The Use of bubble nasal CPAP in the management of IRDS -A Case report and literature review

Abstract

Abstract: A one hour old baby boy presented to the Special Care Baby Unit (SCBU) of the Ahmadu Bello University Teaching
Hospital (ABUTH), Shika, Zaria, on account of respiratory distress noticed from birth. He was a product of supervised pregnancy,
delivered at 37 weeks gestation via emergency caeserien section performed due to severe pre eclampsia and fetal distress.
APGAR scores were 2 and 7 at one and five minutes respectively. He weighed 1850 grams and was found to be dusky, inactive, hypothermic (T = 35.50C) and in severe respiratory distress (SPO2 ranged between 60 % and 72 %). He was tachypnoeic with respiratory rate persistently above 80 cycles/ min, and had reduced air entry in the mid and lower zones of the lungs bilaterally with wide spread coarse crepitations. A diagnosis of perinatal asphyxia was entertained with differential diagnoses of pulmonary hypoplasia, hyaline membrane disease and group B streptococcal (GBS) pneumonia. He had a full sepsis screen including chest radiograph and was commenced on supplemental oxygen via nasal cannula, antibiotics and other supportive measures. The patient however continued to have laboured breathing and subsequently had an apnoeic attack. He was resuscitated and commenced on bubble nasal CPAP. He did remarkably well and was weaned off CPAP after a total of 60 hours. A repeat chest radiograph showed remarkable aeration of the lungs as against an earlier one which showed a reticulogranular (ground glass) appearance.

Keywords: Neonates, Respiratory distress, Bubble nCpap, Downes score.