Outcome of Improvised Bubble Continuous Positive Airway Pressure (bCPAP) in Respiratory Distress Syndrome (RDS) and Factors Associated with its Failure: A Prospective Observational Study

Abstract

Introduction: Bubble CPAP (bCPAP) is the standard treatment for newborn with RDS but is challenged by availability of proper bCPAP delivery devices. The improvised bCPAP using modified nasal prong with expiratory limb immersed in water is commonly used to deliver pressurized air to the neonate’s lungs. The primary objective of the study was to evaluate effectiveness of improvised bCPAP in treating Respiratory distress syndrome (RDS) and to identify factors that may be associated with its failure.

Methods: In this prospective observational study, all consecutively born preterm neonates delivered before 37 weeks of gestation, admitted to the neonatal intensive care unit (NICU) with diagnosis of RDS and needed bCPAP were included in the study. Early rescue surfactant was given according to NICU protocol of the hospital. Those neonates failed to improve despite treatment with Continuous Positive Airway Pressure (CPAP) and needed MV within 96 hours of life are considered as CPAP failure (CPAP-F).

Results: 119 preterm newborn with mean gestational age was 31.95 ± 2.05 weeks and birth weight 1614.33 ± 454.32 gm were enrolled. bCPAP was successful in 22 (18.5%) preterm infants. The mean duration of Continuous Positive Airway Pressure (CPAP) was 61.21 ± 41.81 hours and NICU stay was 12.34 ± 8.12 days. Surfactant was given in 51 (42.9%) and mortality rate was 17 (14.29%). Multivariable logistic regression analysis showed gestational age less than 32 weeks 0.534 (95%CI: 0.340-0.839) and pneumothorax 22 (95%CI: 2.122 - 228.070) are independent risk factors associated with CPAP-F.

Conclusions: Improvised bCPAP is effective in the management of respiratory distress syndrome (RDS). Pneumothorax and gestational age < 32 weeks are independent risk factor for its failure.