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Updated: Jul 3, 2026
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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
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.
Summary
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.
- 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.
