(HealthDay News) – For very premature infants there is no significant difference in death or neurodevelopmental impairment with continuous positive airway pressure (CPAP) vs. surfactant; however, lower oxygen-saturation targets cannot be recommended as mortality is still lower with higher oxygen saturation, according to a study published in the Dec. 27 issue of the New England Journal of Medicine.

Yvonne E. Vaucher, MD, MPH, from the University of California at San Diego, and colleagues reported long-term results from a trial in which infants born between 24 weeks 0 days–27 weeks 6 days were randomized to early CPAP with a limited ventilation strategy (621 infants) or early surfactant administration (613 infants), and to lower (85–89%; 612 infants) or higher target ranges of oxygen saturation (91–95%; 622 infants).

The researchers found that the primary outcome of death or neurodevelopmental impairment occurred in 27.9% of infants in the CPAP group vs. 29.9% in the surfactant group (relative risk, 0.93; P=0.38), and in 30.2 and 27.5%, respectively, in the lower and higher target oxygen saturation groups (relative risk, 1.12; P=0.21). Compared with the higher-oxygen-saturation target, mortality was significantly increased with lower oxygen saturation (relative risk, 1.25; P = 0.046).

“Early CPAP with a limited ventilation strategy can be considered as an alternative to early surfactant treatment, even in infants as immature as those at 24 weeks of gestational age,” the authors write. “Because mortality remained lower in the higher-oxygen-saturation group at the time of follow-up and there were no adverse visual or neurodevelopmental problems, lower oxygen-saturation targets cannot be recommended in these extremely preterm infants.”

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