Outcome of preterm newborns admitted with respiratory distress in relation to time of initiation of CPAP

Abstract

Background

Respiratory distress is a frequent complication in preterm infants, often requiring respiratory support. Respiratory distress syndrome (RDS), caused by surfactant deficiency in the immature lung, is the predominant etiology in this population. Continuous positive airway pressure (CPAP) is a common intervention, but the optimal timing of CPAP initiation remains less clearly defined in the late preterm population (33–36 weeks gestation). This study aimed to determine the outcomes of preterm newborns with respiratory distress in relation to the timing of CPAP initiation.

Methods

This prospective observational study was conducted at a tertiary NICU in central India and enrolled 170 preterm newborns (gestational age 28–36 weeks, birth weight <1800 g) with respiratory distress over 18 months. Infants were categorized as Early CPAP (initiated within 30 min of birth, n = 121) or Late CPAP (after 30 min, n = 49). Primary outcome was need for mechanical ventilation; secondary outcomes included mortality, CPAP duration, surfactant use, and length of hospital stay.

Results

The mortality rate was lower in the early CPAP group compared to the late CPAP group (13.2% vs 24.5%), though this difference did not reach statistical significance on unadjusted analysis (χ² = 3.218, p = 0.073). After adjustment for gestational age and disease severity, early CPAP initiation was independently associated with lower odds of mortality (aOR = 0.34, 95% CI: 0.13–0.89, p = 0.027). Median CPAP duration was significantly longer in the early CPAP group (48.0 vs 24.0 h; p = 0.027). Length of hospital stay was also significantly longer (14 vs 8 days; p = 0.014), while mechanical ventilation duration did not differ significantly (p = 0.140).

Conclusion

Early CPAP initiation in preterm newborns with respiratory distress was associated with lower mortality after adjustment for gestational age and disease severity, although the unadjusted analysis was not statistically significant. These findings suggest a potential benefit of early CPAP initiation in resource-limited settings.