Spectrum of Complications Associated with Bubble CPAP in Very Low Birth Weight Neonates with Respiratory Distress Syndrome

Background: Respiratory Distress Syndrome (RDS) is a major cause of morbidity and mortality among very low birth weight (VLBW) neonates. Bubble Continuous Positive Airway Pressure (bCPAP) has emerged as an effective non-invasive respiratory support modality that helps maintain functional residual capacity and improves oxygenation in preterm infants. Despite its widespread adoption, bubble CPAP therapy may be associated with several complications, including nasal trauma, pneumothorax, abdominal distension, and secondary infections. Understanding the pattern and frequency of these complications is essential for optimizing clinical management and improving neonatal outcomes.

Objective: To evaluate the spectrum and incidence of complications associated with bubble CPAP in very low birth weight neonates with respiratory distress syndrome.

Materials and Methods: This hospital-based observational study was conducted in the Department of Pediatrics, after obtaining ethical approval. The study included 100 inborn preterm neonates with birth weight ≤1500 g and gestational age between 28 and 34 weeks who presented with respiratory distress and required bubble CPAP support. Neonates with major congenital malformations, perinatal asphyxia, or those requiring mechanical ventilation at birth were excluded. Clinical parameters, duration of CPAP therapy, and occurrence of complications were monitored throughout NICU stay. Complications evaluated included pneumothorax, CPAP belly, secondary infection, intracranial hemorrhage, feed intolerance, meningitis, and nasal septum injury. Nasal injury severity was assessed using a standardized scoring system. Statistical analysis was performed using SPSS version 25.0, and categorical data were expressed as frequencies and percentages.

Results: Among the 100 neonates studied, several complications were observed during bubble CPAP therapy. Nasal septum injury was the most frequent complication, occurring in 29% of infants, followed by secondary infections in 26%, feed intolerance in 17%, and intracranial hemorrhage in 15%. Meningitis occurred in 10% of cases, while pneumothorax and CPAP belly were less common, observed in 5% and 4% of neonates respectively. The mean nasal septum injury score was 1.01 ± 1.82, indicating mostly mild injuries. These findings highlight that although bubble CPAP is an effective respiratory support modality, careful monitoring is necessary to prevent device-related complications.

Conclusion: Bubble CPAP is a safe and effective non-invasive respiratory support strategy for VLBW neonates with RDS. However, complications such as nasal trauma, infections, and feeding intolerance may occur. Early recognition, proper interface care, and vigilant monitoring can minimize these adverse events and improve neonatal outcomes.