Cochrane · systematic review · CD001243
Prophylactic or very early initiation of continuous positive airway pressure (CPAP) for preterm infants
Subramaniam, P, Ho, JJ, Davis, PG · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
21
current version
GRADE rated
15
No studies
5
Included studies
NR
No studies 5 · 23.8%Ungraded 1 · 4.8%Very low 3 · 14.3%Low 4 · 19%Moderate 8 · 38.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyProphylactic or very early CPAP compared to supportive care for preventing morbidity and death at any time in preterm infants
Population: preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failed treatment defined as recurrent apnoea, hypoxia, hypercarbia (such as PaCO₂ > 60 mmHg), increasing oxygen requirement, or the need for mechanical ventilation Prophylactic or very early CPAP vs supportive care | RR 0.6 [0.49, 0.74] | 4 studies · 765 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Bronchopulmonary dysplasia at 36 weeks defined as oxygen dependency at 36 weeks postmenstrual age Prophylactic or very early CPAP vs supportive care | RR 0.76 [0.51, 1.14] | 3 studies · 683 participants | Moderate Downgraded: imprecision |
Death at any time Prophylactic or very early CPAP vs supportive care | RR 1.04 [0.56, 1.93] | 4 studies · 765 participants | Moderate Downgraded: imprecision |
Combined outcome of death and bronchopulmonary dysplasia defined as death at any time or oxygen dependency at 36 weeks' postmenstrual age Prophylactic or very early CPAP vs supportive care | RR 0.69 [0.4, 1.19] | 1 study · 256 participants | Low Downgraded: imprecision |
Pulmonary air leak defined as pneumothorax Prophylactic or very early CPAP vs supportive care | RR 0.75 [0.35, 1.16] | 3 studies · 568 participants | Low Downgraded: imprecision |
Intraventricular haemorrhage grade 3 or 4 Prophylactic or very early CPAP vs supportive care | RR 0.96 [0.39, 2.37] | 2 studies · 486 participants | Low Downgraded: imprecision |
Neurodevelopmental impairment Prophylactic or very early CPAP vs supportive care | no estimate extracted | NR | No studies |
Prophylactic CPAP compared to mechanical ventilation for preventing morbidity and death at any time in preterm infants
Population: preterm infants < 37 weeks
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bronchopulmonary dysplasia at 36 weeks defined as oxygen dependency at 36 weeks' postmenstrual age Prophylactic CPAP vs mechanical ventilation | RR 0.89 [0.8, 0.99] | 3 studies · 2150 participants | Moderate Downgraded: imprecision |
Death Death at any time Prophylactic CPAP vs mechanical ventilation | RR 0.82 [0.66, 1.03] | 3 studies · 2358 participants | Moderate Downgraded: imprecision |
Combined outcome of death and bronchopulmonary dysplasia defined as death at any time and oxygen dependency at 36 weeks' postmenstrual age Prophylactic CPAP vs mechanical ventilation | RR 0.89 [0.81, 0.97] | 3 studies · 2358 participants | Moderate Downgraded: imprecision |
Failed treatment defined as the need for mechanical ventilation Prophylactic CPAP vs mechanical ventilation | RR 0.49 [0.45, 0.54] | 2 studies · 1042 participants | Moderate Downgraded: risk of bias |
Pulmonary air leak defined as pneumothorax Prophylactic CPAP vs mechanical ventilation | RR 1.24 [0.91, 1.69] | 3 studies · 2357 participants | Low Downgraded: imprecision, inconsistency |
Intraventricular haemorrhage grade 3 or 4 Prophylactic CPAP vs mechanical ventilation | RR 1.09 [0.86, 1.39] | 3 studies · 2301 participants | Moderate Downgraded: imprecision |
Neurodevelopmental impairment defined as cerebral palsy, developmental delay, intellectual impairment, blindness or sensorineural deafness at 18 to 22 months corrected age Prophylactic CPAP vs mechanical ventilation | RR 0.91 [0.62, 1.32] | 1 study · 976 participants | Moderate Downgraded: imprecision |
Prophylactic CPAP compared to very early CPAP for preventing morbidity and death at any time in preterm infants
Population: preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bronchopulmonary dysplasia at 28 days Prophylactic CPAP vs very early CPAP | RR 0.5 [0.05, 5.27] | 1 study · 72 participants | Very low Downgraded: risk of bias, imprecision |
Failed treatment Prophylactic CPAP vs very early CPAP | no estimate extracted | NR | No studies |
Death at any time (by 28 days) Prophylactic CPAP vs very early CPAP | RR 0.75 [0.29, 1.94] | 1 study · 72 participants | Very low Downgraded: risk of bias, imprecision |
Combined outcome of death and bronchopulmonary dysplasia Prophylactic CPAP vs very early CPAP | no estimate extracted | NR | No studies |
Pulmonary air leak Prophylactic CPAP vs very early CPAP | no estimate extracted | 72 participants | Ungraded |
Intraventricular haemorrhage grade 3 or 4 Prophylactic CPAP vs very early CPAP | no estimate extracted | NR | No studies |
Neurodevelopmental impairment Prophylactic CPAP vs very early CPAP | no estimate extracted | NR | No studies |
Prophylactic CPAP compared to supportive care for preventing morbidity and mortality in very preterm infants
Population: patients with preventing morbidity and mortality in very preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failed Treatment Prophylactic CPAP vs supportive care | RR 0.66 [0.45, 0.98] | 4 studies · 765 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Bronchopulmonary dysplasia at 36 weeks Oxygen dependency at 36 weeks' post‐menstrual age Prophylactic CPAP vs supportive care | RR 0.79 [0.5, 1.24] | 3 studies · 683 participants | Moderate Downgraded: imprecision |
Neonatal death Mortality at any time Prophylactic CPAP vs supportive care | RR 1.04 [0.56, 1.93] | 4 studies · 765 participants | Moderate Downgraded: imprecision |
Death or bronchopulmonary dysplasia Neonatal death at any time or oxygen dependency at 36 weeks' post‐menstrual age Prophylactic CPAP vs supportive care | RR 0.7 [0.41, 1.21] | 1 study · 256 participants | Moderate Downgraded: imprecision |
Pneumothorax Any air leak or pneumothorax Prophylactic CPAP vs supportive care | RR 0.75 [0.34, 1.63] | 3 studies · 568 participants | Moderate Downgraded: imprecision |
IVH grade 3 or 4 Prophylactic CPAP vs supportive care | RR 1.02 [0.3, 3.46] | 2 studies · 486 participants | Moderate Downgraded: imprecision |
Neurodevelopmental outcome Prophylactic CPAP vs supportive care | no estimate extracted | NR | No studies |
Prophylactic CPAP compared to assisted ventilation for preventing morbidity and mortality in very preterm infants
Population: patients with preventing morbidity and mortality in very preterm infants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Bronchopulmonary dysplasia at 36 weeks Oxygen dependency at 36 weeks post‐menstrual age Prophylactic CPAP vs assisted ventilation | RR 0.89 [0.8, 0.99] | 3 studies · 2150 participants | Moderate Downgraded: imprecision |
Neonatal Death Mortality at any time Prophylactic CPAP vs assisted ventilation | RR 0.82 [0.66, 1.03] | 3 studies · 2358 participants | Moderate Downgraded: imprecision |
Death or bronchopulmonary dysplasia Death or oxygen dependency at 36 weeks' post‐menstrual age Prophylactic CPAP vs assisted ventilation | RR 0.89 [0.81, 0.97] | 3 studies · 2358 participants | Moderate Downgraded: imprecision |
Assisted ventilation Need for mechanical ventilation3 Prophylactic CPAP vs assisted ventilation | RR 0.5 [0.42, 0.59] | 2 studies · 1042 participants | Moderate Downgraded: risk of bias |
Pneumothorax Any pneumothorax or air leak Prophylactic CPAP vs assisted ventilation | RR 1.42 [0.68, 2.98] | 3 studies · 2357 participants | Moderate Downgraded: imprecision |
IVH grade 3 or 4 Prophylactic CPAP vs assisted ventilation | RR 0.98 [0.64, 1.5] | 3 studies · 2301 participants | Moderate Downgraded: imprecision |
Neurodevelopmental outcomes ‐ not reported Prophylactic CPAP vs assisted ventilation | no estimate extracted | NR | No studies |