 0.85 to 1.05, p = 0.30). However, on secondary analysis more infants in the CPAP group were alive and free from the need for mechanical ventilation by day 7 (55.3% versus 48.8%; RR 1.14, 95% CI 1.03 to 1.25, p = 0.01) and infants in the CPAP group required fewer days of ventilation (adjusted mean 24.8 versus 27.7; mean difference –3.0, 95% CI –5.6 to –0.3, p = 0.03).