Continuous positive airway pressure (CPAP) for newborns

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.

Also called CPAP

Technology
In this atlas

Overview

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.

How it works

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.

Claims and evidence

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.

Eligibility: 1 inclusion criterion; exclusion criteria not stated

Included: Infants born between 24 weeks 0 days and 27 weeks 6 days of gestation
Excluded: None stated

Effect Interventional Certainty not assessed

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.

Source problem. A cited source is corrected. Check the sources before relying on this claim.
Applies to Newborn
- 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.
- A randomised multicentre trial run by the SUPPORT Study Group of the NICHD Neonatal Research Network; the abstracts name no wards.
- United States (ClinicalTrials.gov locations)
- Extremely preterm infants born at 24 weeks 0 days to 27 weeks 6 days of gestation
- Gestational age 24 weeks 0 days to 27 weeks 6 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.
Certainty method
Not assessed

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

Next evidence check due
Not scheduled
Sources and citations (4)
1. Supports Early CPAP versus surfactant in extremely preterm infants
  
  Publication · The New England journal of medicine · 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. · Published 2010-05-27 · DOI: 10.1056/NEJMoa0911783 · PMID: 20472939 · PMCID: PMC3071534
  
  Locator
  Abstract, RESULTS sentences 2 to 5 and CONCLUSIONS sentence 1
  
  How it applies
  Primary outcome, secondary respiratory outcomes and the authors' conclusion.
  
  Retrieved
  2026-10-15T13:49:22Z
  
  Source effective date
  Not reported
  
  Source state
  Corrected
  
  Snapshot hash
  9fc4e55d5172483fb4c4b81ea1637e4307b7541251313f6a4597626705cb3d6f
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Background Early CPAP versus surfactant in extremely preterm infants
  
  Publication · The New England journal of medicine · 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. · Published 2010-05-27 · DOI: 10.1056/NEJMoa0911783 · PMID: 20472939 · PMCID: PMC3071534
  
  Locator
  Abstract, METHODS sentences 1, 2 and 4
  
  How it applies
  Groups compared, gestational ages and the primary outcome definition.
  
  Retrieved
  2026-10-15T13:49:22Z
  
  Source effective date
  Not reported
  
  Source state
  Corrected
  
  Snapshot hash
  9fc4e55d5172483fb4c4b81ea1637e4307b7541251313f6a4597626705cb3d6f
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Background Early CPAP versus surfactant in extremely preterm infants
  
  Publication · The New England journal of medicine · 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. · Published 2010-05-27 · DOI: 10.1056/NEJMoa0911783 · PMID: 20472939 · PMCID: PMC3071534
  
  Locator
  Abstract, BACKGROUND
  
  How it applies
  Why the comparison was made.
  
  Retrieved
  2026-10-15T13:49:22Z
  
  Source effective date
  Not reported
  
  Source state
  Corrected
  
  Snapshot hash
  9fc4e55d5172483fb4c4b81ea1637e4307b7541251313f6a4597626705cb3d6f
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
4. Background Surfactant Positive Airway Pressure and Pulse Oximetry Trial
  
  Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition ClinicalTrials.gov API v2 record, last update posted 2019-04-18. · NCT: NCT00233324
  
  Locator
  protocolSection.designModule.designInfo.maskingInfo.masking
  
  How it applies
  Registry masking value.
  
  Retrieved
  2026-10-15T13:49:16Z
  
  Source effective date
  2019-04-18
  
  Source state
  Current
  
  Snapshot hash
  5fdcb0c4642696db1bd7bd6b0c6e5107f70fc1151598abf877d724e89872668a
  
  Reuse basis
  Registry record. The raw API JSON is committed. The ClinicalTrials.gov terms page is rendered by JavaScript and its text was not read by a script, so the redistribution basis is unverified; any quotation stays short. The raw file is committed at research/snapshots/mn-ctgov-NCT00233324.json.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact SUPPORT: CPAP against surfactant, primary outcome death or BPD: Bronchopulmonary dysplasia (chronic lung disease of prematurity) (Evaluated for)
Applies to Newborn
- 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.
- A randomised multicentre trial run by the SUPPORT Study Group of the NICHD Neonatal Research Network; the abstracts name no wards.
- United States (ClinicalTrials.gov locations)
- Extremely preterm infants born at 24 weeks 0 days to 27 weeks 6 days of gestation
- Gestational age 24 weeks 0 days to 27 weeks 6 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.
Source problem. A cited source is corrected. Check the sources before relying on this claim.
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.

Record details

Record id: maternal:nasal-cpap
Content hash: 23b0d60c84170ebea694e07e76c51bd91ce71a8eb7eb69e94a6205429c07bf8e