Usefulness of Downe Score as clinical assessment tool and Bubble CPAP as primary respiratory support in neonatal respiratory distress syndrome

Abstract

Background: In preterm neonates respiratory distress syndrome (RDS) is one of the common causes of morbidity and mortality. Application of Bubble CPAP has been shown to be beneficial in terms of reduced need of invasive ventilation and prolonged hospital stay in newborns with RDS. Objective: Present study was conducted to assess the outcome of Bubble CPAP in newborns and usefulness of Downe score in predicting outcome and use as an assessment tool by medical/ nursing staff in resource limited setup. Method: We conducted this prospective study to evaluate effectiveness of Bubble CPAP as primary mode of respiratory support in resource limited setup of periphery with Downe score used as one of the tool to assess response to treatment. The study was conducted from November 2010 to February 2012 and based on inclusion criteria a total of 75 newborns were enrolled. Results: CPAP failure was observed in37.3% of preterm babies with RDS. Chest X ray suggestive of severe RDS, Downe score > 6 at 15-20 minutes of starting CPAP and sepsis/pneumonia was significantly associated with CPAP failure and also were independent predictors of outcome. Area under curve (AUC) for Downe score at 15-20 minutes of starting CPAP was 78.5% (95% CI = 67.9 to 89.1) Conclusion: Bubble CPAP was found to be effective and safe mode of treating mild to moderate RDS and Downe score can be used at periphery to monitor response and to decide about referral in absence of sophisticated test. Keywords: Bubble CPAP, Downe score, Predictors of CPAP failure

Keywords

• Bubble CPAP, Downe score, Predictors of CPAP failure

References

1. Bhakoo ON. Assisted ventilation in neonates: The Indian Perspective. Indian Pediatr 1995; 32: 1261-1264.
2. Nangia S, Saili A, Dutta AK, Gaur V, Singh M, Seth A, et al. Neonatal Mechanical Ventilation-experience at a level II care centre. Indian J Pediatr 1998; 65: 291-296.
3. Engle WA. Surfactant Replacement therapy for Respiratory Distress in Preterm and Term Neonate. Paediatrics 2008; 121: 419-432.
4. Taeusch HW, Ramierez-Schrempp D, Laing IA. Surfactant Treatment of Respiratory Disorders. In: Taeusch HW, Ballard RA, Gleason CA, eds. Avery’s disease of the newborn.8th ed. Philadelphia, 2005; 46: 670AARC Clinical Practice Guidelines. Surfactant Replacement Therapy. Respir Care 1994; 39: 824-829.
5. Lee KS, Dunn MS, Fenwick M, Shennan AT. A comparison of underwater bubble continuous positive airway pressure with ventilator-derived continuous positive airway pressure in premature neonates ready for extubation. Biol Neonate 1998; 73(2):69-75.
6. J Koti J, Murki S, Gaddam P, Reddy A, Reddy MD. Bubble CPAP for RDS in preterm Infants. Indian Pediatr 2010; 47: 139-143.
7. Prasanth SU, Khan F, Maiya PP. Bubble CPAPprimary respiratory support for respiratory distress syndrome in Newborns. Indian Pediatr 2009; 46: 409-411. Lanieta K, Joseph K, Josiah D, Samantha C, Trevor D. An evaluation of Bubble CPAP in neonatal unit in a developing country: effective respiratory support that can be applied by nurses. J trop Pediatr 2006; 52: 249-253.
8. National Neonatology forum, India. Evidence based clinical practice guidelines. October 20 http://www.nnfi.org/images/pdf/nnf_cpg_consolidated_file -January102011.pdf (accessed on June 5, 2011).

9. Vidyasagar D, Velaphi S ,Bhat VB. Surfactant Replacement Therapy in Developing Countries. Neonatology 2011; 99: 355-366.
10. AIIMSNICU protocols 200Protocol for administering continuous positive airway pressure in neonates. http://www.newbornwhocc.org/pdf/cpap_310508.pdf
11. (accessed on October 5, 2011).
12. National Neonatology forum, India. Clinical practice guidelines. http://nnfpublication.org/uploads/Articles/f6479a2b-32a34892-9620-8904c21b0644.pdf (accessed October 10, 2011).
13. WINPEPI software available free fromhttp://www.brixtonhealth.com/pepi4windows.html Boo NY, Zuraidh AL, Lim NL, Zulfiqar MA. Predictors of failure of nasal continuous positive airway pressure in treatment of preterm infants with respiratory distress syndrome. J Trop Pediatr 2000; 46: 172-175.
14. Ammari A, Suri M, Milisavljevic V, Sahni R, Batman D, Sanocka U, et al . Variables associated with the early failure of nasal CPAP in very low birth weight infants. J Pediatr 2005; 147: 341-347.
15. Mrinal SP, Mari JS, Kalavani M, Agarwal R, Vinod KP, Deorari AK. Clinical prediction score for nasal CPAP failure in preterm VLBW neonates with early onset respiratory distress. J Trop Pediatr 2011; 57: 274-279.