Outcome of premature babies with RDS using bubble CPAP

Abstract

Background: Respiratory distress syndrome (RDS) contributes significantly to mortality and morbidity. Continuous positive airway pressure (CPAP), when applied to premature infants with RDS, re-expands collapsed alveoli, splints the airway, reduces work of breathing and improves the respiration. Objectives: To ascertain the immediate outcome of preterm infants with RDS on Bubble CPAP and identify risk factors associated with its failure.Methods: This was a prospective analytical study and inborn preterm infants (gestation 28 to 34 weeks) admitted to the NICU with RDS were included in the study. All the spontaneously breathing infants were stared on bubble CPAP and different variables were recorded. Those in whom CPAP failed were given surfactant and mechanical ventilation.Results: 170 neonates were enrolled in the study. 52 (30.5%) babies failed CPAP. The predictors of failure were; partial or no response to Antenatal Steroids (ANS), white-out on the chest X-ray, Silverman Anderson scoring >6 or FiO2 > 0.4 after 15-20 minutes of CPAP, extreme prematurity. Other maternal and neonatal variables did not influence the need for ventilation. Rates of mortality and duration of oxygen requirement was significantly higher in babies who failed CPAP. No baby had chronic lung disease.Conclusions: Infants with no or partial exposure to antenatal steroids, white-out chest X-ray and those with higher FiO2 requirement after initial stabilization on CPAP are at high risk of CPAP failure (needing mechanical ventilation). Bubble CPAP is safe for preterm infants with RDS; it decreases need of surfactant and mechanical ventilation.

Predictor Factors of Continuous Positive Airway Pressure Failure in Preterm Infants with Respiratory Distress

“…The greater proportion of gestational age made this variable an insignificant predictor. This finding was different from that in the study by Koti et al, 3 Pillai et al, 9 and Arora et al, 7 which claimed no antenatal steroid was proven to be a predictor of nasal CPAP failure. Based on standard operating procedures in the Department of Obstetrics and Gynecology of Dr. Sardjito Hospital, women with gestational age 24+ 0 to 33+ 6 weeks with PROM received antenatal steroids.…”

“…It was probably due to the small number of our sample and the variability of subjects. 40% of our subjects had average gestational age of ≥32, while the reports by Dargaville et al, 5 Bhat et al, 6 and Arora et al, 7 showed the average gestational age of 32 weeks. The majority of our subjects (92.5%) with singleton had a risk of nasal CPAP failure 4.47 times than twins.…”

Timely Respiratory Support Can Improve Clinical Outcomes of Premature Infants in a Country with Limited Medical Resources due to Chronic Conflicts

“…28 In our study, there was a significant association between the use of antenatal steroids and the success of early CPAP. These data agree with those reported by Tavares et al 29 and Arora et al 30 Similarly, there was a strong association between PROM and the need for early CPAP, which was consistent with the observations of Pillai and coworkers. 28 We did not find any relationship between Apgar scores at 1 minute and the use of early CPAP.…”

Nasal Bubble Continuous Positive Airway Pressure: An Experience in a Neonatal Unit in a Tertiary Teaching Hospital in Pokhara

“…Complications were not seen in 69.3% of our patients which is similar to the observation made by Ahmed et al where 75% of their patients had no complications relating to NBCPAP. 16 In this study, low gestational age was one of the predictors for failure of NBCPAP which was in agreement with studies by Adb-Allah et al, Arora V et al and Pillai MS et al [16][17][18] Prematurity is related to apnea and cardiovascular instability which results in increased severity of disease necessitating mechanical ventilator and thus failure of NBCPAP. Ten newborns needed to be shifted to mechanical ventilation due to worsening condition.…”