In very preterm infants, prophylactic nasal continuous positive airway pressure (CPAP) may reduce the incidence of bronchopulmonary dysplasia (BPD) compared with mechanical ventilation, according to findings from a review study published in the Cochrane Database of Systematic Reviews.
The review included 8 randomized controlled trials in the Cochrane Central Register of Controlled Trials and MEDLINE. In total, these studies included a pooled cohort of 3201 preterm infants (<37 weeks of gestation). Researchers included only trials that compared prophylactic nasal CPAP, initiated within the first 15 minutes of life, or very early nasal CPAP, initiated within the first hour of life, with supportive care such as supplemental oxygen therapy, standard nasal cannula, or mechanical ventilation.
A total of 4 trials compared CPAP with supportive care (n=765), 3 trials compared CPAP with mechanical ventilation (n=2364), and 1 trial compared prophylactic CPAP with very early CPAP (n=72).
According to the investigators, treatment with CPAP potentially reduced BPD at 36 weeks compared with supportive care (risk ratio [RR], 0.76; 95% CI, 0.51-1.14) according to 3 studies (n=683) and based on moderate certainty-evidence. However, prophylactic CPAP may have had little to no difference in death across 4 studies (n=765) with moderate-certainty evidence (RR, 1.04; 95% CI, 0.56-1.93). Low-certainty evidence suggested that prophylactic CPAP may reduce a composite outcome of death or BPD (RR, 0.69; 95% CI, 0.40-1.19).
Across 3 studies with 2150 infants, there was moderate-certainty evidence suggesting a probable reduction in the incidence of BPD at 36 weeks with prophylactic or very early CPAP compared with mechanical ventilation (RR, 0.89; 95% CI, 0.8-0.99). Additionally, there was probably a reduction in death or BPD with CPAP compared with mechanical ventilation (RR, 0.89; 95% CI, 0.81-0.97). Additionally, there was probably a reduction in the need for mechanical ventilation with prophylactic or very early CPAP (RR, 0.49; 95% CI, 0.45-0.54).
The researchers noted that there was limited evidence on CPAP compared with supportive care or prophylactic CPAP compared with very early CPAP. The investigators added that there is also “an urgent need to evaluate the cost and effectiveness of prophylactic or very early CPAP in both low- and lower-middle-income settings where surfactant therapy is limited.”
Subramaniam P, Ho JJ, Davis PG. Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants. Cochrane Database Syst Rev. 2021;10(10):CD001243. doi:10.1002/14651858.CD001243.pub4