Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network’s Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks’ gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov: NCT00233324.

Objective To characterize actual achieved patterns of oxygenation in appropriate (AGA) versus small (SGA) for gestational age infants randomized to a lower (85–89%) versus higher (91–95%) oxygen saturation target in the Surfactant, Positive Pressure and Oxygen Trial (SUPPORT). To determine the association between achieved oxygen saturation levels and survival in AGA and SGA infants enrolled in SUPPORT. Study design Median oxygen saturation and intermittent hypoxemia events (<80%, 20sec–5min) were documented in 1054 infants of 24–27 6/7wks gestation while receiving supplemental oxygen during the first three days of life. Results Lower target SGA infants had the lowest oxygen saturation and highest incidence of IH during the first three days of life. The lowest quartile of oxygen saturation (≤92%) during the first three days of life was associated with lower 90 day survival for both AGA and SGA infants. An increased incidence of IH events during the first three days of life was associated with lower 90 day survival only in SGA infants. Conclusion Lower achieved oxygen saturation during the first three days of life was associated with lower 90 day survival in extremely preterm infants. SGA infants had enhanced vulnerability to lower oxygen saturation targets as evidenced by lower achieved oxygen saturation and an association between increased IH events and lower survival.

Objective To test whether infants randomized to a lower oxygen saturation (SpO2) target range while on supplemental oxygen from birth will have better growth velocity from birth to 36 weeks postmenstrual age (PMA), and less growth failure at 36 weeks PMA and 18–22 months corrected age. Study design We evaluated a subgroup of 810 preterm infants from the Surfactant, Positive Pressure, and Oxygenation Randomized Trial, randomized at birth to lower (85–89%, n=402, GA 26 ± 1wk, BW 839 ± 186 g) or higher (91–95%, n=408, GA 26 ± 1wk, BW 840 ± 191 g) SpO2 target ranges. Anthropometric measures were obtained at birth, postnatal days 7, 14, 21, and 28; then at 32 and 36 weeks PMA, and 18–22 months corrected age. Growth velocities were estimated using the exponential method and analyzed using linear mixed models. Poor growth outcome, defined as weight < 10th percentile at 36 weeks PMA and 18–22 months corrected age, was compared across the two treatment groups using robust Poisson regression. Results Growth outcomes including growth at 36 weeks PMA and 18–22 months corrected age, as well as growth velocity were similar in the lower and higher SpO2 target groups. Conclusion Targeting different oxygen saturation ranges between 85% and 95% from birth did not impact growth velocity or reduce growth failure in preterm infants.

IMPORTANCEBoth preterm birth and increased screen time are known to be associated with an increase in risk of developmental and behavioral sequelae. The association between high screen time or a television or computer in the bedroom in early school age and adverse cognitive, executive function, language, and behavior outcomes of extremely preterm children (EPT) is not well understood.OBJECTIVE To assess the association of high screen time with cognition, language, executive function, and behavior of EPT children aged 6 to 7 years; a second objective was to examine the association between high screen time and rates of structured physical activity and weight.