Continuous positive airway pressure for term and ≥34+0 weeks' gestation newborns at birth: A systematic review

Abstract

Background: Respiratory distress is common during transition after birth, but the effect of continuous positive airway pressure applied in the delivery room has not been systematically evaluated in spontaneously breathing term and ≥34⁺⁰ weeks' gestation infants.We aimed to compare delivery room continuous positive airway pressure with no delivery room continuous positive airway pressure for term and ≥34⁺⁰ weeks' gestation newborn infants at birth.

Methods: Information sources: Medline, Embase, Cochrane Databases, Database of Abstracts of Reviews of Effects, and Cumulative Index to Nursing and Allied Health Literature. The Databases were last searched in October 2021.Eligibility criteria: Randomized, quasi-randomized, interrupted time series, controlled before-after, and cohort studies with English abstracts.Synthesis of results: Two authors independently extracted data, assessed risk of bias, and certainty of evidence. The main outcome was admission to the neonatal intensive care unit (NICU) or higher level of care receiving any positive pressure support. Data were pooled using fixed effects models.Risk of bias: Was assessed using the Cochrane Risk of Bias Tool for randomized trials and the Non-Randomized Studies of Interventions Tool (ROBINS-I) for observational studies.

Results: In this meta-analysis, two randomized control trials (323 newborns delivered by cesarean section) showed that delivery room continuous positive airway pressure decreased the likelihood of NICU admission (risk ratio (RR) 95% confidence interval (CI) 0.27 (0.11-0.66), p < 0.005) and NICU respiratory support (RR (95% CI) 0.18 (0.05-0.60), p = 0.005) when compared with no delivery room continuous positive airway pressure. However, in two before-after studies (8,476 newborns), delivery room continuous positive airway pressure use was associated with an increased risk of air leak syndrome when compared with no delivery room continuous positive airway pressure.

Discussion: Certainty of evidence was very low for all outcomes. Among term and ≥34⁺⁰ weeks' gestation infants having or at risk of having respiratory distress, there is insufficient evidence to suggest for or against routine use of continuous positive airway pressure in the delivery room.Funding: No Funding has been received to conduct this study.Clinical Trial Registration: This systematic review has been registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/prospero/) [identifier: CRD42021225812].

Keywords: At-risk; CI, confidence interval; CPAP, Continuous Positive Airway Pressure; GRADE, Grading of Recommendations, Assessment, Development and Evaluation; ILCOR, International Liaison Committee on Resuscitation; Infant neonates; Late preterm; MD, mean difference; Meta-analysis; NICU, neonatal intensive care unit; NNT, number needed to treat; PEEP, positive end expiratory pressure; PICO, population, intervention, comparison, outcome; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses; RCT, randomized controlled trial; RR, risk ratio; Respiratory distress; Spontaneously breathing; Stabilization; Term; Transition after birth.

Fig. 1

PRISMA flow diagram of study selection.

Fig. 2

Summary of Results from Randomized Controlled Trials: Continuous Positive Airway Pressure (CPAP) compared with no CPAP in labor and delivery room among term and late preterm newly born infants born by cesarean delivery with or without respiratory distress. (A) neonatal intensive care unit (NICU) admissions. (B) NICU respiratory support. (C) pulmonary air-leak syndromes. (D) death prior to hospital discharge. Abbreviations: M−H = Mantel-Haenszel method; IV = Inverse Variance method; Fixed = fixed effects; CI = confidence intervals; CPAP = continuous positive airway pressure.

Fig. 3

Summary of Results from Observational Studies: Continuous Positive Airway Pressure (CPAP) compared with no CPAP in labor and delivery room among term and late preterm newly born infants with respiratory distress: pulmonary air-leak syndromes. Abbreviations: M−H = Mantel-Haenszel method; IV = Inverse Variance method; Fixed = fixed effects; CI = confidence intervals; CPAP = continuous positive airway pressure.