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Abstract
Aim of this work is to study the N.CPAP and determine the efficacy of N.CPAP versus the efficacy of theophylline in the treatment of apnea of prematurity and also determine the efficacy of N.CPAP versus ET.CPAP in the treatment of respiratory distress in preterm neonates.
The current study comprised 40 preterm neonate (with gestation age ? 37 wks), selected consecutively from Z.U.H. and were divided to 2 groups with inclusion criteria: preterm neonates (< 37 weeks) with development of respiratory distress or apnea of prematurity.
Group I: included 20 preterm neonates with apnea half of them treated with theophylline (subgroup IA) and another half treated with N-CPAP (subgroup IB).
Group II: included 20 preterm neonates with respiratory distress half of them treated with N.CPAP (subgroup IIA) and another half treated with ET.CPAP (subgroup IIB).
All neonates were subjected to full history taking, clinical examination and full investigation. Also continuous monitoring measures in our NICU were done for every neonate in the study.
A follow up was caring out for them for one week after discontinuing the treatment.
The exclusion criteria:-
1. Congenital anomalies.
2. Birth trauma.
3. Any medication for mother.
4. Other neonatal illness as (sepsis, infection, bleeding disorder,…..) depending on clinical and laboratory investigation as (CBC, CRP, Blood culture,…..).
The mean birth weight was (1.69 ± 0.19) kg, in subgroup IA versus (1.56 ± 0.4) kg, in subgroup IB, and was (1.6 ± 0.4) kg, in subgroup IIA versus (1.76 ± 0.69) kg, in subgroup IIB.
The mean gestational age was (32.7 ± 1.6) wks in subgroup IA versus (31.9 ± 1.7) wks in subgroup IB and was (31.9 ± 1.9) wks, in subgroup IIA versus (33.1 ± 2.2) wks in subgroup IIB. There were (11 males and 9 females) in group I, (12 males and 8 females) in group II.
In group I half of preterm neonates with apnea treated with theophylline with loading dose 5mg/kg/dose and maintance dose 2 mg/kg/6 hrs while the other half treated with N.CPAP with pressure level 5 cm H2O, FiO2 0.6, flow 6L/min as primary setting and changed according to the condition.
In group II half of preterm neonate with respiratory distress (RD) treated with N.CPAP with pressure level 4-5 cm H2O, FiO2 0.6 and flow 6 L /min as primary setting and changed according to the condition while other half treated with ET.CPAP with pressure level 4-5 cm H2O, FiO2 0.6 and flow 6 L /min as primary setting and changed according to the condition.
Frequent blood gases were done and comparison between the pre and post treatment blood gases and clinical condition were recorder in each group.
Our result were:
In subgroup IA: (apnea with theophylline) after treatment blood gases showed significant improvement where pH was less acidic, CO2 retention decreased and PO2 increased. Also the apneic attacks/day showed significant decreased. However in subgroup IB (apnea with N.CPAP) there was no significant difference in blood gases pre and post treatment and the apneic attacks /day showed non significant increased.
In subgroup IA (9) out of (10) respond to treatment (i.e. no attack of apnea) and there were no cases not respond to treatment. However in subgroup IB, there were (2) out of (10) respond to treatment while (8) out of (10) cases not respond to treatment and so the mode of treatment was changed to IMV.
In subgroup IIA (RD with N.CPAP) there were significant increased in PH and decreased in PCO2. There was highly significant increased in PCO2 after treatment in subgroup IIA. However there was no significant difference in HCO3 pre and post treatment. In subgroup IIB (RD with ET. CPAP) there were no significant difference in PH, PO2 and HCO3 pre and post treatment. However PCO2 was highly significant increased (more CO2 retention) after treatment.
In subgroup IIA (6) out of (10) cases respond to treatment (improved) and (3) out of (10) cases not respond to treatment, so the mode of treatment was changed to IMV, while in subgroup IIB only (1) out of (10) cases respond to treatment and (8) out of (10) cases not respond, so the mode of treatment was changed to IMV.
There was (1) out of (10) cases died in subgroup IA due to sepsis, no cases died in subgroup IB, (1) out of (10) cases died in subgroup IIA due to sepsis and (1) out of (10) cases in subgroup IIB died due to sudden cardiac arrest and not respond to resuscitation.
Conclusion:
In preterms with recurrent apnea, treatment with theophylline result in significant improvement in their blood gases where pH becomes less acidic, CO2 retention decreased and PO2 increased, also apneic attacks were significantly decreased, 90 % of them improved in contrast to the preterms treated with N.CPAP showed no significant improvement in their blood gases and increased in the apneic attacks and only 20% of them improved clinically. On the bases of the reported data in the present study we can conclude that N.CPAP is less effective than theophylline in apnea of prematurely.
In preterms complaining of respiratory distress mainly RDS, treated with N.CPAP showed significant improvement in their blood gases, while (20%) of them showed nasal tip necrosis (60%) of them improved clinically. Treatment with ET.CPAP results in more complications, where (40%) had sepsis, (40%) had pneumonia, (10%) had pneumothorax. Only (10%) of them improved clinically so we can conclude that N.CPAP is more effective than ET.CPAP in respiratory distress of preterm.