Abstract
Introduction: Nasal bubble continuous positive airway pressure (NBCPAP) is a modality used for respiratory distress in newborns and provides respiratory support by preventing atelectasis and reducing the work of breathing. The objective of this study was to determine the efficacy, outcomes and complications of NBCPAP in term and preterm newborns requiring NBCPAP. Methods:A prospective observational study was conducted on 75 neonates with mild to moderate respiratory distress requiring respiratory support from August 2020 to December 2020. Assessment of baseline characteristics, indications, complications and outcomes of NBCPAP was carried out on the studied newborns. Outcomes were considered as either success (improvement) or failure (need for mechanical ventilation). Results: The median gestational age was 38 weeks (IQR:35-39 weeks). The median birth weight was 2600 gm (IQR: 2000- 3000 gm). The commonest indication for the requirement of NBCPAP was neonatal sepsis (34%). A total of 65 (86.7%) neonates could be successfully weaned off NBCPAP. Complications were noted in 23 neonates. Modified Downes score on admission (adjusted OR 5.34, 95% CI 1.75- 16.35) and gestational age (adjusted OR 0.68, 95% CI 0.51- 0.92) were independent predictors of failure of NBCPAP. Conclusions: NBCPAP can be successfully utilised in preterm and term babies with mild to moderate respiratory distress. The major predictors of failure of NBCPAP are decreasing gestational age and increasing Downes score.
Highlights
Nasal bubble continuous positive airway pressure (NBCPAP) is a modality used for respiratory distress in newborns and provides respiratory support by preventing atelectasis and reducing the work of breathing
The criteria used in neonatal intensive care unit (NICU) for the instigation of NBCPAP were: babies not maintaining saturation (SPO2 < 90%) on oxygen delivered via nasal prongs or oxygen hood box,1babies with ≥ 3 episodes of apnea over an hour,1babies with Downes’ score of ≥ 3.1,10 (A score of 3 was considered mild respiratory distress and scores 4 - 6 was considered as moderate respiratory distress)
NBCPAP was considered to be successful if the baby could be weaned off using the following criteria- respiratory rate < 60/minute, no or minimal chest retractions, SPO2> 95% maintained with oxygen delivered via nasal prongs or hood box after weaning from the NBCPAP for four consecutive hours and Downes score of 60/minute with SPO2< 90% on a positive end expiratory pressure (PEEP) of 8 cm H2O, a Downes score of ≥ 7 or if the baby had recurrent apneic episodes
Summary
Nasal bubble continuous positive airway pressure (NBCPAP) is a modality used for respiratory distress in newborns and provides respiratory support by preventing atelectasis and reducing the work of breathing. NBCPAP is used in respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), congenital pneumonia, transient tachypnea of the newborn (TTNB), pulmonary edema, apnea and post extubation in neonates. It can be used as a first line respiratory support and has shown to decrease the requirement of mechanical ventilation.[3] NBCPAP has gained popularity due to its simple mechanism; it is assemblable, cost effective and has shown good results without significant complications.[6,7,8] Complications noted include skin abrasions, necrosis of the nasal septum, pneumothorax, gastric distention and feeding intolerance.[9]
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