The Incubator #386 - đ˘ HOT TOPICS 2025 COVERAGE - 20 minutes of prophylactic CPAP for late preterm infants - The PLANT study
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Dec 8, 2025 
Dr. Edgardo Szyld, a neonatologist and clinical research director at Indiana University, presents groundbreaking insights from the PLANT study. He discusses the high risks of respiratory distress in late preterm infants delivered by cesarean, revealing that 20 minutes of prophylactic CPAP significantly reduces NICU admissions without causing pneumothorax. With plans for a broader PLANT 2 trial across 11 centers, Szyld aims to compare outcomes with and without antenatal steroids, addressing the urgent needs of this overlooked population.
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Late Preterms Drive NICU Burden
- Late preterm infants (34â36+6 weeks) make up ~70% of US preterm births and drive substantial NICU burden.
- Cesarean delivery increases respiratory distress risk about fivefold in this group, magnifying impact.
Evidence Shows Benefit But Flagged Safety Concerns
- Prior meta-analysis suggested prophylactic CPAP reduced respiratory support and NICU admission in late preterms.
- Observational studies raised safety concerns (pneumothorax), but risk of bias limited conclusions.
Focus Trials On Higher-Risk Subgroups
- Target higher-risk subgroups when piloting interventions to increase signal and feasibility.
- Include clear pragmatic eligibility (e.g., late preterm born via C-section) to focus studies on clinically relevant populations.