# Bubble CPAP Therapy in Newborns With Respiratory Distress With Its Outcome—A Prospective Observational Study From a Neonatal Intensive Care Unit of Tertiary Care Hospital in Western Nepal

## TL;DR

This study examines the effectiveness of bubble CPAP therapy in treating respiratory distress in newborns at a hospital in Nepal, finding a moderate success rate and identifying common causes of distress.

## Contribution

The study provides real-world data on bubble CPAP outcomes in a low-resource setting, highlighting success rates and common neonatal conditions in Nepal.

## Key findings

- 68.9% of neonates on bubble CPAP therapy were successful, while 31.1% failed.
- Birth asphyxia, respiratory distress syndrome, and prematurity were the leading causes for CPAP initiation.
- Mortality was higher among CPAP failure cases (67.9%) compared to survivors.

## Abstract

Respiratory distress is one of the most common reasons for the admission of neonates to the NICU in low and middle-income countries (LMICs) like Nepal, where bubble CPAP therapy is one of the most emerging and first-line treatments.

The aim is to study the various indications of bubble CPAP therapy in neonates with respiratory distress in different clinical conditions, success and failure rates, and outcomes.

A prospective observational study was conducted for 17 months (Oct 2021–Feb 2023) at Universal College of Medical Sciences, Bhairahawa, Nepal, where 90 neonates with respiratory distress were enrolled and kept on bubble CPAP therapy. Various clinical conditions of CPAP use were observed along with success and failure rates. The final outcome was documented as discharge or death occurred.

A total of 90 babies with respiratory distress required CPAP therapy, where 53.3% were preterm, 44.4% term, and the rest postterm. About 32.2% of neonates had birth asphyxia, 16.7% had respiratory distress syndrome (RDS), 14.4% of cases had prematurity, and 12.2% had meconium aspiration syndrome. The study found a significant mean difference in Silverman score (in preterms) and Downe's score (in terms) before and after 6 h of CPAP (p < 0.001 in each) and 12 h of life (p < 0.001 in each). Out of the total enrolled babies, 67 (74.4%) neonates survived whereas 25.6% had mortality. The present study showed CPAP success and failure rates of 68.9% and 31.1%, respectively. Out of total CPAP failure rate (n = 28) babies, 67.9% had mortality and 32.1% were successfully discharged. No significant association of CPAP failure was seen when compared to gender, religion, gestational age, mode of delivery, resuscitation received, various indications of CPAP use, use of antenatal steroid, and duration of initiation of CPAP.

Birth asphyxia, respiratory distress, and prematurity were three leading causes of respiratory distress for the initiation of CPAP in the present study.