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


METHODS
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.
Departments of Pediatrics, AIIMS Jodhpur; *PGIMER, Chandigarh; Fernandez Hospital Hyderabad and AIIMS, New Delhi, India. Correspondence to: Dr Praveen Kumar, Professor, Neonatal Unit, Department of Pediatrics, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160 012, India. drpkumarpgi@gmail.com.
Neeraj
N
Gupta
Shiv Sajan
SS
Saini
Srinivas
S
Murki
Praveen
P
Kumar
Ashok
A
Deorari
D045422:Continuous Positive Airway Pressure; D003906:Developing Countries; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control / Q000628:therapy