ABSTRACT
To explore the use of non-invasive ventilation with nasal CPAP [continuous positive airway pressure] and BiPAP [Bilevel positive airway pressure] ventilatory support system in neonates and children. Prospective hospital-based study. Hospitalised neonates and children with respiratory distress. Neonates admitted in neonatal intensive care unit with moderate respiratory distress and grunting, requiring >40% oxygen were put on a discontinuous system of nasal CPAP using Benveniste's valve and silastic nasal prongs. A similar study was conducted in the paediatric ICU in a limited number of patients using nasal CPAP and bilevel PAP device. 121 out of 589 babies required respiratory support [20.54%], either mechanical ventilation or nasal CPAP. 54.5% required nasal CPAP. Indications for CPAP were RDS [69.7%], birth asphyxia with respiratory distress [9.1%], pneumonia [6.1%], sepsis [4.5%], aspiration [3%] and others [7.6%]. Nasal CPAP group had statistically significant lower incidence of apnoea, intraventricular haemorrhage [IVH], retinopathy of prematurity [ROP], sepsis and no pneumothorax, compared to mechanically ventilated babies. Birth weight and gestational age had no detrimental effect on the success of CPAP. In the paediatric ICU, nasal CPAP was used in 18 cases out of 159 children [11.3%].The Bi-level PAP device was successfully used in a child with acute Guillain Barre syndrome with respiratory compromise. Non-invasive ventilation in selected cases had clear advantage over endotracheal intubation and mechanical ventilation with less complications, morbidity and duration of intensive care, and was cost-benefit effective. The need for sedation, analgesia and paralysis could be totally avoided. Use of discontinuous system of CPAP was advantageous, in that babies could be given even bath, breast feeding and mother-infant bonding. The child on BiPAP could move around, swallow and verbally communicate