2003 OPEN FORUM Abstracts
BUBBLE CPAP VERSUS INFANT FLOW CPAP IN NEONATES
Raymond Malloy RRT, Brian Glynn RRT, Susan Pullar RRT, Kelly Delaney RRT, Jay Greenspan MD. Departments of Pulmonary Care and Neonatology, Thomas Jefferson University Hospital, Philadelphia, PA.
BACKROUND: At Thomas Jefferson University Hospital, the normal procedure for premature infants 32 weeks gestation with respiratory distress syndrome is to start Continuous Positive Airway Pressure (CPAP) within the first twelve hours of life. Infants who meet this criterion are treated with Bubble CPAP device or an Infant Flow device with a CPAP level of + 5 cm h20 and a Fi02 to maintain adequate Sp02's between 88%- 92%. HYPOTHESIS: We hypothesized that the weight loss during the first week of life is less with the Infant Flow device since the work of breathing (WOB) or abdominal distention should be less secondary to decrease resistance and continuous flow during exhalation.
Methods: Newborns of gestational ages less than or equal to 32 weeks gestation with respiratory distress were ordered CPAP + 5 cmh20 and were placed on either bubble CPAP or Infant Flow CPAP and managed as per protocol. Surfactant was given if CPAP failed and the patient required intubation.
RESULTS: 14 Infants were studied with a mean gestational age of 27.8 weeks for Bubble CPAP and 28.5 weeks gestation for Infant Flow infants. The average days spent on Bubble CPAP was 8.7. The average days spent on Infant Flow was 7.75. In a 7 day period there was an average loss in weight of 122.5 grams with Bubble CPAP and an average loss in weight of 51.75 grams for Infant Flow CPAP babies. There were 2 Bubble CPAP failures (1 infant was intubated and 1 infant went to Infant Flow CPAP) and 0 Infant Flow CPAP failures.
CONCLUSION: We conclude that there is a trend in weight loss in the first week of life with Bubble CPAP possibly due to an increase in expiratory resistance from the continuous flow therefore increasing the work of breathing or increasing swallowing of air. Further monitoring and data collection needs to continue to increase the sample size.