468 - Delivery Room CPAP Utilization and Outcomes in Infants ≥35 weeks: A Multicenter Cohort Study from the DRIVE Network

Publication Number: 1450.468

Krista Birnie, Stanford University School of Medicine, Palo Alto, CA, United States; Ruby Gupta, Children's Hospital of Wisconsin, Milwaukee, WI, United States; Nicole T. Spillane, Hackensack University Medical, Bronxville, NY, United States; Elizabeth Awe, Medical College of Wisconsin, Milwaukee, WI, United States; Erwin T. Cabacungan, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI, United States; Sandy Cheung, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Demarest, NJ, United States; Arun Gupta, Stanford University School of Medicine, Palo Alto, CA, United States; Joanna N. Jain, Stanford University School of Medicine, San Jose, CA, United States; Neha S. Joshi, Stanford University School of Medicine, Palo Alto, CA, United States; Sabrina Malik, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States; Joseph Reiter, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Paul Wildenhain, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Adam Frymoyer, Stanford University School of Medicine, San Carlos, CA, United States

Background: The indication for continuous positive airway pressure (CPAP) in the delivery room (DR-CPAP) in late preterm and term infants remains unclear. Notably, there is a significant gap in the literature regarding DR-CPAP utilization and outcomes in this population, underscoring the need for focused research to inform evidence-based best practices around DR-CPAP.

Objective: To describe the epidemiology, disposition, and outcomes in infants ≥ 35 wks gestational age (GA) without congenital anomalies who received only DR-CPAP (i.e. highest level of DR intervention was CPAP).

Design/Methods: Multi-center retrospective cohort study using the Delivery Room Intervention and Evaluation (DRIVE) network. DRIVE, established by the American Academy of Pediatrics, collects data on all infants who received CPAP or more intensive resuscitative interventions in the DR. Twenty-one U.S. hospitals (median [IQR] birth volume 1,845 [540 - 3,361] births/yr) submitted data from January 2023 to February 2025. Infants ≥ 35 wks GA who received only DR-CPAP were included. Those with major congenital anomalies or who received more advanced resuscitation were excluded. Only DR-CPAP utilization among live births was examined including interhospital variation. High variation was defined as a coefficient of variation (CV%) >20%. For infants who received only DR-CPAP, disposition and air leak syndrome (pneumothorax or pneumomediastinum) were assessed. Multivariable logistic regression was performed to investigate predictors of NICU admission.

Results: Among 61,738 infants ≥ 35 wks, 7.2% received only DR-CPAP, with the highest rates in 35- and 36-wk infants (23.6% and 17.3%; Figure 1). Interhospital variation in only DR-CPAP was high (CV% 65%) and seen across all GA groups. The characteristics of infants who received only DR-CPAP (n=4,577) is shown in Table 1. Of only DR-CPAP infants, 58% were admitted to and remained in Well Baby Nursery (WBN) (Figure 2). Predictors of NICU admission in only DR-CPAP infants were late preterm (OR 3.6, p< 0.001), male sex (OR 1.2, p=0.002), max FiO2 >30% (OR 2.2, p< 0.001), and max PEEP ≥ 6 cm H20 (OR 3.1, p< 0.001); mode of delivery was not predictive. Air leak syndrome occurred in 2.2% of only DR-CPAP infants and was more common in 40 and ≥41 wk infants (4.0% and 6.3%, respectively).

Conclusion(s): The use of only DR-CPAP in infants ≥ 35 wks is common with large interhospital variation. The majority of term infants who received only DR-CPAP did not require NICU admission. Development of evidence-based practices around DR-CPAP in late preterm and term infants may help reduce unwanted variation.

Table 1
Characteristics of Infants ≥35 weeks who received only DR-CPAP (n=4,577).

Figure 1
Percentage of infants ≥ 35 weeks who received only DR-CPAP by gestational age. Data represent 61,738 births across n=21 United States hospitals in the DRIVE network.

Figure 2
Disposition of infants ≥ 35 weeks who received only DR-CPAP by gestational age. Data represent n=4,577 infants whose highest level of delivery room intervention was CPAP across n=21 United States hospitals in the DRIVE network.