Effective application of continuous positive airway pressure technique in the treatment of respiratory failure in newborns

Recently, Vinh International Hospital performed an elective cesarean section for a pregnant woman who was 39 weeks and 1 day pregnant and weighed 3.1 kg. After 30 minutes, the baby began to show symptoms: pale skin, SpO2 < 90%, rapid breathing rate of 70 - 80/minute, groaning, chest retraction, and flaring nostrils. Immediately, the baby was prescribed oxygen through a cannula, had a chest X-ray at the bedside, and had the necessary tests done.

Diagnostic Imaging Results: Poor lung brilliance, diffuse interstitial opacity at the apex and base of both lungs, thickened interlobular fissures, and blood gas test showed respiratory acidosis. Combining clinical signs, the Neonatal Pediatrician gave the diagnosis: Neonatal respiratory failure, monitoring for slow alveolar fluid absorption/Neonatal infection.

The baby was prescribed continuous positive airway pressure (NCPAP) to treat neonatal respiratory failure. Photo: Kim Chung

After 60 minutes of oxygen therapy, the baby was still struggling, groaning and was prescribed continuous positive airway pressure (NCPAP). Immediately after that, the baby had positive changes: The skin on the lips was pinker, SpO2 >92%, less struggling, less groaning.

Regarding nutrition and medication, the baby is maintained with milk through a gastric tube, antibiotics to prevent secondary infection, and adjustment of accompanying disorders.

After 4 days of NCPAP, the patient's lung condition improved, breathing was regular without effort, and he was switched to nasal oxygen therapy and then completely weaned off. After 10 days of intensive treatment, the child's health condition stabilized and he was discharged from the hospital.

The joy of the family welcoming a healthy baby, after 10 days of intensive treatment by doctors. Photo: Kim Chung

Master. Doctor Nguyen Thi Ngoc Quynh - Department of Pediatrics, Vinh International Hospital, who directly treated the patient, said: Respiratory failure is the most common syndrome and the leading cause of neonatal death, requiring rapid emergency care and proper treatment. There are many causes in the lungs or outside the lungs that cause respiratory failure. Slow absorption of alveolar fluid is common in babies born by cesarean section when there are no signs of labor, born too quickly, and mothers using β-blockers. The cause is that there is still fluid in the alveoli, hindering ventilation and gas exchange.

When the child showed signs of respiratory failure, the child was given oxygen support through a nasal prong, SpO2 was monitored, the respiratory failure did not improve, so continuous positive airway pressure was switched to increase lung expansion, support alveolar fluid absorption, and enhance gas exchange. When breathing NCPAP, the child was fed through a gastric tube to reduce intra-abdominal pressure, maintain the necessary amount of fluid, and treat accompanying disorders.

Given the dangers of respiratory distress syndrome, pregnant women need to be monitored and managed well during pregnancy, especially for pregnant women with the following risk factors:

• Premature birth: Risk of hyaline membrane disease, apnea, congenital heart disease.

• Postpartum: Meconium inhalation, asphyxiation.

• Cesarean section: Slow absorption of alveolar fluid.

• Mother's water breaks early, fever before or during birth, dirty or smelly amniotic fluid, gynecological infections: pneumonia, neonatal infection.

• Diabetic mother: Affects surfactant synthesis (hydamina propria), neonatal hypoglycemia.

Nasal Continuous Positive Airway Pressure (NCPAP) is a non-invasive treatment that is often used for children with respiratory failure when oxygen therapy fails. By maintaining a continuous positive pressure throughout the breathing cycle, NCPAP helps increase compliance, increase lung volume; dilate small bronchi to help children expel mucus more easily; prevent lung collapse, reduce pulmonary edema, and reduce venous return to the heart.

InVinh International Hospital, by coordinating smoothly according to the combined Obstetrics - Pediatrics model, successfully applying the NCPAP breathing technique has effectively treated many cases without invasion, reducing the rate of intubation and death, and ensuring the health of newborns./.