• Nasal bubble continuous airway pressure therapy safely treats newborn breathing distress. • Newborn respiratory distress in this rural setting is mostly driven by infections. • Low birth weight and prematurity strongly predict respiratory treatment failure. • Initial Downes scores reliably predict newborn respiratory treatment outcomes. To evaluate the clinical profile, etiologies, and outcomes of neonates with respiratory distress managed with Nasal Bubble Continuous Positive Airway Pressure (NBCPAP) in a tertiary care center in rural Nepal. This prospective observational study included 195 neonates admitted to the Neonatal Intensive Care Unit (NICU) with mild to moderate (Downes score 3-7) respiratory distress between August 2022 and July 2023 were included. Treatment success was defined as stabilization and successful weaning on NBCPAP without escalation to mechanical ventilation. Demographic data, maternal risk factors, and NBCPAP outcomes were analyzed using bivariate and multivariable binary logistic regression to identify predictors of NBCPAP failure. The mean gestational age was 34.98 ±2.66 weeks, and mean birth weight was 2332.56 ±652.64 grams. The leading causes of distress were congenital pneumonia (25.1%) and sepsis (22.6%). NBCPAP had a success rate of 90.3% and was well tolerated, with minor complications including abdominal distension (3%) and nasal injury (2.6%). The mortality rate was 4.1%. NBCPAP failure (9.7%) was significantly associated with lower gestational age (P=0.002), low birth weight (P18 hours (P=0.003), and higher Downes score at admission (P=0.016). Multivariate analysis identified low birth weight was identified as an independent predictor of outcome (adjusted OR: 0.998, 95% CI: 0.997–1.000, p = 0.008). NBCPAP is safe, effective and easily available primary respiratory support strategy for neonatal respiratory distress in low-resource settings. Lower birth weight was independently associated with treatment failure.
Lamichhane et al. (Fri,) studied this question.