DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20180542

Bubble continuous positive airway pressure machine versus indigenous bubble continuous positive airway pressure as a respiratory support in preterm babies with respiratory distress syndrome: a prospective outcome research at a tertiary care centre in Gujarat, India

Rekha Thaddanee, Ankur Chaudhari, Hasmukh Chauhan, Shamim Morbiwala, Ajeet Kumar Khilnani

Abstract


Background: In India, there is high burden of prematurity in newborns due to high birth rate and lack of good antenatal care. The objective of this study was to compare the outcome (efficacy and safety) of Bubble Continuous Positive Airway Pressure (B-CPAP) machine and Indigenous Bubble Continuous Positive Airway Pressure (I-CPAP) as a primary mode of respiratory support in preterm new-borns with respiratory distress syndrome (RDS). It was a prospective observational comparative study conducted at NICU of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to July 2017.

Methods: Eighty-one preterm babies <36 weeks of gestation age with respiratory distress (Silverman Anderson scoring >4) within 6 hours of birth were included (out of 182 preterm newborns with respiratory distress syndrome) and put on respiratory support either with B-CPAP machine (n = 48) or with I-CPAP (n = 33). Outcome was compared in the form of CPAP failure, survival and complication rates.

Results: There was no significant difference in the demographic profile of patients in both groups except number of neonates between 1.5-2.5 kg birth weight were significantly high in B-CPAP (45.8%) compared to I-CPAP (33.3%) (p = 0.00074). There were no significant differences in CPAP failure rates in B-CPAP (27%) versus I-CPAP (24.2%). The survival rate (72.9% in B-CPAP) versus (75.7% in I-CPAP) in both groups was also similar (CI 95%, p = 0.774). The complications, such as moderate to severe nasal septal damage, occurred significantly more frequent with B-CPAP machine (47.9%) than on I-CPAP (6%) (CI 95%, p = 0.000062).

Conclusions: Efficacy of I-CPAP as a primary mode of respiratory support for preterm new-born with respiratory distress was comparable to B-CPAP. The ease with which it can be assembled makes it a suitable alternative to B-CPAP.


Keywords


B-CPAP, CPAP failure, Indigenous continuous positive airway pressure, Respiratory distress syndrome

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References


Upadhyay A, Deorari AK. Continuous positive airway pressure-a gentler approach to ventilation. Indian Pediatr. 2004;41:459-69.

Report of the National Neonatal Perinatal Database. NNF India, 2002-2003. Available at http://www.newbornwhocc.org/pdf/nnpd_report_2002-03.PDF Accessed 4th September 2017.

Gupta N, Saini SS, Murki S, Kumar P, Deorari A. Continuous positive airway pressure in preterm neonates: an update of current evidence and implications for developing countries. Indian Pediatr. 2015;52:319-28.

Sankar MJ, Deorari AK. CPAP: a gentler mode of ventilation. J Neonatol. 2007;21:160-5.

Lee US, Dunn MS, Fenwick M, Shennan AT. A comparison of underwater bubble continuous positive airway pressure (CPAP) with ventilator derived CPAP in preterm neonates ready for extubation. Biol Neonate. 1998;73:69-75.

Jain H, Arya S, Mandloi R, Menon S. To study the effectiveness of indigenous bubble CPAP in management of respiratory distress in newborns. Int J Pediatr Res. 2016;3:291-4.

Kaur C, Sema A, Beri RS, Puliyel JM. A simple circuit to deliver bubbling CPAP. Indian Pediatr. 2008;45:312-4.

Silverman WA, Anderson DH. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatr. 1956;17:1-10.

Ballard JL, Khoury JC, Wedig L, Eilers-Walsman BL, Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr. 1999;119:417-23.

Committee for the classification of retinopathy of prematurity. An international classification of retinopathy of prematurity. Arch Ophthalmol. 1984;102:1130-4.

Bancalari E, Jobe AH. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723-9.

Hegde D, Mondkar J, Panchal H, Manerkar S, Jasani B, Kabra N. Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure as primary mode of respiratory support for respiratory distress in preterm infants. Indian Pediatr. 2016;53:129-33.

Mathai SS, Rajeev A, Adhikari KM. Safety and effectiveness of bubble continuous positive airway pressure in preterm neonates with respiratory distress. Med J Armed Forces India. 2014;70:327-31.

Ammari A, Suri M, Milisavljevic V, Sahni R, Bateman D, Sanocka U, et al. Variable associated with the early failure of nasal CPAP in very low birth weight infant. J Pediatr. 2005;147:341-7.

Kawaza K, Machen HE, Brown J, Mwanza Z, Iniguez S, Gest A, et al. Efficacy of a low-cost bubble cpap system in treatment of respiratory distress in a neonatal ward in Malawi. PLoS One. 2014;9:e86327.