Success of bubble continuous positive airway pressure (bCPAP) in the treatment of respiratory distress syndrome among preterm neonates in a low-resource setting at SKBZ CMH, Muzaffarabad

Authors

  • Iqra Shoukat SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan
  • Raja Imtiaz Ahmed Azad Jammu & Kashmir Medical College (AJKMC), Muzaffarabad, Pakistan
  • Kiran Ashfaq Ahmed SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan
  • Saba Latif SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan
  • Rabbia Mehboob SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan

DOI:

https://doi.org/10.59736/IJP.24.03.1111

Keywords:

Bubble CPAP, Neonatal Intensive Care, Preterm Neonates, Respiratory Distress Syndrome, Non-Invasive Ventilation

Abstract

Background: One of the most potent technologies to be added to the list of tools of non-invasive modalities in the management of Respiratory distress syndrome is Bubble Continuous Positive Airway Pressure (bCPAP). We want to determine the effectiveness and predictors of bCPAP failure in preterm neonates with respiratory distress syndrome(RDS).

Methods: A descriptive longitudinal study was conducted at the Department of Pediatrics, SKBZ CMH, Muzaffarabad, s from November 2025 to April 2026. Non-probability consecutive sampling was used to enroll 89 preterm babies (< 37 weeks) with RDS. Infants who had severe congenital abnormalities or sepsis were not included. The bCPAP protocol was initiated at 4-5 cm  and adjusted to 7 cm  to maintain SpO2 between 90 and 94. Preventing intubation, mechanical ventilation, or rescue surfactant was considered successful. The data was analyzed using SPSS version 25, and p ≤ 0.05 was deemed significant.

Results: Sixty-nine (77.5%) of 89 preterm neonates could successfully be treated with bCPAP while 20 (22.5%) failed to be treated with bCPAP successfully. The mean gestational age was 32.32 ± 2.79 weeks and the mean birth weight was 1718.5 ± 453.2 g. There was no significant difference between sex and treatment outcome (p = 0.913). Likewise, the severity of RDS did not significantly correlate with failure to use of bCPAP (p = 0.888), nor did maternal antenatal comorbidities (p = 0.519). Lower gestational age and lower birth weight were significantly related to failure of bCPAP; sex and severity of RDS were not independently predictive of bCPAP failure in the illustrative predictor analysis.

Conclusion: In this low-resource setting, bCPAP was successful in providing respiratory support in about three-fourth of the preterm neonates with RDS. The relationships of treatment failure with neonatal maturity and birth weight were potentially but not definitely associated

Author Biographies

  • Iqra Shoukat, SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan

    Department of Pediatrics

  • Raja Imtiaz Ahmed, Azad Jammu & Kashmir Medical College (AJKMC), Muzaffarabad, Pakistan

    Department of Pediatrics

  • Kiran Ashfaq Ahmed, SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan

    Department of Pediatrics

  • Saba Latif, SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan

    Department of Pediatrics

  • Rabbia Mehboob, SKBZ Combined Military Hospital (CMH), Muzaffarabad, Pakistan

    Department of Pediatrics

References

Ekhaguere OA, Okonkwo IR, Batra M, Hedstrom AB. Respiratory Distress Syndrome Management in Resource-Limited Settings: Current Evidence and Opportunities in 2022. Front Pediatr. 2022; 10:961509.

Bashir J, Ahmed Z, Ghafoor M, Hussain M, Zaman S, Babar MW. Frequency of Respiratory Distress Syndrome in Preterm Infants Delivered at Pak Emirates Military Hospital, Rawalpindi. Pak Armed Forces Med J 2022;72(4):1314-17.

Pattnaik P, Adebisi K, Lee B. Neonatal respiratory distress syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026.

Fatima T, Riffat O, Azhar F, Adeel M, Sikander I, Rani S. Comparison of Nasal Continuous Positive Airway Pressure and Heated Humidified High Flow Nasal Cannula in Premature Neonates with Respiratory Distress Syndrome. Esculapio. 2025;21(1):80-5.

Haq W, Naz N, Taj S, Arsh, Bhittani R. Impactofantenatalsteroid administration on neonatal respiratory outcomes. Biol Clin Sci Res J. 2024;2024(1):692.

Khan M, Ali H, Azmatullah M, Din N. Evaluation of neonatal respiratory support outcomes in local population: from surfactant therapy to high-frequency ventilation—a retrospective cohort study. Biol Clin Sci Res J. 2024;2024(1):1190.

Aftab M, Roshan E, Hayyat K, Uzair M, Mateen M, Javed S. Role of bubble continuous positive airway pressure (CPAP) in respiratory distress in preterm neonates. Pak J Intensive Care Med. 2025;5(1):42.

Pak A, Sci I, Zia J, Zaman N, Zafar A, Mumtaz H, et al. 41 premature neonates with respiratory distress syndrome. Ann PIMS-Shaheed Zulfiqar Ali Bhutto Med Univ. 2022.

Department PD. Multiple Indicator Cluster Survey (MICS) 2020-21: Azad Jammu & Kashmir. Muzaffarabad: Department PD; 2021.

Irum Q, Ammara A, Anam Z, Komal W, Manahil H, Ahsen F. Effect of surfactant administration in respiratory distress syndrome in terms of radiological changes in preterm infants: a multicenter study. J Pak Med Assoc. 2026;76(4):541-5.

Tahreem N, Malagi NN, Thobbi AN, Raziyabanu. Early bubble continuous positive airway pressure as the initial mode of management of respiratory distress syndrome in preterm neonates. Int J Contemp Pediatr2025;12(10):1671-5.

Fatima K, Zulfiqar S, Farooq A, Aziz M. Outcome of Nasal continuous positive airway pressure in neonates: A cross-sectional study. Pak J Med Sci. 2024;40(8):1831-6.

Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Lavizzari A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2025. Neonatology. 2026:1-26.

Jamil M, Abbas M, Naz S, Qadir A, Abbas H, Khan MA. Efficacy of Bubble CPAP in Managing Respiratory Distress in Neonatal Intensive Care Units. Esculapio. 2024;20(1):95-9.

Asif A, Ayub A, Shah SA, Wahid S, Zaman S, Goheer L. Comparison of bubble CPAP versus head box oxygen in preterm neonates with respiratory distress syndrome. Rawal Med J. 2023;48(1).

Sweet DG, Carnielli VP, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology. 2023;120(1):3-23.

Schmolzer GM, Kumar M, Pichler G, Aziz K, O'Reilly M, Cheung PY. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ. 2013;347: f5980.

Koyamaibole L, Kado J, Qovu JD, Colquhoun S, Duke T. An evaluation of bubble CPAP in a neonatal unit in a resource-limited setting. Arch Dis Child. 2006;91(11): F837-F840.

Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358(7):700-08.

Dargaville PA, Aiyappan A, De Paoli AG, Dalton RGB, Kuschel CA, Kamlin COF, et al. Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences. Neonatology. 2013;104(1):8-14.

Downloads

Published

2026-10-09

Issue

Section

Original article

How to Cite

1.
Shoukat I, Ahmed RI, Ahmed KA, Latif S, Mehboob R. Success of bubble continuous positive airway pressure (bCPAP) in the treatment of respiratory distress syndrome among preterm neonates in a low-resource setting at SKBZ CMH, Muzaffarabad. Int J Pathol [Internet]. 2026 Oct. 9 [cited 2026 Oct. 10];24(3):323-31. Available from: https://jpathology.com/index.php/OJS/article/view/1111

Most read articles by the same author(s)