EFFECTIVENESS OF BUBBLE CONTINUOUS POSITIVE AIRWAY PRESSURE AS A PRIMARY MODE OF RESPIRATORY SUPPORT IN PRETERM NEONATES WITH RESPIRATORY DISTRESS SYNDROME AT DISTRICT LEVEL TERTIARY CARE HOSPITAL

Continuous positive airway pressure and surfactant represent the first- and second-line treatment for respiratory distress syndrome in preterm neonates, as European and American guidelines, since 2013 and 2014, respectively, started to recommend surfactant replacement only when continuous positive airway pressure fails. These recommendations, however, are not personalized to the individual physiopathology. Simple clinical algorithms may have improved the diffusion of neonatal care, but complex medical issues can hardly be addressed with simple solutions. The treatment of respiratory distress syndrome is a complex matter and can be only optimized with personalization. We performed a review of tools to individualize the management of respiratory distress syndrome based on physiopathology and actual patients’ need, according to precision medicine principles. Advanced oxygenation metrics, lung ultrasound, electrical impedance tomography, and both quantitative and qualitative surfactant assays were examined. When these techniques were investigated with diagnostic accuracy studies, reliability measures have been meta-analysed. Amongst all these tools, quantitative lung ultrasound seems the more developed for the widespread use and has a higher diagnostic accuracy (meta-analytical AUC = 0.952 [95% CI: 0.951–0.953]). Surfactant adsorption (AUC = 0.840 [95% CI: 0.824–0.856]) and stable microbubble test (AUC = 0.800 [95% CI: 0.788–0.812]) also have good reliability, but need further industrial development. We advocate for a more accurate characterization and a personalized approach of respiratory distress syndrome. With the above-described currently available tools, it should be possible to personalize the treatment of respiratory distress syndrome according to physiopathology.

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Bubble continuous positive airway pressure machine versus indigenous bubble continuous positive airway pressure as a respiratory support in preterm babies with respiratory distress syndrome: a prospective outcome research at a tertiary care centre in Gujarat, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180542 ◽

2018 ◽

Vol 5 (2) ◽

pp. 493 ◽

Cited By ~ 2

Author(s):

Rekha Thaddanee ◽

Ankur Chaudhari ◽

Hasmukh Chauhan ◽

Shamim Morbiwala ◽

Ajeet Kumar Khilnani

Keyword(s):

Continuous Positive Airway Pressure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Tertiary Care ◽

Respiratory Support ◽

Preterm Babies ◽

Cpap Failure

Background: In India, there is high burden of prematurity in newborns due to high birth rate and lack of good antenatal care. The objective of this study was to compare the outcome (efficacy and safety) of Bubble Continuous Positive Airway Pressure (B-CPAP) machine and Indigenous Bubble Continuous Positive Airway Pressure (I-CPAP) as a primary mode of respiratory support in preterm new-borns with respiratory distress syndrome (RDS). It was a prospective observational comparative study conducted at NICU of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to July 2017.Methods: Eighty-one preterm babies <36 weeks of gestation age with respiratory distress (Silverman Anderson scoring >4) within 6 hours of birth were included (out of 182 preterm newborns with respiratory distress syndrome) and put on respiratory support either with B-CPAP machine (n = 48) or with I-CPAP (n = 33). Outcome was compared in the form of CPAP failure, survival and complication rates.Results: There was no significant difference in the demographic profile of patients in both groups except number of neonates between 1.5-2.5 kg birth weight were significantly high in B-CPAP (45.8%) compared to I-CPAP (33.3%) (p = 0.00074). There were no significant differences in CPAP failure rates in B-CPAP (27%) versus I-CPAP (24.2%). The survival rate (72.9% in B-CPAP) versus (75.7% in I-CPAP) in both groups was also similar (CI 95%, p = 0.774). The complications, such as moderate to severe nasal septal damage, occurred significantly more frequent with B-CPAP machine (47.9%) than on I-CPAP (6%) (CI 95%, p = 0.000062).Conclusions: Efficacy of I-CPAP as a primary mode of respiratory support for preterm new-born with respiratory distress was comparable to B-CPAP. The ease with which it can be assembled makes it a suitable alternative to B-CPAP.

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Early Routine versus Late Selective Surfactant in Preterm Neonates with Respiratory Distress Syndrome on Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial

Neonatology ◽

10.1159/000345198 ◽

2013 ◽

Vol 103 (2) ◽

pp. 148-154 ◽

Cited By ~ 17

Author(s):

Hemasree Kandraju ◽

Srinivas Murki ◽

Sreeram Subramanian ◽

Pramod Gaddam ◽

Ashok Deorari ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Continuous Positive Airway Pressure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Controlled Trial ◽

Preterm Neonates ◽

Randomized Controlled

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The Outcome of Continuous Positive Airway Pressure (CPAP) in Preterm Neonates in Central India - A Prospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/593 ◽

2020 ◽

Vol 7 (49) ◽

pp. 2898-2902

Author(s):

Suman Sudha Tirkey ◽

Rakesh Kumar Verma

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Success Rate ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Central India ◽

Categorical Variables ◽

Preterm Neonates ◽

Care Hospital

BACKGROUND Neonatal respiratory distress syndrome (RDS) is among the common complications in infants born before 37 weeks. In India the incidence of RDS ranges from 0.69 - 8.3 %. CPAP is a less invasive method frequently used in premature infants having RDS). We wanted to assess the outcome of preterm neonates treated with CPAP. METHODS Prospective observational study was done in NICU of a tertiary care hospital, Raipur, Chhattisgarh in central India, during April-2014 to April-2015. Eligible Children were included in the study and evaluated using SAS (Silverman Anderson Scoring), blood gas analysis and pulse oximetry. Quantitative variables were presented as mean and standard deviation; categorical variables were presented as frequency and percentages. RESULTS Out of total 50 babies on CPAP, 38 improved with success rate of 76 % whereas 12 babies (24 %) failed requiring higher mode of ventilation. CPAP was more successful among females (n = 22) with a success rate of 88.0 %. CPAP proved more effective in moderate grade RDS with success rate of 83.3 % (statistically significant p < 0.05). Based on SAS score, shows the improvement in respiratory distress following CPAP. CONCLUSIONS Nasal CPAP is safe effective, non-invasive means of respiratory support in RDS. It can considerably decrease the requirement for mechanical ventilation (MV) and surfactant therapy. KEYWORDS Respiratory Distress Syndrome, Positive Airway Pressure, Silverman Anderson Score

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Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

BMC Pediatrics ◽

10.1186/s12887-021-02741-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arash Malakian ◽

Mohammad Reza Aramesh ◽

Mina Agahin ◽

Masoud Dehdashtian

Keyword(s):

Mechanical Ventilation ◽

Continuous Positive Airway Pressure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Airway Pressure ◽

Distress Syndrome ◽

Positive Airway Pressure ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Abstract Background The most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications. Methods 148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications. Results there was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002). Conclusions In the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group. Trial registration IRCT20180821040847N1, Approved on 2018-09-10.

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