A Two Year Experience in Continuous Positive Airway Pressure Ventilation Using Nasal Prongs and Pulse Oximetry.

Abstract

In a prospective study 26 of the 116 consecutive neonates suffering from respiratory distress survived on varying concentrations of humidified oxygen. Continuous positive airway pressure (CPAP) of 4-12 cm of water was applied through short nasal prongs to 90 neonates. Haemoglobin oxygen saturation (SaO2) rose in all and it was maintained steadily above 85% in 46 (51%) infants who survived. The mean duration of CPAP among the survivors was 61 hours (range 8-190 hours). Common indications of CPAP ventilation were hyaline membrane disease (HMD) (27.7%), meconium aspiration syndrome (MAS) (20%), apnea of prematurity (18.8%) and asphyxia (17.7%). Neonates weighing >1000 gm faired well with overall survival of 60 to 82.35%. However, among the 16 babies weighing <1000 gm, only 3 (18.75%) survived. 4 infants on CPAP died due to pneumothorax, none had complications of oxygen toxicity. The 44 CPAP failures, fared poorly even when shifted to intermittent positive pressure ventilation (IPPV) regardless of their weight and 1 among the 5 survivors developed grade 1 intraventricular haemorrhage. It was concluded that nasal CPAP ventilation with pulse oximetry is a simple and efficient method of treating respiratory distress in newborns. This technique can be adopted even by smaller hospitals where the equipment and expertise for IPPV and arterial blood gas (ABG) monitoring are not feasible.