BCPAP has higher success rate than VCPAP for managing preterm neonates with early onset respiratory distress, with comparable safety.

ELBW babies have a major contribution to mortality in a NICU. Babies with birth weight <750 g and gestation <28 wk have poor survival. RDS, pulmonary hemorrhage, IVH and sepsis are the common causes of death while RDS, sepsis and hyperbilirubinemia are the most common morbidities.

SummaryBackground: Bubble continuous positive airway pressure (BCPAP) is a low-cost nasal CPAP delivery system with potential benefits for developing nations. The objective of the study was to compare the efficacy and safety of BCPAP with ventilator CPAP (VCPAP) in preterm neonates with moderate respiratory distress. Methods: In a pilot randomized controlled trial, 30 preterm neonates (gestation <37 weeks) with Silverman-Anderson score between 5 to 7 and oxygen requirement >30% within first 6 h of life were randomly allocated to BCPAP or VCPAP after informed parental consent. Proportion of neonates with success or failure, while using the allocated mode of CPAP delivery (primary outcome) was compared. Results: The success rate was comparable [VCPAP: 80% (12/15) vs. BCPAP: 87% (13/15)] between the two groups. Dislodgement was commonest problem with equal frequency [10/15, (67%)] in each group. Conclusion: BCPAP appears to be a promising method of CPAP delivery in preterm neonates with moderate respiratory distress.

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Survival of preterm neonates in developing world has improved. Developing countries lag behind in nutritional management in NICU especially parenteral nutrition (PN). This randomized controlled trial was done to evaluate the effect of aggressive parenteral nutrition on nitrogen retention of sick VLBW and extremely low birth weight (ELBW) babies. From September 2009 to February 2010, total 34 babies were randomized to receive aggressive parenteral nutrition (APN)(n=17) or standard parenteral nutrition (SPN) (n=17). The average daily total and PN calory intake of babies in APN group was significantly higher during first week. APN was well-tolerated; however, nitrogen retention was not significantly higher in APN group. Aggressive parenteral nutrition in sick VLBW babies is feasible in developing world, though it did not improve nitrogen retention in first week of life.