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August 2015

CPAP, Surfactant, or Both for the Preterm InfantResolving the Dilemma

Author Affiliations
  • 1Department of Paediatrics, Royal Hobart Hospital, Hobart, Australia
  • 2Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
JAMA Pediatr. 2015;169(8):715-717. doi:10.1001/jamapediatrics.2015.0909

He is not a bad helmsman who can steer a course between Scylla and Charybdis….


For preterm infants of less than 30 weeks’ gestation, it is now well accepted that respiratory support with nasal continuous positive airway pressure (CPAP) is a viable alternative to routine intubation at the start of life. Other than for advanced resuscitation, intubation in the delivery room appears to offer little advantage for the group as a whole and exposes the vulnerable lung to a form of barotrauma for which it is ill prepared structurally and biochemically. Recent position statements have recommended that early CPAP, without prior surfactant therapy, should be considered as an alternative to intubation in the delivery room in extremely preterm infants.1,2

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