Outcome of Early Cpap in the Management of Respiratory Distress Syndrome (RDS) in Premature Babies with ≤32 Weeks of Gestation, A Prospective Observational Study

Abstract

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 ≤ 32 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, located in Kochi, Kerala, between January 2007 to December 2010. 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 < 32 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 18.6% (9.5% to 27.7%), Who developed ROP was 37.1% (25.8% to 48.5%) and the proportion of children, who met with mortality was 7.1% (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 hemorrhage was reported. Conclusion: Early institution of CPAP in the management of RDS in premature neonates, can significantly reduce the need for mechanical ventilation (MV) and surfactant therapy, with minimum associated complications.

Keywords

• continuous positive airway pressure (cpap)
• outcome
• complications
• respiratory distress syndrome (rds)