ISSN - 0973-0958

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Bubble CPAP in the Management of Respiratory Distress Syndrome in Resource Constrained Settings: The Luth Experience
Beatrice Ezenwa, Patricia Akintan, Iretiola Fajolu, Jejelola Ladele, Chinyere Ezeaka.
Neonatology unit,Department of Pediatrics, Lagos University Teaching Hospital, Lagos, Nigeria.
Respiratory distress syndrome (RDS) is a common health problem especially in preterm newborns. In Nigeria, prematurity accounts for about 25% of neonatal mortality and RDS have been identified as the major cause of these deaths. The major problem in RDS is immaturity of the lungs with deficiency of surfactant. Surfactant reduces surface tension in the alveoli, thereby preventing collapse of the lungs during expiration. Bubble continuous positive airway pressure (bCPAP) is a low cost intervention that delivers continuous distending pressure on alveoli thus preventing collapse during expiration.
Objective: To describe the experience in the use of bubble CPAP in the neonatal unit of Lagos University Teaching Hospital (LUTH) and to determine the outcome and efficacy of improvised bCPAP in the management of babies with respiratory distress syndrome.
Study design: Retrospective observational study
Subjects: Inborn preterm infants (gestation 25 to 34 weeks) admitted to the Neonatal Intensive Care unit (NICU) and managed for respiratory distress and with chest X- ray findings of RDS.
Intervention: Improvised bCPAP
Results: Forty-two subjects who were diagnosed with RDS were recruited into the study. Oxygen saturation was monitored in all babies and there were significant differences in mean oxygen saturations pre- and post-CPAP commencement from a mean of 82.93±4.07 to 94.±1.11 (p=0.02). Thirty-two babies were successfully weaned off CPAP with overall CPAP success rate of 76.2%. There were ten RDS specific mortality with case fatality rate of 23.8% during the study period. The mean birth weight of survivors were higher (1435.4g) compared to those who died (963.4g), p<0.05. Babies that died had lower mean gestational age (27.8 weeks) than those that did not (30.3 weeks) though this was not statistically significant (p >0.05).
Conclusion: Improvised bCPAP is a simple and cost effective intervention that can be used in resource limited settings to treat RDS in preterm babies and reduce morbidity and mortality due to surfactant deficiency.

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