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Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 96-100

Continuous positive airway pressure in meconium aspiration syndrome: An observational study

1 Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh, India
2 Department of Neonatology, Arpan Children's Hospital, Ahmedabad, Gujarat, India
3 Department of Pediatrics, Paramitha Children Hospital, Hyderabad, Andhra Pradesh, India

Correspondence Address:
Dr. Srinivas Murki
Department of Neonatology, Fernandez Hospital, Hyderabad, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2249-4847.154107

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Background: Continuous positive airway pressure (CPAP) as a treatment modality is well established in respiratory distress syndrome. There is still a lot of skepticism for use of CPAP in meconium aspiration syndrome (MAS). We studied the use of CPAP as a primary treatment modality in MAS and tried to identify factors predicting CPAP failure. Objectives: The aim was to identify failure rates of MAS on bubble or ventilator nasal CPAP and potential predictors of CPAP failures in MAS cases. Design: Multicenter observational analytical study. CPAP failures were compared with CPAP success for perinatal and neonatal variables. Methods: From January 2012 to May 2013, 97 babies were admitted with diagnosis of MAS, out of which 66 babies were enrolled in the study. Bubble or ventilator nasal CPAP was started if the SpO 2 in room air was <90%. CPAP failure was defined as the need for mechanical ventilation (MV). Outcome variables were compared between the MAS infants who failed CPAP and those who were successfully managed with CPAP. Results: Sixteen infants (24%) out of 66 failed to CPAP. Reasons for failure were: 10 infants had increased oxygen requirement (7 had persistent pulmonary hypertension and 3 had sepsis with multiorgan dysfunction). Two infants were ventilated for poor efforts (due to recurrent seizures), 3 (4.5%) for worsening pneumothorax and one infant for severe metabolic acidosis. Baseline variables were compared between the infants who failed CPAP and those who were successfully managed with CPAP alone. On univariate analysis, factors significantly associated with CPAP failure were out-born status, abnormal cardiotocograph, high FiO 2 at 1 h and high positive end-expiratory pressure at 1 h (P < 0.05) of starting CPAP. On logistic regression analysis, only out-born status was independently associated with CPAP failure (OR = 25, 95% CI: 1.5-300, P < 0.01) and there was a trend toward CPAP failure in infants depressed at birth (OR = 10, 95% CI: 0.9-122). Conclusion: CPAP when applied early may reduce the need for MV in newborns with moderate to severe MAS infants.

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