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Prophylactic CPAP at Cesarean Birth in Late-Preterm Newborns: A Multicenter RCT
Birju A Shah1, Lise DeShea1, Georg M Schmölzer2
1Divison of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health College of Medicine, Oklahoma City, Oklahoma.
Insights
Prophylactic CPAP in the delivery room is safe for late-preterm infants. This intervention reduced respiratory support needs at 30 minutes and unplanned NICU admissions, though overall support duration did not significantly differ.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Clinical Trials
Background:
- Late-preterm (LPT) infants frequently require neonatal intensive care unit (NICU) admission due to respiratory distress.
- Assessing interventions to reduce respiratory support needs in LPT infants is crucial.
Purpose of the Study:
- To evaluate if prophylactic continuous positive airway pressure (CPAP) reduces respiratory support duration in LPT infants.
- To determine the safety and feasibility of prophylactic CPAP in this population.
Main Methods:
- A randomized controlled trial (PLaNT) involving LPT infants born via cesarean delivery.
- Infants were randomized to 20 minutes of prophylactic CPAP or standard care.
- Primary outcomes included duration of respiratory support and NICU admission.
Main Results:
- No deaths or air leaks were observed in the 115 analyzed infants.
- Prophylactic CPAP significantly reduced respiratory support at 30 minutes (OR, 0.4) and unplanned NICU admissions (OR, 0.35).
- No significant difference was found in the overall duration of respiratory support initiated within the first week.
Conclusions:
- Twenty minutes of prophylactic CPAP is a feasible and safe intervention for LPT infants.
- The intervention shows promise in reducing early respiratory support needs and NICU admissions.
- Further research may explore optimal CPAP duration and settings for LPT infants.
Background:
Respiratory distress is a leading cause of admission to neonatal intensive care units (NICUs) among late-preterm (LPT) infants. Our objective was to assess whether prophylactic CPAP provided to breathing LPT infants reduces the duration of respiratory support and to determine safety and feasibility of the intervention.
Methods:
The Prophylactic CPAP at Cesarean Birth for Late Preterm Newborns Trial (PLaNT) was a randomized controlled trial at 5 sites in North and South America. Pregnant mothers expecting an LPT singleton or twins and cesarean delivery were approached. Newborns were randomized to 20 minutes of prophylactic CPAP at 5 to 6 cm H2O initiated within 5 minutes of delivery for spontaneously breathing LPT infants or to standard care (control group). Main outcome measures were duration of respiratory support initiated within the first week and NICU admission.
Results:
Of 122 enrolled infants from August 2023 to January 2025, 7 were excluded due to screening failures or absence of spontaneous breathing. Among 115 infants, no air leaks or deaths were observed. The groups did not differ in duration of respiratory support initiated within the first week. When compared with those in the control group, infants in the prophylactic CPAP group were significantly less likely to receive respiratory support at 30 minutes (odds ratio [OR], 0.4; 95% CI, 0.2-0.9) or to have unplanned NICU admissions (OR, 0.35; 95% CI, 0.1-0.9).
Conclusions:
Twenty minutes of prophylactic CPAP in the delivery room was feasible and safe for LPT infants. Although the duration of respiratory support did not reach statistical significance between groups, prophylactic CPAP reduced respiratory support at 30 minutes and unplanned NICU admissions.
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