• Osama Anwaar Allama Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot
  • Mudassar Hussain Allama Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot
  • Maria Shakeel Allama Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot
  • Mirza Muhammad Ahsan Baig Allama Iqbal Memorial Teaching Hospital/Khawaja Muhammad Safdar Medical College Sialkot


Background: Nasal continuous positive pressure has been used for management of respiratory distress in neonates in various conditions as a primary modality. Objective of the study is to evaluate the frequency of improved outcome and complications of use of nasal CPAP through infant flow drivers in neonates with respiratory distress. The study was conducted from 2nd April 2017 to 2nd October 2017 in neonatal intensive care unit of Allama Iqbal Memorial Teaching Hospital Sialkot. Methods: All neonates with respiratory distress fulfilling the clinical criteria (Neonates with gestational age 28 weeks to 40 weeks having clinical signs of respiratory distress classified according to down score (tachypnea, grunting, decreased air entry, cyanosis, recessions), neonates having pc02 <60 mmhg, neonates having x-ray findings consistent with respiratory distress syndrome (RDS), Transient tachypnea of newborn (TTN) and pneumonia) were included in the study. Nasal CPAP was used at variable settings. Outcome, complications, indications, associated diseases and hospital stay along with other baseline characteristics were assessed. Success was defined as improvement of the respiratory distress as assessed by down score, maintenance of SPO2 above 90% in room air after weaning from CPAP for about consecutive 4 hours and normalization of blood gases while the failure as need for mechanical ventilation. Results: Total 60 neonates were included in the study. Mean weight was 2113.3±580.32 g while mean gestational age was 33.35±2.59 weeks. Total 52 (86.7%) babies were successfully weaned off from nCPAP while only 8 (13.3%) neonates required mechanical ventilation. Main indication of use of CPAP was RDS (65%). No complications were observed in 73.3% babies while 26.7% had complications of which nasal deformities accounted for 20% and abdominal distension for 6.37%. Conclusion: Nasal CPAP can be safely and easily used as primary support for neonates with respiratory distress even in resource limited developing countries. It reduces the need for mechanical ventilation and thus hospital stay.Keywords: Continuous positive airway pressure; Noninvasive ventilation; Respiratory distress Syndrome; Developing countries


Kamath BD, Macguire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics 2011;127(6):1139–46.

Shah LC, Chowdhury MA, Hoque MH, Rahman AMM. Effect of Bubble CPAP in PTLBW Neonates with Respiratory Distress. Acad J Pediatr Neonatol 2017;3(2):555609.

Diblasi RM. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respir Care 2009;54(9):1209–35.

Thukral A, Sankar MJ, Chandrasekaran A, Agarwal R, Paul VK. Efficacy and safety of CPAP in low- and middle-income countries. J Perinatol 2016;36(Suppl 1):S21–8.

De Paoli AG, Morley C, Davis PG. Nasal CPAP for neonates: what do we know in 2003? Arch Dis Child Fetal Neonatal Ed 2003;88(3):F168–72.

Haque K, Waheed K. Managing neonatal Respiratory Distress Syndrome in Pakistan: Evidence based pragmatic guidelines. Pak Pediatr Rev 2013;1(3):139–47.

Pandit PB, Courtney SE, Pyon KH, Saslow JG, Habib RH. Work of breathing during constant- and variable-flow nasal continuous positive airway pressure in preterm neonates. Pediatrics 2001;108(3):682–5.

Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012;379(9832):2162–72.

Iqbal A, Waqar T, Safdar CA, Iqbal T. Experience of nasal continuous positive airway pressure(CPAP) by Infant flow driver in a neonatal unit of a developing country. Pak Armed Forces Med J 2014;64(1):75–9.

Hameed M, Sattar S. Role of nasal CPAP in management of neonates with respiratory distress Pak Paed J 2010;34:75–9.

Bhat L, Khanijo K. Can Higher PEEP and FiO2 with Bubble CPAP Reduce Need for Invasive Ventilation in Preterm Babies with Respiratory Distress Syndrome? J Neonatal Biol 2016;5(1):1000205.

Mazzella M, Bellini C, Calevo MG, Campone F, Massocco D, Mezzano P, et al. A randomised control study comparing the Infant Flow Driver with nasal continuous positive airway pressure in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001;85(2):F86–90.

Liptsen E, Aghai ZH, Pyon KH, Saslow JG, Nakhla T, Long J, et al. Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs variable-flow devices. J Perinatol 2005;25(7):453–8.

Hameed NN, Abdul Jaleel RK, Saugstad OD. The use of continuous positive airway pressure in preterm babies with respiratory distress syndrome: a report from Baghdad, Iraq. J Matern Fetal Neonatal Med 2014;27(6):629–32.

Saxena A, Thapar RK, Sondhi V, Chandra P. Continuous positive airway pressure for spontaneously breathing premature infants with respiratory distress syndrome. Indian J Pediatr 2012;79(9):1185–91.

Romero-Maldonado S, Hernanez-Ruiz M, Perez-Valdez MT, Lopez-Perez MR, Delgado Franco D, Maida-Claros R, et al. Bubble CPAP versus Variable Flow CPAP in Preterm Newborns with Respiratory Distress: A Randomized Controlled Trial. Acad J Pediatr Neonatol 2017;5(1):555704.

Dargaville PA, Gerber A, Johansson S, De Paoli AG, Kamlin CO, Orsini F, et al. Incidence and Outcome of CPAP Failure in Preterm Infants. Pediatrics 2016;138(1):e20153985.

Robertson NJ, McCarthy LS, Hamilton PA, Moss AL. Nasal deformities resulting from flow driver continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 1996;75(3):F209–12.

Soomro T, Tikmani SS. Success of Bubble CPAP in Treatment of Respiratory Distress Syndrome in Preterm Infants. J Gen Pract 2016;4(4).

Kawaza K, Machen HE, Brown J, Mwanza Z, Iniguez S, Gest A, et al. Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi. PloS One 2014;9(1):e86327.

Kirsten GF, Kirsten CL, Henning PA, Smith J, Holgate SL, Bekker A, et al. The outcome of ELBW infants treated with NCPAP and InSurE in a resource-limited institution. Pediatrics 2012;129(4):e952–9.




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