title: A Randomized Trial Comparing Efficacy of Bubble and Ventilator Derived Nasal CPAP in Very Low Birth Weight Neonates with Respiratory Distress.
abstract: BACKGROUND
  Continuous Positive Airway Pressure (CPAP) has an established role in the care of Very Low Birth Weight (VLBW) babies with respiratory distress. Bubble CPAP (BCPAP) is a cheap alternative for countries where resources are limited. However, data comparing efficacy of BCPAP with conventional ventilator derived (VCPAP) is limited.
  
  
  OBJECTIVE
  To compare CPAP failure rates between BCPAP and VCPAP among VLBW, with moderate respiratory distress. Secondary objectives were to compare the rates of Intraventricular Haemorrhage (IVH), pulmonary air leaks and deaths between the two groups and determine the predictors of CPAP failure.
  
  
  METHODS
  VLBW babies with moderate respiratory distress (Silverman Anderson score 4-7), born or admitted in Neonatal Intensive Care Unit (NICU) within 28 days of life were randomized to receive either BCPAP (n=34) or VCPAP (n=34). CPAP failure rate in both the groups was compared.
  
  
  RESULTS
  The baseline characteristics were similar in both the groups. Five out of 34 (14.70%) babies in BCPAP group and 11 out of 34 (32.35%) in VCPAP failed CPAP (p=0.08). IVH (BCPAP group 24% and VCPAP group 9%, p= 0.10) and mortality (BCPAP group 6% and VCPAP group 9%, p=0.642) were comparable in both the groups. Factors such as gestational age <30 weeks, weight <1000 grams, Respiratory Distress Syndrome (RDS), shock, pulmonary haemorrhage, Disseminated Intravascular Coagulation (DIC) and multi-organ dysfunction were significantly associated with CPAP failure in our study.
  
  
  CONCLUSIONS
  The CPAP failure rates in VLBW babies with moderate respiratory distress were found to be similar whether bubble CPAP or ventilator CPAP was used. There was no difference in complication rates of IVH or mortality with either method of CPAP.
authors: Assistant Professor, Department of Pediatrics, PGIMER and Dr. RML Hospital , Delhi, India .
authors: Sheetal
authors: S
authors: Agarwal
authors: Head, Department of Neonatology, PGIMER and Dr. RML Hospital , Delhi, India .
authors: Arti
authors: A
authors: Maria
authors: Senior Resident, Department of Pediatrics, PGIMER and Dr. RML Hospital , Delhi, India .
authors: Mahesh K
authors: MK
authors: Roy
authors: Senior Resident, Department of Pediatrics, PGIMER and Dr. RML Hospital , Delhi, India .
authors: Ankit
authors: A
authors: Verma
keywords: Failure rate; Newborn; Pressure delivery system