Continuous Positive Airway Pressure for Spontaneously Breathing Premature Infants with Respiratory Distress Syndrome

To analyze the outcome of inborn preterm neonates with respiratory-distress-syndrome(RDS), using the approach of administering nasal-continuous-positive-airway-pressure(CPAP) alone and administering surfactant only if they require mechanical ventilation(MV). All preterm neonates diagnosed as RDS from 01-May-2006 to 10-July-2010 were prospectively enrolled for the study at a referral centre in India. Nasal-CPAP alone was administered to all spontaneously breathing neonates. Surfactant was administered in babies < 28 wk gestational age if the baby was intubated for resuscitation at birth. For the remaining babies, surfactant was administered if the baby required ventilation for RDS in first 72 h. The primary outcome assessed was survival to discharge. Of the 83 babies with RDS, 33(39.76%) neonates needed MV of which one baby was transferred due to non-availability of ventilator. Of the remaining 32 babies administered MV, 31 were administered surfactant. Fifty (61.24%) babies were managed with CPAP alone. Overall, 72/82(87.8%) babies managed at the authors' center survived the neonatal period, and 71/82(86.8%) babies were discharged to home. Among the neonates who were ventilated, 26/32(81.25%) survived the neonatal period, and 25/32(78.12%) were discharged home. Among the babies receiving CPAP, 46/50 (92%) survived and were discharged to home. Institution of CPAP alone in all spontaneously breathing preterm babies with RDS and administration of surfactant to only those needing MV reduces the need for intubations and surfactant administration without affecting the outcome adversely. Extreme preterms with RDS, however, may be given surfactant if they happen to be intubated for resuscitation at birth.