Study of Respiratory Distress Syndrome in Newborn with Special Reference to the Role of Bubble CPAP in its Management

Abstract

Background: Respiratory distress syndrome is the most important cause of morbidity and mortality in preterm neonates. Intermittent positive pressure ventilation with surfactant therapy was standard treatment of RDS. IIPV is invasive, costly and requires expertise. It is not a viable option for many of the resource limited SNCU set ups of our country. Trials have showed that CPAP is noninvasive, easy to use, safe and effective. This study was done to find out effectiveness of CPAP in RDS, and also to find CPAP failure factors. Methods: This was a prospective observational study, carried out at SNCU of Dhiraj hospital, Piparia, Vadodara district, Gujarat, India form February 2014 to March 2015. Neonates with diagnosis of respiratory distress syndrome were included in this study. Results: Total 57 (42 inborn and 15 out born) cases of RDS were analyzed in this study. Incidence of RDS was 3.68% of live births. 5(8.8%) settled down with low flow oxygen only. 24 (42.1%) successfully treated with CPAP only. 15 (26.3%) were treated with CPAP and surfactant. 13 (22.8%) were CPAP failure cases which required ventilator support. The variables significantly associated with failure of CPAP were: no exposure to antenatal steroids (p value of 0.025), grade 3-4 RDS on CXR (p value of 0.03), PDA (p value of 0.0264), sepsis/pneumonia (p value of <0.001) and Silverman Anderson score of ≥7 at admission (p value of 0.001). 3 (5.3%) went on DAMA. 5 (8.8%) expired and 49 (85.9%) were discharged. 4 out of 5 (80%) death occurred in very preterm group. 4 (80%) of death occurred in neonates whose mothers did not receive any dose of antenatal steroid. There was no mortality in neonates who were in need of surfactant and received within 6 hours of life. 75% of neonates having sepsis and asphyxia both along with RDS expired. Conclusions: Bubble CPAP is safe and very effective in low resource settings. CPAP failure is significantly associated with no antenatal steroids, grade 3 to 4 x-ray changes of RDS, Silverman Anderson score of ≥7 at beginning of CPAP, presence of significant PDA and association of sepsis/pneumonia.