Early CPAP vs. Surfactant Treatment for Extreme Prematurity: No Difference in Mortality and Neurodevelopmental Outcomes

Infants who survive extreme premature birth are at significant risk for neurodevelopmental impairment. In a multicenter trial, researchers compared mortality and neurodevelopmental outcomes in 1316 extremely premature neonates (born at 24–27 weeks' gestation) who were randomized in the delivery room to receive immediate continuous positive airway pressure (CPAP) and limited ventilation or intubation with surfactant treatment followed by conventional ventilation. Neonates were also randomized to lower- or higher-target oxygenation saturations (85%–89% vs. 91%–95%).

Prior to discharge, 237 neonates (18%) died; mortality rates did not differ significantly between the CPAP and surfactant treatment groups, but mortality was significantly higher i…