Outcome of Respiratory Distress in Neonates with Bubble CPAP at Neonatal Intensive Care Unit of a Tertiary Hospital

ABSTRACT Introduction Respiratory distress is one of the commonest problem seen in neonates during admission in Neonatal Intensive Care Unit. Hyaline Membrane disease, Meconium Aspiration Syndrome, septicemia, congenital pneumonia, Transient Tachypnea of Newborn are the major causes of respiratory distress in neonates. Bubble Continuous Positive Airway Pressure is a non-invasive respiratory support delivered to a spontaneously breathing newborn to maintain lung volume during expiration. The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure. Methods This was a descriptive cross-sectional study conducted at Kathmandu Medical College Teaching Hospital over six months (October 2018 - March 2019) period. All preterm, term and post term babies with respiratory distress were included. Ethical clearance was received from Institutional Review Committee of Kathmandu Medical College and statistical analysis was done with SPSS 19 version. Results Sixty three babies with respiratory distress were included in this study with 45 (71%) male predominance. The mean birth weight receiving Bubble Continuous Positive Airway Pressure was 2661.75+84 gms and gestational age was 36.67±3.4 wks. The Bubble Continuous Positive Airway Pressure was started at 8.05+2 hr of life and duration of Bubble Continuous Positive Airway Pressure required for settling respiratory distress was 95.71+3 hrs. Out of 63 babies, improvement of respiratory distress in neonates with Bubble Continuous Positive Airway Pressure was 39 (61%) with confidence interval of 38% to 62% whereas 24 (39%) babies required mechanical ventilation and other modalities. Conclusions This study concludes usefulness of Bubble Continuous Positive Airway Pressure in neonates with respiratory distress.


INTRODUCTION
2][3] Saeed Z et al. described respiratory distress as the most common presenting problem encountered within the first 48-72 hours of life with a prevalence of 4.24% in neonates. 4aline Membrane Disease (HMD), Meconium Aspiration Syndrome (MAS), septicemia, congenital pneumonia, Transient Tachypnea of Newborn (TTN) are the major causes of respiratory distress in preterm, term and post Free Full Text Articles are Available at www.jnma.com.npterm neonates. 5ntinuous Positive Airway Pressure (CPAP) is an effective therapy for managing respiratory distress in preterm, term and post term neonates. 69][10] The main objective of this study was to observe the outcome of respiratory distress in neonates with Bubble CPAP (B-CPAP).

METHODS
This was a descriptive cross-sectional study done at 10   The study highlighted that mean duration of B-CPAP use within 24 hrs was 94.47±36.9hrs and after 24 hrs was 128±13.8hrs (Table 3).
Before B-CPAP, the mean respiratory rate was 83.02±7/ min, which had decreased after 48-96 hrs of B-CPAP.
Similarly, the initial PEEP required before B-CPAP was 5.63±0.6cm of water, which was decreased after Free Full Text Articles are Available at www.jnma.com.np48-96 hrs of B-CPAP.It showed decreasing trend of respiratory rate and PEEP pressure requirement after the use of B-CPAP (Table 3).

DISCUSSION
This descriptive cross-sectional study included all newborns (preterm and term) with respiratory distress who were treated with B-CPAP as the primary respiratory support.The included newborns were mostly term (71%) and 60% babies were of normal weight (2.5 -4 kg).The controversy of early vs delayed CPAP continues to have many trials favoring early CPAP were carried out to be better in the larger infants prior to routine use of antenatal steroids and postnatal surfactant. 15he evidence suggested exogenous surfactant use with early CPAP with brief ventilation in extremely Low Birth Weight (ELBW) babies had decreased the use of mechanical ventilation. 16Similarly, this study also showed B-CPAP within 24 hrs (early CPAP) in neonates with respiratory distress was effective in reducing respiratory effort and required lesser duration (94.47±36.9hrs) of B-CPAP as compared to after 24 hrs (128±13.8hrs).This finding was also strongly supported by the study done by Mathai SS et al, in which B-CPAP use within 24 hrs had less duration of B-CPAP (44.93±24.56hrs) required as compared to after 24 hrs (85.57±54.16hrs). 17 This study described the commonest cause of respiratory distress requiring B-CPAP was congenital pneumonia (23%) followed by MAS (19%), birth asphyxia (13%) and HMD (11%
had HMD and neonatal sepsis.Six babies (10%) were diagnosed as congenital acyanotic heart disease by Echo, out of which four had isolated ASD, one had ASD with VSD and one had ASD with PDA.During Free Full Text Articles are Available at www.jnma.com.np

Table 4 . Clinical parameters under B-CPAP.
). Mathur NB et al. postulated congenital pneumonia as the main cause of respiratory distress (68%) with maternal history of PROM >24 hrs as one of the risk factor for it. 18This study also corroborated similar findings as out of 15 babies with congenital pneumonia, nine babies had maternal history of PROM highlighting it as one of the major risk factor.Saha LC, Chowdhury MA, Hoque MdM ,Al Mamun MdA, Rahman M. Effect of bubble CPAP in PT lbw neonates with respiratory distress.Acad J Ped Neonatol.2017;3(2):1-6.[Full Text] 14. Askin DF.Complications in the transition from fetal to neonatal life.J Obstet Gynecol Neonatal Nurs.2002;31(3):318-27.[PubMed] 15.Ho JJ, Henderson-Smart DJ, Davis PG.Early versus delayed initiation of continuous distending pressure for respiratory distress syndrome in preterm infants.Mathai SS, Rajeev A, Adhikari KM.Safety and effectiveness of bubble continuous positive airway pressure in preterm neonates with respiratory distress.Medical J Armed Forces India.2014 Oct;70(4):327-31.[PubMed | Full Text | DOI] 18. Mathur NB, Garg K, Kumar S. Respiratory distress in neonates with special reference to pneumonia.Indian Pediatr.2002;39(6):529-37.[PubMed] 19.Koyamaibole L, Kado J, Qovu J, Colquhoun S, Duke T.An evaluation of bubble-CPAP in a neonatal unit in a developing country: effective respiratory support that can be applied by nurses.J Trop Pediatr.2006;52(4):249-53.[PubMed | Full Text | DOI]