A descriptive study on the use of bubble CPAP in a level 2 neonatal intensive care unit in Bangalore, India

Abstract

Background: Respiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm infants. An effective way to reduce the incidence of chronic lung injury is to use continuous positive airway pressure (CPAP) and avoid mechanical ventilation. Objective:To assess the effectiveness of bubble CPAP (BCPAP) on immediate outcome of preterm infants with mild to moderate RDS in a level 2 neonatal intensive care unit (NICU) in Bangalore, India.Method: A prospective analytical study was carried out on preterm neonates of gestational age 28 to 36 weeks with mild to moderate RDS admitted to a level 2 NICU in Bangalore, India, from November 2011 to May 2013. Downe score (DS) was used to assess the severity of RDS. Effectiveness of CPAP was judged using DS and fraction of inspired oxygen (FiO2) requirement.Results: BCPAP was effective in 91% of the studied babies. At the start of CPAP 11%, 48% and 41% of babies had DS of 4, 5 and 6 respectively. At 6 hours of CPAP therapy, 56% of the babies had a score of less than 4. At 12 hours of CPAP therapy 89% of babies had a score of 4 or less, only 3% and 8% of the babies having DS of 5 and 6 respectively. Nine percent of the babies persisted in having a FiO2 requirement of 50% or more at 6 and 12 hours of CPAP therapy. BackgroundRespiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm infants 1 . Diagnosis of RDS is based on a chest x-ray consistent with RDS, and response to surfactant therapy 2 . Mechanical ventilation is invasive and can injure the airway and lung parenchyma. An effective way to reduce the incidence of chronic lung injury is the use of continuous positive airway pressure (CPAP) and avoidance of mechanical ventilation 1,3 . Bubble CPAP (BCPAP) prevents alveolar collapse, ensures gas exchange throughout the respiratory cycle and allows lung inflation to be maintained. It can be effectively given through the silastic nasal tubes or nasal prongs which eliminate the need for the endotracheal intubation 4 . CPAP preserves spontaneous breathing, does not require endotracheal intubation and may result in less lung injury than mechanical ventilation 5 . However, not all preterm infants with RDS respond to BCPAP and not all preterm infants with RDS are candidates for initial treatment with CPAP 4,6 .

Efficacy of bubble continous positive airway pressure in newborns with respiratory distress and its outcome in tertiary care hospital, Tirupathi

“…A statistically significant association was found between bubble CPAP success and gestational age. Similar significant association was found with 32-34 weeks in Parasuramappa et al study [13] . This was similar to the findings in Urs et al [14] .…”

“…In the present study the success rates in males and females were 73.50% and 61.50%. Parasuramappa et al study [13] showed a success rate of 61.5% in males & 38.5% in females. In Singh et al, [10] success rates were 55.6% & 4.4% in males and females respectively.…”

“…In the success group, 42.4%, 34.7% and 22.9% of the babies had DS of 4, 5 and 6 respectively at the start of CPAP therapy. In a study conducted by Parasuramappa et al [13] in the success group, ~ 49 ~ 12.1%, 51.6% and 36.3% of the babies had DS of 4, 5 and 6 respectively at the start of CPAP therapy. Among the babies having an initial score of 5, 63.8% and 95.8% showed statistically significant improvement to a score of <4 at 6 hours and 12 hours of CPAP therapy.…”