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High versus low PEEP in the delivery room: a preimplementation and postimplementation cohort study.

Kriszta Molnar1, Jule Broghammer2, Paul-Philipp Warth2

  • 1Department of Neonatology, University Children's Hospital, Tübingen University Hospital, Tübingen, Germany kriszta.molnar@med.uni-tuebingen.de.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|June 29, 2026
PubMed
Summary

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This summary is machine-generated.

Higher positive end-expiratory pressure (PEEP) in preterm infants may improve outcomes. A PEEP of 10 cmH2O was associated with fewer respiratory complications compared to 6 cmH2O.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Pediatric Critical Care

Background:

  • Optimal positive end-expiratory pressure (PEEP) for preterm infants immediately after birth remains undetermined.
  • Establishing appropriate initial PEEP is crucial for lung aeration and preventing respiratory complications in premature neonates.

Purpose of the Study:

  • To investigate the impact of two initial PEEP levels (10 cmH2O vs. 6 cmH2O) on short- and long-term outcomes in preterm infants.
  • To evaluate the influence of early postnatal PEEP on respiratory support needs and morbidities.

Main Methods:

  • Retrospective analysis of preterm infants (gestational age <32 weeks) between 2015-2023.
  • Comparison of infants receiving high PEEP (10 cmH2O) versus low PEEP (6 cmH2O) based on a protocol change in 2019.
Keywords:
Intensive Care Units, NeonatalNeonatology

Related Experiment Videos

  • Inclusion of 718 infants with a median gestational age of 29 weeks.

    • Main Results:

    • No significant difference in the SpO2/FiO2 ratio at 5 minutes between groups.
    • Infants receiving low PEEP required less-invasive surfactant administration and had longer non-invasive ventilation durations.
    • Low PEEP was associated with increased risk of intubation within 72 hours, bronchopulmonary dysplasia, and retinopathy of prematurity.

    Conclusions:

    • Higher initial PEEP (10 cmH2O) may offer benefits in reducing short- and long-term adverse outcomes in preterm infants.
    • The findings suggest a potential advantage of higher PEEP for neonatal respiratory support.
    • Randomized controlled trials are necessary to confirm the efficacy of higher PEEP levels.