# Continuous positive airway pressure (CPAP) for newborns Technology · id `maternal:nasal-cpap` · Maternal & Newborn Atlas · release `fc5a600ec7387e71` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Also called: CPAP Browse, life stage: Newborn Browse, care area: Preterm and sick newborns ## In plain language Breathing support for a baby who is breathing without a ventilator. A steady gentle pressure of gas is delivered to the baby, in one bubble CPAP system cleared for hospital use through a nasal interface. In the SUPPORT trial, extremely preterm babies started on CPAP in the delivery room were compared with babies who were intubated and given surfactant. ## Technical summary Technology page (the nasal interface rests on the 510(k) summary of one bubble CPAP system; SUPPORT's abstract says CPAP only). SUPPORT: CPAP started in the delivery room, with a protocol-driven limited ventilation strategy afterwards, against intubation and surfactant within 1 hour of birth, in infants of 24 weeks 0 days to 27 weeks 6 days. The primary outcome did not differ. Infants in the CPAP group less often needed intubation or postnatal corticosteroids for BPD and had fewer ventilator days. The SUPPORT CPAP paper has a published erratum that was not read. ## Claims, with the population each applies to ## Context: Extremely preterm infants born at 24 weeks 0 days to 27 weeks 6 days (SUPPORT trial) Recipient: Newborn; Population: 1316 infants born at 24 weeks 0 days to 27 weeks 6 days of gestation were enrolled. They were randomly assigned both to CPAP or intubation with surfactant and to one of two target ranges of oxygen saturation. The abstract does not describe the infants as having respiratory distress syndrome; entry was by gestational age.; Care setting: A randomised multicentre trial run by the SUPPORT Study Group of the NICHD Neonatal Research Network; the abstracts name no wards.; Geography: United States (ClinicalTrials.gov locations); Life stage: Extremely preterm infants born at 24 weeks 0 days to 27 weeks 6 days of gestation; Gestational age: 24 weeks 0 days (168 days) to 27 weeks 6 days (195 days), measured at birth; Postnatal age: Not reported; Follow-up: The CPAP paper's primary outcome was death or bronchopulmonary dysplasia, defined as the need for supplemental oxygen at 36 weeks (with an attempt at withdrawal of oxygen in infants receiving less than 30% oxygen). The oxygen paper's primary outcome was severe retinopathy of prematurity or death before discharge. ### In the SUPPORT trial, infants born at 24 weeks 0 days to 27 weeks 6 days were randomly assigned to CPAP started in the delivery room (followed by a protocol-driven limited ventilation strategy) or to intubation and surfactant within 1 hour of birth. The primary outcome, death or bronchopulmonary dysplasia, did not differ significantly: 47.8% with CPAP and 51.0% with surfactant (relative risk with CPAP 0.95; 95% CI 0.85 to 1.05). Defining BPD as the need for any supplemental oxygen at 36 weeks gave 48.7% and 54.1% (relative risk 0.91; 95% CI 0.83 to 1.01). Infants given CPAP less often needed intubation or postnatal corticosteroids for BPD (P<0.001), needed fewer days of mechanical ventilation (P=0.03) and were more likely to be alive and free from mechanical ventilation by day 7 (P=0.01). The rates of other adverse neonatal outcomes did not differ significantly between the groups. - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Newborn; Population: 1316 infants born at 24 weeks 0 days to 27 weeks 6 days of gestation were enrolled. They were randomly assigned both to CPAP or intubation with surfactant and to one of two target ranges of oxygen saturation. The abstract does not describe the infants as having respiratory distress syndrome; entry was by gestational age.; Care setting: A randomised multicentre trial run by the SUPPORT Study Group of the NICHD Neonatal Research Network; the abstracts name no wards.; Geography: United States (ClinicalTrials.gov locations); Life stage: Extremely preterm infants born at 24 weeks 0 days to 27 weeks 6 days of gestation; Gestational age: 24 weeks 0 days (168 days) to 27 weeks 6 days (195 days), measured at birth; Postnatal age: Not reported; Follow-up: The CPAP paper's primary outcome was death or bronchopulmonary dysplasia, defined as the need for supplemental oxygen at 36 weeks (with an attempt at withdrawal of oxygen in infants receiving less than 30% oxygen). The oxygen paper's primary outcome was severe retinopathy of prematurity or death before discharge. - Limitations: Only the abstract was read. PubMed links a published erratum to this paper (N Engl J Med 2010;362:2235, with no PubMed record); its text was not read, so it is not known whether the correction changes any figure here. The trial was open-label (registry masking: none), enrolled infants by gestational age and not by a diagnosis of respiratory distress syndrome, and used a factorial design in which the same infants were also assigned to oxygen targets (a separate claim). The authors' conclusion is that the results support considering CPAP as an alternative to intubation and surfactant; it is not a finding that CPAP is better on the primary outcome. - Last checked: 2026-10-15 - Source problem: a cited source is corrected. Check the sources before relying on this claim. - Sources: 1. Supports: Early CPAP versus surfactant in extremely preterm infants (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. PubMed links a published erratum (N Engl J Med 2010 Jun 10;362(23):2235, no PubMed record), so the snapshot is marked corrected. The erratum text was not read, so what it changed is not known.) Locator: Abstract, RESULTS sentences 2 to 5 and CONCLUSIONS sentence 1. Retrieved 2026-10-15T13:49:22Z. Source state: Corrected. Snapshot hash: 9fc4e55d5172483fb4c4b81ea1637e4307b7541251313f6a4597626705cb3d6f. How it applies: Primary outcome, secondary respiratory outcomes and the authors' conclusion. 2. Background: Early CPAP versus surfactant in extremely preterm infants (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. PubMed links a published erratum (N Engl J Med 2010 Jun 10;362(23):2235, no PubMed record), so the snapshot is marked corrected. The erratum text was not read, so what it changed is not known.) Locator: Abstract, METHODS sentences 1, 2 and 4. Retrieved 2026-10-15T13:49:22Z. Source state: Corrected. Snapshot hash: 9fc4e55d5172483fb4c4b81ea1637e4307b7541251313f6a4597626705cb3d6f. How it applies: Groups compared, gestational ages and the primary outcome definition. 3. Background: Early CPAP versus surfactant in extremely preterm infants (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. PubMed links a published erratum (N Engl J Med 2010 Jun 10;362(23):2235, no PubMed record), so the snapshot is marked corrected. The erratum text was not read, so what it changed is not known.) Locator: Abstract, BACKGROUND. Retrieved 2026-10-15T13:49:22Z. Source state: Corrected. Snapshot hash: 9fc4e55d5172483fb4c4b81ea1637e4307b7541251313f6a4597626705cb3d6f. How it applies: Why the comparison was made. 4. Background: Surfactant Positive Airway Pressure and Pulse Oximetry Trial (Registry, edition ClinicalTrials.gov API v2 record, last update posted 2019-04-18.) Locator: protocolSection.designModule.designInfo.maskingInfo.masking. Retrieved 2026-10-15T13:49:16Z. Source state: Current. Snapshot hash: 5fdcb0c4642696db1bd7bd6b0c6e5107f70fc1151598abf877d724e89872668a. How it applies: Registry masking value. ## Connected pages - SUPPORT: CPAP against surfactant, primary outcome death or BPD: Bronchopulmonary dysplasia (chronic lung disease of prematurity) (`maternal:bronchopulmonary-dysplasia`) [a claim, not a settled fact; see claim `maternal:claim-support-cpap-vs-surfactant` and its context] - Filed under this front: Newborn support: warmth, breathing, feeding (`maternal:front-newborn-support`) - Used by: Fisher and Paykel Bubble CPAP System (`maternal:fisher-paykel-bubble-cpap`) - Investigated in: SUPPORT trial (CPAP against surfactant; oxygen saturation targets) (`maternal:support-trial`) ## Provenance Content hash: 23b0d60c84170ebea694e07e76c51bd91ce71a8eb7eb69e94a6205429c07bf8e Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-15