Can Higher PEEP and FiO2 with Bubble CPAP Reduce Need for Invasive Ventilation in Preterm Babies with Respiratory Distress Syndrome?

Lata Bhat, Kavita Khanijo, Supriya Bisht, Amit Wadhawan, Mahendra Singh and Vishnu Bhat

Objectives: To evaluate the clinical course and outcome in preterm babies with RDS using higher PEEP and FiO2 as appropriate on bubble CPAP as the primary mode of respiratory support. CPAP failure and oxygen requirement by 28 days of life were primary outcome. Incidence of pneumothorax, hypotension, NEC, IVH and ROP and survival till discharge were thesecondary outcomes measured.
Method: Preterm babies (gestation 26 to 36 weeks) admitted to tertiary level NICU (both inborn and outborn) with RDS were managed with bubble CPAP as a primary mode of respiratory support. Higher pressure upto 8-10 cm of water and FiO2 upto 80-100% was given (if required) during CPAP.
Results: Total 73 neonates were studied, out of which 52% received antenatal steroids and 54.8% received surfactant. Overal CPAP success rate was 95.9% with success in severe, moderate and mild RDS cases 84.6%, 97.5% and 100% respectively. Among <28 week age-group, 85.7% cases were successful. Peak CPAP pressure of ≥ 8cm water was given to 21.4% babies in success group.
 Conclusions: Bubble CPAP may be considered as a primary mode of respiratory support in RDS even in very preterm and ELBW babies irrespective of the severity. Early CPAP and surfactant, peak pressure upto 8-10 cm H2O and FiO2 100% with trained and committed staff with 1:1 care can lead to higher success rate. CPAP is safe even in very preterm infants with RDS and associated with lesser lung injury and other complications.