In 2008, results of the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial suggested that surfactant administration conferred no mortality advantage over continuous positive airway pressure (CPAP); however, a lower target range of oxygen saturation was associated with less severe retinopathy but a higher mortality rate than a higher target range of oxygen saturation. After following the study subjects over time, those results appear to hold.

The original trial involved 1,316 infants born at gestational ages ranging from 24 weeks to 27 weeks and six days. In addition to being randomized to receive either noninvasive CPAP with limited ventilation or intubation with surfactant administration, infants were randomized to one of two target oxygen saturation levels: 85% to 89% or 91% to 95%.

Those infants surviving to 18 to 22 months (corrected age) were evaluated for neurodevelopmental impairments; in the follow-up analysis, the primary study outcome was the combination of impairment at 18 to 22 months or death before the assessment could take place.

Death or neurodevelopmental impairment occurred at similar rates: 28% of those in the CPAP group and 30% in the surfactant group. Similarly, oxygen saturation levels had little effect on the primary outcome, with death or impairment occurring in 30% of the lower saturation group and 28% of the higher saturation group.

As in the first trial, when mortality was considered alone, infants in the lower oxygen saturation group had a significantly higher death rate (22%) than those in the higher oxygen saturation group (18%).

The authors conclude that CPAP is a valid alternative to surfactant administration but that the lower oxygen saturation range (85% to 89%) should not be used as a target.

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