1. CPAP Murila fv

2. Respiratory distress syndrome 28% of neonatal deaths are due to prematurity The most common respiratory disorder in the preterm is Respiratory distress syndrome due to lack of surfactant Typically affects preterm infants below 35 weeks Increase in the alveolar surface tension and a tendency for alveolar collapse, progressive atelectasis and reduced compliance Treatment –Surfactant,CPAP, mechanical ventilation

3. Mechanical Ventilation Expensive Expertise Chronic lung disease Intraventricular haemorrhage

4. - CPAP(Continuous positive airway pressure) A positive pressure applied to the airways of a spontaneously breathing baby throughout the respiratory cycle First used in the 1970s Splints the upper airway and decreases obstruction and apnoea Expansion of the lungs and prevents alveolar collapse In so doing, it reduces protein leak and conserves surfactant It maintains positive pressure in the airways during spontaneous breathing hence increasing functional residual capacity and improving oxygenation in infants with RDS

5. Nasal CPAP Nasal CPAP is gas delivered under a low pressure into the nose. CPAP is used to treat: 1.Respiratory distress 2.Apnoea of prematurity 3.Weaning from ventilation 4.Upper airway obstruction 5. May help in the management of pulmonary oedema

6. Effects of Cpap It increases the lung volume It reduces atelectasis It conserves surfactant It regularises the respiratory rate It reduces the incidence of apnoea When used after extubation it reduces the chance of reintubation Reduces work of breathing It supports the nasopharyngeal airway It improves compliance It lowers resistance It reduces pulmonary oedema

7. Technique of CPAP CPAP single nasal tube Bi-nasal prongs. CPAP is supplied using - a ventilator set on the CPAP mode, - “bubbling bottle” system - Neopuff device

8. Initiation of CPAP Usual Range 3 – 8cm H20 Pressure 5-6 cm H2O Increase as necessary to improve oxygenation Max 8-10 CM H2O Clinical state,CXR, Blood gases 30-60min

9. Weaning No exact Science Assess saturation,apnoea,bradycardia, work of breathing FIO2<0.40 Wean by 1cm steps till Pressure 5cm or less Onto low flow oxygen

10. Failure of CPAP Increasing apnoea Rising Fio2>60% oxygen PaCO2>60mmHg Ph>7.25

11. Complications of CPAP Displacement,blockage by secretions Kink Alveolar overdistension- - pneumothorax - reduced tidal volumes leading to CO2 retention - increased work of breathing, - impaired systemic venous return,decreased cardiac output,renal dysfunction CPAP belly bowel distension, swallowed air, distended loops So always have NG tube No link to nec Nasal trauma

12. Coin Study 1999-2006 Australia,New Zealand,Canada, US 610 gestation 25-28 weeks CPAP or Intubation CPAP - fewer ventilation days - 46% failed and needed mechanical ventilation

13. Kijabe study Dr Omoding(2012) 61 preterm neonates The median duration of Bubble CPAP treatment was 5 days (IQR 3 to 7 days) No report of the major complications

14. CPAP Relatively cheap Easy to use Complications few Saves lives

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