JOURNAL CLUB · ARTICLE OF THE WEEK
Prophylactic CPAP at caesarean birth in late-preterm newborns (PLaNT)
Shah BA, DeShea L, Schmölzer GM, et al. Pediatrics. 2026;158(2):e2025070998. A multicentre, international pilot randomised controlled trial.
IN THEATRE FOR
LATE PRETERMS
No difference in the primary outcome
Duration of respiratory support in the first week did not differ significantly (12.3 vs 21.0 h; mean difference -8.7 h, 95% CI -37.8 to 7.7).
Less support at 30 minutes
Fewer prophylactic-CPAP infants needed respiratory support at 30 minutes (27% vs 47%; OR 0.41, 95% CI 0.2-0.9).
Fewer unplanned NICU admissions
Prophylactic CPAP reduced unplanned NICU admission (OR 0.35, 95% CI 0.1-0.9); in the 35-36 week subgroup, NICU admission was 24% vs 54%.
Safe and feasible
No air leaks and no deaths in either group; 20 minutes of CPAP was deliverable in the operating room.
WHY THIS MATTERS
- Late-preterm infants are about 8% of births but a third need NICU care, usually for respiratory distress
- Caesarean birth multiplies that risk through delayed lung-fluid clearance
- CPAP is cheap and familiar, and may speed lung-fluid clearance and keep alveoli open
- Prophylactic delivery-room CPAP for this group had little RCT evidence
- A simple delivery-room step that avoids a NICU admission matters for babies, families and SCN flow
STRENGTHS
- First RCT of prophylactic CPAP in this specific high-risk group (breathing, late-preterm, caesarean)
- Multicentre and international
- Pragmatic, real-world delivery-room design
- Allocation concealed until the baby was confirmed breathing
- Confirmed safety - no air leaks at 5-6 cm H2O
LIMITATIONS
- A pilot: modest sample (115), underpowered for the primary outcome
- Unblinded - you cannot mask CPAP (performance / detection bias)
- 4 of 5 sites admitted all babies <35 weeks to NICU, so the admission benefit was clearest at 35-36 weeks
- Twins shared an allocation (some clustering)
- Only one pressure and duration tested - the optimal dose is unknown
Practice implications
Late-preterm babies born by caesarean are among the commonest SCN admissions, usually for transient respiratory distress from slow lung-fluid clearance. This pilot shows that giving a spontaneously breathing late-preterm baby 20 minutes of CPAP (5-6 cm H2O) in theatre is safe and feasible, and - while it did not shorten total respiratory support - it roughly halved the need for support at 30 minutes and reduced unplanned NICU admissions, most clearly at 35-36 weeks. It is a low-cost, low-harm intervention that could keep more well-but-borderline babies with their mothers. It is a pilot, not practice-changing on its own; a larger trial is needed before routine adoption. Follow your local delivery-room and CPAP guidelines.
Which late-preterm caesarean babies would you consider prophylactic CPAP for, and which not?
The primary outcome was negative but key secondary outcomes were positive - how do you weigh that in a pilot?
How would reducing unplanned NICU admissions change flow and family experience in your unit?
What pressure, duration and delivery method would you want tested in a larger trial?
Pediatrics 2026 TRIAL: PLaNT
NCT05204719 ATTENDING A BIRTH
Delivery-room support JOURNAL CLUB
Article of the week & archive
Take-home message: In this pilot RCT, 20 minutes of prophylactic CPAP in theatre for spontaneously breathing late-preterm babies born by caesarean was safe and feasible. It did not shorten total respiratory support (the primary outcome), but it reduced the need for support at 30 minutes (27% vs 47%) and unplanned NICU admissions - most clearly at 35-36 weeks. A promising, low-harm delivery-room intervention that now needs a larger trial before routine use.
For educational purposes only. Journal club appraisal - figures paraphrased from the published paper; read the full article for complete data. Always align practice to your local guidelines.