{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:05:11Z","timestamp":1791813911840,"version":"4.3.4"},"reference-count":24,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,11,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE:<\/jats:title><jats:p>We designed a multicenter randomized trial to compare 3 approaches to the initial respiratory management of preterm neonates: prophylactic surfactant followed by a period of mechanical ventilation (prophylactic surfactant [PS]); prophylactic surfactant with rapid extubation to bubble nasal continuous positive airway pressure (intubate-surfactant-extubate [ISX]) or initial management with bubble continuous positive airway pressure and selective surfactant treatment (nCPAP).<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN\/METHODS:<\/jats:title><jats:p>Neonates born at 2607 to 2967 weeks' gestation were enrolled at participating Vermont Oxford Network centers and randomly assigned to PS, ISX, or nCPAP groups before delivery. Primary outcome was the incidence of death or bronchopulmonary dysplasia (BPD) at 36 weeks' postmenstrual age.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>648 infants enrolled at 27 centers. The study was halted before the desired sample size was reached because of declining enrollment. When compared with the PS group, the relative risk of BPD or death was 0.78 (95% confidence interval: 0.59\u20131.03) for the ISX group and 0.83 (95% confidence interval: 0.64\u20131.09) for the nCPAP group. There were no statistically significant differences in mortality or other complications of prematurity. In the nCPAP group, 48% were managed without intubation and ventilation, and 54% without surfactant treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Preterm neonates were initially managed with either nCPAP or PS with rapid extubation to nCPAP had similar clinical outcomes to those treated with PS followed by a period of mechanical ventilation. An approach that uses early nCPAP leads to a reduction in the number of infants who are intubated and given surfactant.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2010-3848","type":"journal-article","created":{"date-parts":[[2011,10,25]],"date-time":"2011-10-25T00:59:48Z","timestamp":1319504388000},"page":"e1069-e1076","source":"Crossref","is-referenced-by-count":452,"title":["Randomized Trial Comparing 3 Approaches to the Initial Respiratory Management of Preterm Neonates"],"prefix":"10.1542","volume":"128","author":[{"given":"Michael S.","family":"Dunn","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kaempf","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Providence St Vincent Medical Center, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"de Klerk","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Florida Hospital Memorial Medical Center, Daytona Beach, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"de Klerk","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Florida Hospital Memorial Medical Center, Daytona Beach, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Reilly","sequence":"additional","affiliation":[{"name":"Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diantha","family":"Howard","sequence":"additional","affiliation":[{"name":"Vermont Oxford Network, Burlington, Vermont;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla","family":"Ferrelli","sequence":"additional","affiliation":[{"name":"Vermont Oxford Network, Burlington, Vermont;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette","family":"O'Conor","sequence":"additional","affiliation":[{"name":"Vermont Oxford Network, Burlington, Vermont;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger F.","family":"Soll","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and General Clinical Research Center, University of Vermont, Burlington, Vermont; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Vermont Oxford Network DRM Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2011,11,1]]},"reference":[{"issue":"3","key":"2021120900331372500_B1","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1542\/peds.2009-2959","article-title":"Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network","volume":"126","author":"Stoll","year":"2010","journal-title":"Pediatrics"},{"issue":"12","key":"2021120900331372500_B2","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1056\/NEJM199303253281208","article-title":"Pulmonary surfactant therapy","volume":"328","author":"Jobe","year":"1993","journal-title":"N Engl J Med"},{"issue":"4","key":"2021120900331372500_B3","first-page":"CD000511","article-title":"Prophylactic animal-derived surfactant extract for preventing morbidity and mortality in preterm infants","author":"Soll","year":"1997","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"2021120900331372500_B4","first-page":"CD007836","article-title":"Animal-derived surfactant extract for treatment of respiratory distress syndrome","author":"Seger","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"2021120900331372500_B5","first-page":"CD000510","article-title":"Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants","author":"Soll","year":"2001","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"2021120900331372500_B6","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1542\/peds.79.1.26","article-title":"Is chronic lung disease in low birth weight infants preventable? 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