Bubble CPAP (Continuous Positive airway pressure) therapy as a primary mode of respiratory support in preterm newborns with mild to moderate respiratory distress syndrome

Background: Respiratory distress syndrome (RDS) is an important cause of morbidity and mortality in preterm infants. Bubble CPAP when used appropriately, is more cost-effective, non-invasive, requires less training and has a lower risk of complications. However, not all preterm infants with RDS respond to CPAP. Aims: To study the immediate outcome of preterm infants with mild to moderate respiratory distress syndrome on Bubble CPAP. To study the safety and effectiveness of B-CPAP and to identify the risk factors associated with its failure. Setting: NICU, Department of pediatrics, Mamata general hospital and medical college, Khammam. Design- Prospective observational study Material and Methods: This duration bound study was conducted from February 2018 to February 2020. Based on the inclusion criteria 73 Preterm babies with mild to moderate respiratory distress syndrome requiring respiratory support were included in this study. Details of birth history, use of antenatal steroids, gestational age, type of delivery, birth weight, Downes score and chest X-ray were recorded. And the effectiveness and outcome of bubble CPAP were studied. Results: Out of the total of 73 cases, 53(72.60%) were treated successfully, while 20(27.40%) failed bubble CPAP. Conclusion: Bubble CPAP is the safe primary mode of respiratory support in Preterm newborns with mild to moderate RDS, more effective with early Initiation and in Preterm babies born to mothers with the use of antenatal steroids.


Methodology
The study was conducted in the Neonatal Intensive    The failure rate of bubble CPAP varies from 20% to 40% among various studies. In the study by Jagdish Koti et al [11]. 25% of patients failed CPAP during the first week of life. Whereas in the study by Urs et al [12]. 20% of infants failed CPAP. In the study by Ajay Sethi et al [13]. around 40% of the newborn with RDS had failed CPAP, while a study conducted by Boo et al [14]. the failure rate was 38%. The differences may be attributed to birth weight and gestational age of infants enrolled, type of nasal interface, the CPAP device, age of starting CPAP, use of antenatal steroids and surfactant.
In this study outcome of bubble CPAP varies between genders but not statistically significant.
There were 44 (60.27%) female infants and 29(39.73%) male infants who required CPAP, Success rate was 79.55% in the female gender, while in the male it was 62.07%.
In a study by Urs et al [12]. the outcome of CPAP did not vary between genders. Sandri et al [15]. have shown a higher need for respiratory support in male infants with RDS.
In the present study observations, the success rate was 69.23% in preterm newborns with 31 to 34 weeks of gestational age and 86.36% in > 34 weeks gestational age. The success rate was 72% in preterm newborns with birth weight 1000g to 1500g and 83.33% in >2000g but not statistically proven.
There was 41% failure in preterm newborns with gestational age < 31 weeks and 33.33% failure rate in the group of preterm newborns with <1500 g birth weight.
In Jagdish Koti et al [11]. study there was 27% failure in preterm newborns with gestational age <30 weeks and a 25% failure rate in the group of preterm newborns with < 1500g birth weight.
In Urs et al [12]. study statistically significant success was observed in preterm newborns born between 32 -34 weeks and in infants with birth weight between 1000-1500 g.
In the present study statistically significant success was observed in preterm newborns born to mothers who received compete for 2 doses of antenatal steroids with a success rate of 90.90% and 57% success in partial antenatal steroid use. These observations are similar to Parasuramappa H et al [16]. study who observed 97.8% success in antenatal steroids received a group of preterm newborns and similar to Urs et al [12]. In Jagdish Koti et al [11]. study it is observed that 75% success rate in preterm newborns who received CPAP within 2.07 _+1.6 hours of life. As the present study includes preterm newborns who are born outside the institute and then referred to our hospital for further management the differences are observed.
Bubble CPAP is effective in the management of mild to moderate RDS. In a study by Boo et al [14].
moderate RDS was one of the predictors of failure of CPAP whereas in the study by Urs et al [12].
moderate RDS was successfully managed by bubble CPAP as they initiated Bubble CPAP at Downes score of 4.

Conclusion
To conclude, Bubble CPAP is an effective and safe primary mode of respiratory support in preterm newborns with mild to moderate RDS.

What does this study add?
B-CPAP is more effective with early Initiation and in preterm babies born to mothers with antenatal steroids.