Early bubble continuous positive airway pressure as the initial mode of management of respiratory distress syndrome in preterm neonates
DOI:
https://doi.org/10.18203/2349-3291.ijcp20252964Keywords:
Respiratory distress syndrome, Preterm neonates, Bubble CPAP, Non-invasive ventilation, Bronchopulmonary dysplasia, Mechanical ventilationAbstract
Background: Respiratory distress syndrome (RDS) is a common and serious condition in preterm neonates caused primarily by surfactant deficiency and immature lungs. Early application of bubble continuous positive airway pressure (bCPAP) offers a non-invasive respiratory support method that may reduce the need for mechanical ventilation and associated complications. The present study aimed to evaluate the efficacy and safety of early bubble CPAP as the initial mode of respiratory support in preterm neonates with RDS.
Methods: A prospective observational study was conducted on 100 preterm neonates between 28 and 34 weeks of gestation presenting with clinical and radiological features of RDS within 6 hours of birth. All neonates were initiated on bCPAP within 1 hour of birth or diagnosis. The primary outcome was bCPAP success, defined as avoidance of invasive mechanical ventilation within 72 hours. Secondary outcomes included the duration of bCPAP therapy, complications, incidence of bronchopulmonary dysplasia (BPD), length of stay in the neonatal intensive care unit (NICU), and survival to discharge.
Results: The mean gestational age and birth weight were 31.5±1.8 weeks and 1450±320 grams, respectively. Successful bCPAP therapy was achieved in 72% of neonates. The mean duration of bCPAP was 72.12±18.54 hours. Complications included apnea requiring intubation (12%), nasal trauma (10%), pneumothorax (5%), and BPD (8%). Neonates who failed bCPAP had significantly lower gestational ages and birth weights and higher incidences of BPD and mortality (p<0.05). Survival to discharge was 94%.
Conclusion: Early bubble CPAP is an effective and safe respiratory support strategy in preterm neonates with RDS, reducing the need for mechanical ventilation and associated complications.
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References
Maryam I, Ali SM, Firdaus U. Clinico-epidemiological profile and outcomes of respiratory distress in newborns prospective observational study in a tertiary care. Int J Contemp Pediatr. 2024;11(11):1590-5. DOI: https://doi.org/10.18203/2349-3291.ijcp20243086
Cheng-Hwa Ma C. The Role of Surfactant in Respiratory Distress Syndrome. Open Respir Med J. 2012;6:44-53. DOI: https://doi.org/10.2174/1874306401206010044
Sivanandan S, Agarwal R, Sethi A. Respiratory distress in term neonates in low-resource settings. Semin Fetal Neonatal Med. 2017;22(4):260-6. DOI: https://doi.org/10.1016/j.siny.2017.04.004
Ho JJ, Subramaniam P, Sivakaanthan A, Davis PG. Early versus delayed continuous positive airway pressure (CPAP) for respiratory distress in preterm infants. Cochrane database Syst Rev. 2020;10(10):CD002975. DOI: https://doi.org/10.1002/14651858.CD002975.pub2
Boel L, Hixson T, Brown L, Sage J, Kotecha S, Chakraborty M. Non-invasive respiratory support in preterm infants. Paediatr Respir Rev. 2022;43:53-59. DOI: https://doi.org/10.1016/j.prrv.2022.04.002
Ekhaguere OA, Mairami AB, Kirpalani H. Risk and benefits of Bubble Continuous Positive Airway Pressure for neonatal and childhood respiratory diseases in Low- and Middle-Income countries. Paediatr Respir Rev. 2019;29:31-6. DOI: https://doi.org/10.1016/j.prrv.2018.04.004
Baldursdottir S, Falk M, Donaldsson S, Jonsson B, Drevhammar T. Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design. Arch Dis Child - Fetal Neonatal Ed. 2020;105(5):550-4. DOI: https://doi.org/10.1136/archdischild-2019-318073
Arora V, Gediya SG, Jain R. Outcome of premature babies with RDS using bubble CPAP. Int J Contemp Pediatr. 2017;4(3):939. DOI: https://doi.org/10.18203/2349-3291.ijcp20171702
Bahman-Bijari B, Malekiyan A, Niknafs P, Baneshi MR. Bubble-CPAP vs. Ventilatory-CPAP in preterm infants with respiratory distress. Iran J Pediatr. 2011;2:3.
Aggarwal K, Garg P, Narayan J, Chaudhary AK. A Clinical Study on Role of Bubble CPAP in Respiratory Distress Syndrome in Preterm Neonates. Int J Pharm Clin Res. 2023;15(6):1007-13.
Thukral A, Sankar MJ, Chandrasekaran A, Agarwal R, Paul VK. Efficacy and safety of CPAP in low- and middle-income countries. J Perinatol. 2016;36(S1):S21-8. DOI: https://doi.org/10.1038/jp.2016.29
Viagulam CMJ, Saravanan S. Early initiation of bubble CPAP and its outcome in neonates with respiratory distress. Int J Paediatr Geriatr. 2020;3(2):80-4. DOI: https://doi.org/10.33545/26643685.2020.v3.i2b.99
Al-Lawama M, Alkhatib H, Wakileh Z, Elqaisi R, AlMassad G, Badran E, et al. Bubble CPAP therapy for neonatal respiratory distress in level III neonatal unit in Amman, Jordan: A prospective observational study. Int J Gen Med. 2018;12:25-3. DOI: https://doi.org/10.2147/IJGM.S185264
Kachare A, Wagh H, Wagh S. Clinical Outcome of Bubble Cpap (Continuous Positive Airway Pressure) in Neonates Admitted With Respiratory. Int J Acad Med Pharm. 2023;5(5):215-22.
Manandhar SR. Outcome of Respiratory Distress in Neonates with Bubble CPAP at Neonatal Intensive Care Unit of a Tertiary Hospital. JNMA J Nepal Med Assoc. 2019;57(216):92-7. DOI: https://doi.org/10.31729/jnma.4294
Shayani LA, Marães VRF da S. Bubble CPAP as first ventilatory choice in extremely premature infants: Relation to outcomes and bronchopulmonary dysplasia. J Neonatal Nurs. 2024;30(4):368-74. DOI: https://doi.org/10.1016/j.jnn.2023.11.009
Balaji RVJ, P.K.Rajiv, Patel VK, Kripail M. Outcome of Early CPAP in the Management of Respiratory Distress Syndrome (RDS) in Premature Babies with ≤ 32 Weeks of Gestation, A Prospective Observational Study. Indian J Neonatal Med Res. 2015;3(2):1-6.
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