Key messages
We did not find any study that compared CPAP with supportive care for apnoea of prematurity.
We found four studies comparing one type of CPAP to another. The studies were small and the care given by healthcare workers may have been influenced by knowing which treatment the baby was receiving. Therefore, we don’t know from these studies whether there is any difference between different types of CPAP for reducing apnoea in babies born too early.
What is apnoea of prematurity?
Babies born early (preterm) may experience prolonged pauses in their breathing. In a baby born too early, we call such pauses apnoea of prematurity. Apnoea may be due to immaturity of the mechanisms controlling breathing or to weakness of the muscles that keep their airway open during breathing. In severe apnoea the baby’s heart rate will slow and there will be a drop in the level of oxygen. If this happens too often it may affect the baby’s brain development. When babies have apnoea, supportive care is usually given. This may be in the form of stimulation, by stroking the baby or moving their limbs, providing oxygen, or both.
What is CPAP?
Continuous positive airway pressure (CPAP) is a form of breathing support, often referred to as a type of non-invasive ventilation. The continuous pressure is applied usually through a nose piece, allowing the baby to continue to breathe by themselves but making breathing easier. This is probably because the positive pressure that is applied helps to keep the airway open.
What did we want to find out?
We wanted to find out whether using CPAP in preterm babies might reduce apnoea or the need for a more invasive form of treatment such as mechanical ventilation, i.e. using a machine to do the breathing for the baby. We also wanted to know whether any particular method of applying CPAP was more effective.
What did we do?
We searched for studies that included preterm babies where the researchers thought CPAP was necessary for apnoea of prematurity. We included studies that compared CPAP with supportive care (such as stimulation, oxygen, or both) or studies that compared different types of CPAP.
What did we find?
We did not find any studies that compared CPAP with supportive care. We found four small studies, involving 138 babies. They compared two different forms of CPAP. There were three comparisons with only one study in each comparison and one study did not provide any useful data. The duration of CPAP in the four studies was between 4 and 48 hours. From these four studies, we do not know whether there is any difference between different forms of CPAP. This is because each comparison had only one study, the results were very imprecise because the studies were small, and the care given by the healthcare workers might have been influenced by their awareness of which treatment the baby was receiving.
How up-to-date is the evidence?
The evidence is up-to-date to 6 September 2022.
