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Subject: BENEFITS OF HIGHER OXYGEN, BREATHING DEVICE PERSIST AFTER INFANCY

U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH
NIH News Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD) <http://www.nichd.nih.gov/> Embargoed for Release:
Wednesday December 26, 2012, 5 p.m. EST

CONTACT: Robert Bock or Marianne Glass Miller, 301-496-5133,
<e-mail:[log in to unmask]>

BENEFITS OF HIGHER OXYGEN, BREATHING DEVICE PERSIST AFTER INFANCY Preterm
infants still better off as toddlers, NIH network study confirms

By the time they reached toddlerhood, very preterm infants originally
treated with higher oxygen levels continued to show benefits when compared
to a group treated with lower oxygen levels, according to a follow-up study
by a research network of the National Institutes of Health that confirms
earlier network findings. Moreover, infants treated with a respiratory
therapy commonly prescribed for adults with obstructive sleep apnea fared as
well as those who received the traditional therapy for infant respiratory
difficulties, the new study found.  

In the original 2010 study
<http://www.nichd.nih.gov/news/releases/pages/051610-preterm-survival.aspx),
of infants born between 24 to 27 weeks of gestation, investigators in the
Neonatal Research Network found:

-- Infants were more likely to survive if they had received higher oxygen
levels, although they were at higher risk of an eye condition that can
impair vision or lead to blindness.

-- Continuous positive airway pressure (CPAP)[
http://www.nhlbi.nih.gov/health/health-topics/topics/cpap/], a treatment
typically reserved for adults with obstructive sleep apnea, was as effective
as standard therapy with a ventilator
<http://www.nhlbi.nih.gov/health/health-topics/topics/vent/> and surfactant
<a sticky substance that coats the inside of the lungs>.

For the current study, the researchers checked on the children's progress,
comparing the groups' survival rates and cognitive and motor development 18
to 22 months after they were originally due to be born.  The re-evaluation
of the original study treatment groups examined: 

-- Children treated with oxygen saturation levels that were either low (85
percent to 89 percent) or high (91 percent to 95 percent). 
 
-- Children treated with CPAP therapy and those treated with a ventilator
and surfactant. 

The researchers compiled the results of their analysis in terms of a
combined primary outcome. This primary outcome took into account two
possibilities: whether an infant either died in the first or second year of
life or had a neurodevelopmental impairment -- any of a number of conditions
affecting the nervous system.  These included cerebral palsy, blindness,
hearing loss or low scores on tests of infant mental and motor development.
The researchers selected this outcome because infants who died before 18
months of age could not be classified as having a neurodevelopmental
impairment.

In terms of the primary outcome, the researchers found no differences
between the groups.

When the researchers looked at outcome measures separately, however, they
did observe differences.  The researchers documented higher survival rates
among children who received oxygen with higher saturation rates.  The
study's original findings showed that survivors in this group also had a
greater risk of developing retinopathy of prematurity
<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002585/>, an eye condition
that can impair vision or cause blindness.  Although those receiving higher
oxygen levels were more likely to have had corrective eye surgery, by the
time the children reached 18 to 22 months corrected age -- their age had
they been born at the approximate time they were due. The researchers found
that there was no difference in the rate of vision problems between the two
groups. 

"CPAP for infants has been available since the 1970s. This is the first
study to compare surfactant treatment to CPAP in a large group of infants,
and these results reassure us that CPAP is as good a choice in the first
hour of life as traditional methods for very preterm babies who need help
breathing," said senior author Rosemary D. Higgins, M.D., of the Pregnancy
and Perinatology Branch of the Eunice Kennedy Shriver National Institute of
Child Health and Human Development (NICHD), one of two NIH institutes
supporting the study.  "We've also confirmed that higher oxygen targets
improve survival and don't appear to threaten survivors' vision in the
longer term."

The study also received funding from the National Heart, Lung and Blood
Institute.

Their findings appear in the New England Journal of Medicine.

The research was conducted at hospitals affiliated with the NICHD-funded
Neonatal Research Network
<http://www.nichd.nih.gov/research/supported/pages/nrn.aspx>.  

More than 1,300 preterm infants born between 2005 and 2009 were included in
the study.  Between 18 and 22 months after the infants' original due date,
researchers assessed whether the children had cerebral palsy
<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001734/> and evaluated their
vision, hearing, physical mobility and cognitive development.  

The researchers found that 60 percent of the children showed typical
physical and cognitive development for their age.

"Although these findings can give delivery room practitioners confidence in
a suitable approach, they can't help predict how these children will grow or
how well they'll do in school," Dr. Higgins said.  "Our group will continue
to monitor the health of a subset of these children through childhood, to
determine if there are any major differences between the groups."

About the Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD): The NICHD sponsors research on development,
before and after birth; maternal, child, and family health; reproductive
biology and population issues; and medical rehabilitation. For more
information, visit the Institute's website at <http://www.nichd.nih.gov/>.  

About the National Institutes of Health (NIH): NIH, the nation's medical
research agency, includes 27 Institutes and Centers and is a component of
the U.S. Department of Health and Human Services. NIH is the primary federal
agency conducting and supporting basic, clinical, and translational medical
research, and is investigating the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and its programs,
visit <www.nih.gov>.

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<http://www.nih.gov/news/health/dec2012/nichd-26.htm>.

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