Remarks

• The GDG noted that the evidence on harms (increased pneumothorax) was of uncertain clinical significance and the overall certainty of the body of evidence was low due to imprecision and indirectness.
• The GDG noted that there were limited data on the timing of initiation and duration of CPAP. Based on most of the trials included in the evidence review, the GDG suggests that CPAP may be considered as soon as the diagnosis of respiratory distress syndrome (RDS) is clinically suspected, and that duration should be based on clinical judgement.
• The GDG also noted that CPAP implementation must be done with skilled staff, quality equipment and quality consumables (including humidified blended oxygen–air and monitors).
• The GDG decided not to make a separate recommendation on the timing of CPAP for infants with RDS.