Prophylactic CPAP at Cesarean Birth in Late-Preterm Newborns: A Multicenter RCT.

Abstract

Respiratory distress is a leading cause of admission to neonatal intensive care units (NICUs) among late-preterm (LPT) infants. Our objective was to assess whether prophylactic CPAP provided to breathing LPT infants reduces the duration of respiratory support and to determine safety and feasibility of the intervention. The Prophylactic CPAP at Cesarean Birth for Late Preterm Newborns Trial (PLaNT) was a randomized controlled trial at 5 sites in North and South America. Pregnant mothers expecting an LPT singleton or twins and cesarean delivery were approached. Newborns were randomized to 20 minutes of prophylactic CPAP at 5 to 6 cm H2O initiated within 5 minutes of delivery for spontaneously breathing LPT infants or to standard care (control group). Main outcome measures were duration of respiratory support initiated within the first week and NICU admission. Of 122 enrolled infants from August 2023 to January 2025, 7 were excluded due to screening failures or absence of spontaneous breathing. Among 115 infants, no air leaks or deaths were observed. The groups did not differ in duration of respiratory support initiated within the first week. When compared with those in the control group, infants in the prophylactic CPAP group were significantly less likely to receive respiratory support at 30 minutes (odds ratio [OR], 0.4; 95% CI, 0.2-0.9) or to have unplanned NICU admissions (OR, 0.35; 95% CI, 0.1-0.9). Twenty minutes of prophylactic CPAP in the delivery room was feasible and safe for LPT infants. Although the duration of respiratory support did not reach statistical significance between groups, prophylactic CPAP reduced respiratory support at 30 minutes and unplanned NICU admissions.