Abstract
Objective To decide the optimum initiating pressure of nasal CPAP in newborns with respiratory distress.
Methods The study was done in neonatal intensive care unit (NICU) between November 2009 and November 2011 as a prospective randomised trial in 50 newborns with respiratory distress with Silverman Anderson score of 4–6, excluding babies with major congenital malformation, severe cardiovascular instability and frequent apnea at birth or requiring surfactant at birth. Alternate newborn enrolled was put on nasal CPAP with PEEP of 5 cm of water and FiO2 of 50% or PEEP of 7 cm of water and FiO2 of 50%. Clinical and investigative monitoring was done with X-ray chest on admission to confirm indication and repeated at 3–5 h to check lung expansion and rule out any contraindication or complication. USG Skull was done between 3–5 days to rule out intracranial hemorrhage.
Results Twenty-five babies in each group were put on nasal CPAP with starting FiO2 of 50% and PEEP of 5 cm of water in one group and FiO2 of 50% and PEEP of 7 cm of water in other group. No statistically significant difference was found between various characteristics of both groups like sex, mode of delivery, gestation and birth weight etc. All the patients survived in each group and there was no statistically significant difference between the outcomes of each group. Two patients on initial PEEP of 5 cm group failed on CPAP and three patients on PEEP 7 group failed and had to be shifted on mechanical ventilation.
Conclusions There is no difference in outcome of patients with initial PEEP of 5 cm of water or 7 cm of water. We should initiate CPAP on PEEP of 5 cm, as there is no benefit of starting at a higher PEEP of 7 cm of water; although we got a range of initiating pressure from 5 to 7 cm which is safe in newborns with respiratory distress.
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