Positive End-Expiratory Pressure (PEEP) Levels during Resuscitation of Preterm Infants at Birth (The POLAR Trial).

Extremely premature babies — born between 23 and 28 weeks of pregnancy — need immediate breathing support at birth because their lungs are far too immature to breathe on their own. One of the first tools doctors use is CPAP (Continuous Positive Airway Pressure), which delivers a continuous gentle pressure through a mask to help keep tiny airways open. The right amount of this pressure — not too little to be ineffective, not too much to cause harm — is not yet well established. Current guidelines suggest using a CPAP pressure of 5 to 6 centimetres of water, but growing evidence suggests that higher pressures (8 to 10 cm) may be more effective immediately after birth when the lungs are at their most collapsed. The POLAR Trial randomly assigns very preterm babies to either the standard pressure or a higher, individualised pressure strategy, and measures which approach leads to better survival without serious lung complications and less need for full mechanical ventilation in the first three days of life. This trial involves babies born between 23 weeks and 28 weeks and 6 days who need respiratory support at birth. Babies with major congenital abnormalities, known lung conditions such as severe pulmonary hypoplasia, or whose families have chosen palliative rather than intensive care are not eligible. The study takes place in neonatal intensive care units across multiple hospitals and involves no extra procedures beyond standard resuscitation care.