To study the Effectiveness of Early CPAP in the management of respiratory distress syndrome (RDS) in premature babies with ? 34 weeks of gestation.
Keywords:
Respiratory Distress Syndrome (RDS), CPAP, Mechanical ventilation, Premature neonatesAbstract
Background : Controversies still exist in the management of Respiratory Distress Syndrome (RDS) in Premature infants. The standard treatment of Intermittent positive pressure ventilation (IPPV) with surfactant therapy may not be the ideal intervention in resource limited settings like India, considering the invasive nature, higher cost and high risk of chronic lung disease. Even though early CPAP therapy has been shown to be successful in many clinical trials in the management of RDS, studies documenting the outcome of early CPAP therapy are very scarce in India. Aims : To assess the outcome and incidence of various adverse outcomes of early CPAP therapy in premature neonates with ? 34 weeks of gestation, in a tertiary care teaching hospital. Materials and Methods : The study was a prospective observational study, undertaken in neonatal care unit of a tertiary care teaching hospital, between January 2014 to December 2016. All the eligible children were included in the study, no sampling was done. Statistical Analysis: Quantitative variables were presented is mean and standard deviation, categorical variables were presented as frequency and percentages. 95% CI for the primary outcome measures were assessed using Z-test. Results : Seventy premature newborn with < 34 weeks of gestation were included in the final analysis. Majority of the cases received bubble CPAP. The incidence of CPAP failure was 30% (95% CI 19.3% to 40.7%) in study population. The proportion of neonates who required surfactant was 18% (9.5% to 27.7%), Who developed ROP was 37% (25.8% to 48.5%) and the proportion of children, who met with mortality was 7% (1.1% to 13.2%) Nasal Trauma, Hypotension, Intra Ventricular Hemorrhage and CPAP belly were the most common complications, occurring in 80% (70.6% to 89.4%), 11.4% ( 4% to 18.9%) and 10% (3 % to 17%) of neonates each respectively. No case of pulmonary haemorrhage was reported. Conclusion: Early institution of CPAP in the management of RDS in premature neonates, can signifiantly reduce the need for mechanical ventilation (MV) and surfactant therapy, with minimum associated complications.
Downloads
References
Avery ME , Mead J. Surface properties in relation to atelectasis and hyaline membrane diseases. AMA journal of dieases of children. 1959;97(5,part1):517-23.
Dreyfuss D, Saumon G. Ventilator- induced lung injury: lessons from experimental studies. American journal of respiratory and critical care medicine. 1998;157(1):294-323.
Kamper J, Wolff K, Larsen C, Lindenhurst S. Early treatment with nasal continuous positive airway pressure in very low birth weight infants. Actapaediatrica (Oslo, Norway:1992). 1993;82(2):193-97.
Sandra F, Ancora G, Lanzoni A , Tagliabue P, Colnago M, Ventura ML, et al. Prophylactic nasal continuous positive airways pressure in newborns of 28- 31 weeks gestation: mutlicentre randomized controlled clinical trials. Archives of disease in childhood fetal and neonatal edition. 2004;89(5):F394-98.
Dunn MS, Kaempf J, de Klerk A, de Klerk R, Reilly M, Howard D, et al. Randomized trials comparing three approaches to the initial respiratory management of preterm neonates. Pediatrics.2011;128(5):e1069-76.
Vendor H, Robertson B, Greison G, Ebbesen F, Albertson P, Lindstrom K, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish - Swedish Multicentre study group. The New England journal of medicine. 1994;331(16):1051-15.
Bowlin K, Gudmundsdottir T, Katz-Salamon M, Jonsson B, Blennow M. Implementation of surfactant treatment during continuous positive airway pressure. Journal of perinatology :official journal of the California Perinatal Association. 2001;27(7):422-27.
Diblasi RM. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infants.
Respiratory care. 2009;54(9):1209-35.
Sekar K. The role of continuous positive airway pressure therapy in the management of respiratory diatress in extremely premature infants. The journal of pediatric pharmacology and therapeutic:JPPT:the official journal of PPAG. 2006;11(3):145-52.
Gregory GA, Kitterman JA, Phibbs RH, Tooley WH, Hamilton WK. Treatment of the idiopathic respiratory distress syndrome with continuous positive airway pressure. The New England journal of medicine. 1971;284(24):1333-40.
Dunn PM, Thearle MJ, Parsons AC, Watts JL. Use of the ' Gregory box (CPAP) in treatment of RDS of the newborn: preliminary reports. Archives of diseases in childhood. 1972;47(254):674-75.
Bassiouny MR, Gupta A, el Bualy M. Nasal continuous positive airway pressure in the treatment of respiratory distress syndrome:an experience from a developing country. Journal of tropical pediatrics.1994;40(6):341-44.
Sai Sunil Kishore M, Dutta S, Kumar P. Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome. Act apaediatrica ( Oslo, Norway: 1992). 2009;98(9):1412-15.
Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. Early CPAP versus surfactant in extremely preterm infants. The New England journal of medicine. 2010;362(21):1970-79.
Tapia JL, Urzua S, Bancalari A, Meritano J, Torres G, Fabres J, et al. Randomized trial of early bubble continuous positive airway pressure for very low birth weight infants. The journal of pediatrics. 2012;161(1):75-85.e1.
Kandraju H, Murki S, Subramanian S, Gaddam P, Dearari A, Kumar P. Early routine versus late selective surfactant in preterm neonates with respiratory distress syndrome on nasal continous positive airways pressure: a randomized controlled trials. Neonatology. 2013;103(2):148-54.
Zaharie G, Ion DA , Schmidt N, Popa M, Kudor-Szabadi L, Zaharie T. (Prophylactic CPAP versus therapeutic CPAP in preterm newborns of 28- 32 gestational weeks). Pneumologia (Bucharest, Romania ).2008;57(1):34-37.
Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB . Nasal CPAP or intubation at birth for very preterm infants . The New England journal of medicine. 2008;358(7):700-08.
Bohlin K. RDS--CPAP or surfactant or both. Actapaediatrica (Oslo, Norway: 1992) Supplement. 2012;101(464):24-28.
Schmolzer GM, Kumar M, PichlerG, Arizona K, O' Reilly M, Cheung PY. Non - invasive versus invasive respiratory support in preterm infants at birth :systematic review and meta - analysis. BMJ(Clinical researched ).2013;347:f5980.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.