Preterm Neonatal Need for Mechanical Ventilation in Prophylactic Continuous Positive Air Pressure (CPAP) Versus Therapeutic CPAP

Abstract

Introduction: Preterm birth leads to number of life-threatening complications especially respiratory issues. Continuous Positive Airway Pressure (CPAP) is a conventional method used to keep the airways functional. However, limited literature is available on comparative benefit of prophylactic nasal CPAP vs. therapeutic CPAP specially in terms of preventing need for mechanical ventilation.
 Aims & Objectives: To compare the frequency of need for mechanical ventilation in prophylactic CPAP versus therapeutic CPAP in preterm neonates.
 Place and duration of study: The study was carried out at Neonatal Intensive Care Unit (NICU), Department of Pediatrics, Combined Military Hospital, Lahore between February 1 to August 1, 2019.
 Material & Methods: This randomized controlled trial was conducted on 174 cases using non-probability consecutive sampling. The patients were divided into two groups randomly (group-A and Group -B) using lottery method. Group ‘A’ received therapeutic CPAP only and Group ‘B’ received prophylactic CPAP in the first half an hour after birth. Data was entered and analyzed using the software SPSS version 20. For inferential statistics, p-value ? 0.05 was considered significant.
 Results: The mean age of patients in Therapeutic group was 16.71 ± 13.05 hours and in Prophylactic group the mean age was 12.62 ± 16 hours. In tTherapeutic group 61(70.1%) cases needed mechanical ventilation and in Prophylactic group 23(26.4%) cases needed mechanical ventilation, the frequency of mechanical ventilation was statistically higher in therapeutic CPAP group as compared to Prophylactic CPAP group, p-value < 0.001. There was significant association of need for mechanical ventilation with gender, gestational age and birth weight.
 Conclusion: This study concludes that the frequency of mechanical ventilation was statistically higher in Therapeutic CPAP group as compared to Prophylactic CPAP group in preterm infants between 28-32 weeks of gestation. Hence in future, every expected preterm baby is recommended to be given prophylactic CPAP to minimize the related complications. This can help to reduce the neonatal mortality rate.