# Effectiveness of Delivery Room Continuous Positive Airway Pressure in Term Neonates With Respiratory Distress: A Single-Center Experience

## TL;DR

This study shows that using CPAP right after birth helps term newborns with breathing issues, reducing the need for ventilation and NICU stays.

## Contribution

The study provides evidence for the effectiveness of immediate delivery room CPAP in term neonates with respiratory distress.

## Key findings

- 76% of neonates recovered within 30 minutes of DR-CPAP.
- Only 7.5% of admitted neonates required CPAP, and no complications like pneumothorax were observed.
- Delayed breastfeeding was significantly associated with NICU admission.

## Abstract

Background

Neonatal intensive care unit (NICU) admission can represent a critical period for full-term newborns and may reflect underlying health needs. Continuous positive airway pressure (CPAP), a noninvasive method of respiratory support, is now widely used to prevent and treat respiratory distress. CPAP aims to minimize reliance on mechanical ventilation, allow earlier intervention, and reduce both NICU admissions and overall hospital stay.

Methods

This retrospective descriptive study was conducted over seven months (November 2023 to May 2024) at a tertiary care hospital. Inborn, spontaneously breathing term neonates (gestational age ≥36 weeks + 6 days to <41 weeks + 6 days) with a Modified Downe’s score >3 and <7 at birth were included. Neonates with major anomalies, intubation at birth, prolonged positive-pressure ventilation, or genetic syndromes were excluded. Delivery room CPAP (DR-CPAP) was applied at FiO₂ 30% (titrated) and PEEP 5 cm H₂O for up to 30 minutes. The primary outcome was improvement or deterioration of labored breathing, as measured by the Modified Downe’s score, after DR-CPAP. Secondary outcomes included duration of respiratory support, NICU stay, and complications (e.g., air-leak syndrome). Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2018; IBM Corp., Armonk, NY, USA): continuous variables were reported as mean ± SD, categorical variables as frequencies (%), and associations tested using chi-square or t-tests, with p < 0.05 considered significant. Given a 20% expected NICU admission rate, a sample size of 90 neonates provided approximately 80% power to detect a 15% difference at α = 0.05.

Results

Ninety-three neonates were included (male: 49 (53%); female: 44 (47%)). Seventy-one of 93 (76%) recovered within 30 minutes of DR-CPAP, while 22 (24%) required NICU admission; none required mechanical ventilation. Among admitted neonates, only seven (7.5% of the total) required CPAP, and the remaining 15 received free-flow oxygen via hood or nasal prongs. No complications, such as pneumothorax, were observed. A significant association was found between delayed initiation of breastfeeding (>1 hour) and NICU admission (p < 0.01). Gestational age, sex, meconium-stained liquor, weight at admission, and mode of delivery were not significantly associated.

Conclusions

Our study demonstrates that DR-CPAP is an effective intervention for term neonates experiencing respiratory distress syndrome. This approach significantly reduced the need for subsequent mechanical ventilation and the duration of NICU stay in our single-center experience. The early application of CPAP immediately post-delivery can be safely implemented in resource-limited settings to improve neonatal outcomes.