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Updated: Aug 5, 2026

The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
Association Between Delivery Room Continuous Positive Airway Pressure and Neonatal Outcomes in Late Preterm and Term
Yoxin Chin1, Maclean Hill1, Arun Sett1,2,3
1Newborn Services, Joan Kirner Women's and Children's Hospital, Melbourne, Victoria, Australia.
Objective:
To explore the effects of delivery room continuous positive airway pressure (DR-CPAP) in late preterm and term infants.
Design:
Systematic review and meta-analysis.
Data Sources:
Cochrane Library, Embase, Emcare and MEDLINE were searched through March 26, 2025.
Eligibility Criteria:
Observational studies and randomised clinical trials (RCTs) comparing outcomes in infants receiving DR-CPAP versus no DR-CPAP.
Methods:
Meta-analyses were conducted using a random-effects model to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Risk of bias was assessed per Cochrane guidelines, and certainty of evidence was graded using the GRADE framework.
Main Outcome:
Pneumothorax.
Results:
Seven studies (five non-randomised, two RCTs) involving 135 472 infants were included. In observational data, DR-CPAP was associated with a significant increased risk of pneumothorax (unadjusted OR: 45.79; 95% CI: 31.47-66.63; moderate certainty; adjusted OR: 24.18; 95% CI: 2.32-251.63; moderate certainty). RCTs reported no pneumothorax events in both groups, preventing meta-analytic estimation. DR-CPAP was also associated with increased use of surfactant in observational studies (OR: 5.68; 95% CI: 2.97-10.86; very low certainty). For neonatal intensive care unit admissions, DR-CPAP was associated with significantly higher odds in observational studies (OR: 14.56; 95% CI: 13.27-15.98; moderate certainty), but significantly lower odds in RCTs (OR: 0.24; 95% CI: 0.09-0.63; very low certainty).
Conclusions:
DR-CPAP was associated with potential harm in observational studies, though confounding cannot be excluded. Evidence from RCTs remains limited, and is of very low certainty. Well-designed, robust clinical studies are urgently needed to guide practice.
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