Outcome of Early Cpap in the Management of Respiratory Distress Syndrome (RDS) in Premature Babies with ≤32 Weeks of Gestation, A Prospective Observational Study
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, con...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Pvt. Ltd.
2015-04-01
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| Series: | Indian Journal of Neonatal Medicine and Research |
| Subjects: | |
| Online Access: | http://www.ijnmr.net/articles/PDF/2035/1-%2013361_F(P)_PF1(PNJ)_PFA(AK).pdf |
| Summary: | 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. |
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| ISSN: | 2277-8527 2455-6890 |