Abstract: ObjectiveTo systematically evaluate the risk factors of failure of continuous positive pressure ventilation (CPAP) for premature infants and its effect on the outcome of premature infants. MethodsPubMed, EMBASE, The Cochrane library, CBM, CNKI, Wanfang and VIP were selected to search the analysis of the causes of failure of CPAP treatment for premature infants and the influence of failure of CPAP treatment on the outcome of premature infants from initiation establishment of database to April 1st 2019. The quality of the included studies were assessed. Statistical analysis was performed employing Rev Man 5.3. Effects were expressed by odds ratio (OR), standardized mean difference (SMD) and 95%CI for categorical variables. ResultsOnly 10 trials with 13,075 cases were included. The risk factors (gestational age, birth weight, antenatal steroids, plurality, men, PEEP, FiO2, RDS ) of the OR/SMD and 95% CI were distributed as follows: -0.83（-1.10,-0.55）, -0.97（-1.39，-0.55）, 0.83（0.76,0.90）, 0.88（0.79,0.98）, 1.29（1.19,1.40）, 0.96（0.54,1.38）, 7.6（3.93,11.26）, 5.94（3.55，9.94）and P<0.05. The difference of other risk factors had no statistically significance. The outcomes of the OR/SMD and 95%CI were distributed as follows: 5.07(3.66, 7.01), 3.99(3.50, 4.55), 11.32（1.74,73.69）, 2.25（1.54,3.27）, 2.42（1.78,3.29）, 3.64（2.58,5.15）and P<0.05. ConclusionThe low gestational age, low birth weight, plurality, men, PEEP, FiO2, RDS are risk factors for CPAP failure, and antenatal steroids is a protective factor for it. Failure of CPAP treatment will lead to the increase of premature infant mortality, BPD, pneumothorax, ROP, NEC and IVH.