Use of Nasal Continuous Positive Airway Pressure as a Mode of Respiratory Support in Newborns at SAT Hospital, Trivandrum

Abstract

Background: Respiratory distress is one of the leading causes of mortality in a newborn ICU. Though endotracheal intubation and mechanical ventilation is the gold standard in the management of acute respiratory failure, it is not without complications. The Continuous positive airway pressure (CPAP) is used as an alternative for maintaining an increased trans-pulmonary pressure during expiratory phase of respiration in a spontaneously breathing infant. However CPAP is considered as effective as to mechanical ventilation and has fewer complications, its usefulness in a tertiary care ICU in resource poor settings is yet to be studied. Objective: To study the use of Nasal CPAP in managing respiratory distress in a tertiary care pediatric ICU. Methods: this descriptive study was performed in the 75 consecutive newborn babies with respiratory distress admitted in inborn nursery of SAT Hospital, Trivandrum. The Outcome measures are the efficacy of nasal CPAP as measured by improvement in Downe score as assessed at intervals after intervention. Results: A total of 75 infants were treated with nasal CPAP; of these, 55 infants (73.3%) improved with CPAP alone, 44 cases had Hyaline membrane disease out of these 63.63% improved with nasal CPAP, 13 (17.3%) died and 7 (9.3%) required ventilation. All cases with meconeum aspiration improved with nasal CPAP. There were no major complications like pneumothorax. Conclusions: Nasal CPAP seems to be a safe alternative to routine intubation and mechanical ventilation in managing respiratory distress cases in resource limited settings.