Association Between Delivery Room Continuous Positive Airway Pressure and Neonatal Outcomes in Late Preterm and Term Infants: A Systematic Review and Meta-Analysis

Abstract

Objective

To explore the effects of delivery room continuous positive airway pressure (DR-CPAP) in late preterm and term infants.

Design

Systematic review and meta-analysis.

Data Sources

Cochrane Library, Embase, Emcare and MEDLINE were searched through March 26, 2025.

Eligibility Criteria

Observational studies and randomised clinical trials (RCTs) comparing outcomes in infants receiving DR-CPAP versus no DR-CPAP.

Methods

Meta-analyses were conducted using a random-effects model to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Risk of bias was assessed per Cochrane guidelines, and certainty of evidence was graded using the GRADE framework.

Main Outcome

Pneumothorax.

Results

Seven studies (five non-randomised, two RCTs) involving 135 472 infants were included. In observational data, DR-CPAP was associated with a significant increased risk of pneumothorax (unadjusted OR: 45.79; 95% CI: 31.47–66.63; moderate certainty; adjusted OR: 24.18; 95% CI: 2.32–251.63; moderate certainty). RCTs reported no pneumothorax events in both groups, preventing meta-analytic estimation. DR-CPAP was also associated with increased use of surfactant in observational studies (OR: 5.68; 95% CI: 2.97–10.86; very low certainty). For neonatal intensive care unit admissions, DR-CPAP was associated with significantly higher odds in observational studies (OR: 14.56; 95% CI: 13.27–15.98; moderate certainty), but significantly lower odds in RCTs (OR: 0.24; 95% CI: 0.09–0.63; very low certainty).

Conclusions

DR-CPAP was associated with potential harm in observational studies, though confounding cannot be excluded. Evidence from RCTs remains limited, and is of very low certainty. Well-designed, robust clinical studies are urgently needed to guide practice.