Outcome of Continuous Positive Airway Pressure (CPAP) Administration in Delivery Room for Neonates with ≧35 Weeks of Gestational Age with Respiratory Distress: A Randomized Control Trial in a Tertiary Care Hospital

Abstract

The sixth edition of Neonatal Resuscitation program (NRP 2011) recommends the use of delivery room Continuous Positive Airway Pressure (DR CPAP) for neonates with respiratory distress in the delivery room irrespective of gestational age. However, there is no convincing evidence of benefit of DR CPAP amongst late preterm and term neonates.

Methodology

This single center, open label, randomized control trial was carried out in a tertiary care teaching hospital. Neonates delivered with GA ≧ 35 weeks developing labored breathing in the delivery room or requiring free flow oxygen to maintain SPO₂ in target range were randomized to receive DR CPAP or free flow oxygen (DR FFO). The early neonatal outcome in the DR, and for those requiring NICU admission, was recorded.

Results

131 neonates were enrolled in the study, 62 (47.32 %) neonates were randomized to DR CPAP while 69 (52.67 %) to DR FFO group. There was no statistically significant difference observed among neonates from both groups who improved in the DR (P value:.55) or those shifted to NICU in view of respiratory distress (P value:.54). There was no significant difference in the modified Downes score amongst 2 groups at the time of NICU admission (P value:.39).

Conclusion

This randomized control trial showed no significant difference in the delivery room or early neonatal outcome after the administration of DR CPAP or FFO amongst neonates with gestational age ≧ 35 weeks presenting with respiratory distress. Robust evidence needs to be generated to support the current recommendation of administering DR CPAP irrespective of gestation age.