{ "release_id": "fc5a600ec7387e71", "id": "maternal:nasal-cpap", "owner": "maternal", "kind": "technology", "slug": "nasal-cpap", "name": "Continuous positive airway pressure (CPAP) for newborns", "aliases": [ "CPAP" ], "atlases": [ "maternal" ], "summary_plain": "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.", "summary_technical": "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.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-15", "next_review_due": null, "identifiers": [], "navigation": { "maternal": { "life-stage": [ "newborn" ], "care-area": [ "preterm-and-sick-newborn" ] } }, "payload": { "principle": "A continuous pressure of gas gives respiratory support to a baby who breathes spontaneously. In one bubble CPAP system, heated humidified gas reaches the baby through a nasal interface and the pressure comes from an expiratory limb that ends in a water column.", "strengths": [ "In SUPPORT, infants given CPAP less often needed intubation or postnatal corticosteroids for BPD, needed fewer days of mechanical ventilation and were more likely to be alive and free of mechanical ventilation by day 7, compared with intubation and surfactant." ], "limitations": [ "SUPPORT's primary outcome, death or BPD, did not differ significantly between CPAP and surfactant.", "SUPPORT enrolled extremely preterm infants (24 weeks 0 days to 27 weeks 6 days) by gestational age and open-label (registry masking: none); the abstract does not describe the infants as having RDS.", "A published erratum to the SUPPORT CPAP paper was not read." ], "required_infrastructure": [ "A hospital neonatal unit: the one bubble CPAP system whose clearance was read is for use in the hospital clinical environment such as a NICU or PICU, prescribed by a physician." ] }, "content_digest": "23b0d60c84170ebea694e07e76c51bd91ce71a8eb7eb69e94a6205429c07bf8e", "review": { "content_digest": "23b0d60c84170ebea694e07e76c51bd91ce71a8eb7eb69e94a6205429c07bf8e", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "fc5a600ec7387e71", "id": "maternal:claim-support-cpap-vs-surfactant", "owner": "maternal", "subject_entity_id": "maternal:nasal-cpap", "category": "effect", "statement": "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.", "context": { "id": "maternal:ctx-support-infants-24-27w", "label": "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_note": "Extremely preterm infants born at 24 weeks 0 days to 27 weeks 6 days of gestation", "life_stage_terms": { "maternal": [ "newborn" ] }, "gestational_age_min_days": 168, "gestational_age_max_days": 195, "gestational_age_basis": "at_birth", "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "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.", "eligibility": { "inclusion": [ "Infants born between 24 weeks 0 days and 27 weeks 6 days of gestation" ], "exclusion": [] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": "2026-10-15", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, RESULTS sentences 2 to 5 and CONCLUSIONS sentence 1", "applicability_note": "Primary outcome, secondary respiratory outcomes and the authors' conclusion.", "snapshot": { "id": "maternal:pubmed-20472939-2026-10-15", "retrieved_at": "2026-10-15T13:49:22Z", "content_hash": "9fc4e55d5172483fb4c4b81ea1637e4307b7541251313f6a4597626705cb3d6f", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "maternal:pubmed-10-1056-nejmoa0911783", "source_type": "publication", "title": "Early CPAP versus surfactant in extremely preterm infants", "canonical_url": "https://doi.org/10.1056/NEJMoa0911783", "identifiers": [ { "scheme": "doi", "value": "10.1056/NEJMoa0911783", "normalized_value": "10.1056/nejmoa0911783", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "20472939", "normalized_value": "20472939", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC3071534", "normalized_value": "PMC3071534", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2010-05-27", "publisher": "The New England journal of medicine", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. 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