Abstract
Background: To observe the survival of preterm infants with respiratory distress syndrome treated with bubble CPAP in a tertiary care hospital. Methods: This prospective observational study was conducted in the NICU of Civil hospital Sukkur from 1st July 2013 to 18th August 2015. All consecutively born preterm neonates with gestational age between 27 weeks to 36 weeks of gestation, admitted to the neonatal intensive care unit with respiratory distress are included in the study. These neonates were managed by Bubble continuous positive airway pressure (bCPAP) in combination with surfactant (bovine derivative) via intubation, Surfactant replacement, extubation (INSURE) protocol Success was considered when neonates were clinically stable and required 90% and PaCO2 <40-45 mmHg. Results: Mean age of enrolled infants was 1.35 ± 0.60 days, 70 (57.9%) were males and 51 (42.1%) were female, mean weight was 1.76 ± 0.37 kg and mean gestational age was 33 ± 2.3 weeks. Overall 77 (63.6%) preterm infants were successfully weaned off from CPAP. Multivariable analysis showed weight of infant less than 1.5 kg or 8.63 (95% CI: 1.71-43.57), respiratory rate of more than 70 breaths per minute, or 9.59 (95% CI: 2.59-35.52), nasal flaring or 3.35 (95% CI: 1.08-10.31) and typical findings of RDS on chest X-rays 12.04 (95% CI: 1.89-76.52) are independent risk factors for failure of bCPAP. However, gestational age 0.70 (95% CI: 0.54-0.89) is protective against failure. Conclusion: bCPAP has a high proportion of success in the management of respiratory distress syndrome in preterm. It could be most useful in resource-constrained settings.
Highlights
About 15 million preterm babies are born around the world and more than one million die soon after birth mainly due to respiratory complications [1,2]
Respiratory distress syndrome (RDS) is a common and serious complication of preterm birth accounting for 50% cases [3,4] preterm, it is the major cause of mortality in preterm neonates [5]
The effectiveness of locally adapted Bubble continuous positive airway pressure (bCPAP) has been documented [8,9]. bCPAP is a simple and cost effective respiratory support system (RSS) which consists of products that are available and health care provider can be trained to make and use this RSS [8]. bCPAP circuits consisted of inspiratory limb, the interface and the proximal part of the expiratory limb
Summary
About 15 million preterm babies are born around the world and more than one million die soon after birth mainly due to respiratory complications [1,2]. The expiratory limb of the circuit is immersed in this bottle and the depth of the immersion in centimeters below the water surface correspond to the desired bCPAP in cm H2O usually between 5 cm to 8 cm of H2O [8]. This provides positive pressure in the whole respiratory cycle [9], increases the functional residual capacity of lungs and lowers work of breathing [10]. We intend to observe the efficacy of Bubble CPAP with surfactant replacement therapy in the management of RDS in preterm neonates. To observe the survival of preterm infants with respiratory distress syndrome treated with bubble CPAP in a tertiary care hospital
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