Continuous positive airway pressure in preterm neonates: an update of current evidence and implications for developing countries.

CONTEXT Continuous Positive Airway Pressure (CPAP) is a cost-effective and minimal invasive respiratory support for the newborn. OBJECTIVE To review the evidence related to various aspects of CPAP usage and its applicability for developing countries. EVIDENCE ACQUISITION We conducted a literature search on PubMed, CENTRAL, and Cochrane Database of Systematic Reviews using the terms CPAP OR continuous positive airway pressure OR, non-invasive ventilation AND newborn OR neonate OR infant. We also searched the reference lists from the above articles and of review articles. Extracted manuscripts and reviews were analyzed and results related to various aspects of CPAP usage were summarized in narrative form. RESULTS Early use of CPAP with early rescue surfactant (InSurE) is the ideal approach for management of respiratory distress syndrome in preterm and extremely preterm infants. Delivery room CPAP is feasible and reduces the need for surfactant and mechanical ventilation by nearly 50%. Prophylactic surfactant for extreme preterms should be discouraged. Heated humidified high flow nasal cannula is best utilized for post-extubation respiratory support. The search for ideal interface still continues and binasal prongs or nasal masks are the good contenders. Evidence on the ideal CPAP delivery is still inconclusive. CONCLUSIONS CPAP, if used early and judiciously, is an effective intervention and need immediate scaling-up in resource-limited settings. Future research should focus on the ideal interface and the CPAP delivery methods.