A randomised controlled trial comparing the efficacy of Bubble Continuous Positive Airway Pressure (B-CPAP) and Ventilator Continuous Positive Airway Pressure (V-CPAP) in preterm neonates with respiratory distress

Preterm birth remains a major global health issue, causing around 965000 neonatal deaths and 125000 deaths in children under five each year. In 2020, 13.8 million babies were born prematurely, with South East Asia and sub Saharan Africa bearing the highest burden. The early neonatal period is particularly critical, with most deaths occurring during labour or within 24 hours of birth. Prematurity and low birth weight are leading causes of neonatal mortality.

Respiratory distress is the most common complication in preterm infants, often resulting from conditions such as respiratory distress syndrome, congenital pneumonia, or pulmonary hypoplasia. A large cohort study from India and Pakistan found that 23 per cent of preterm neonates died within 28 days, with major causes including maternal hypertension, placental malperfusion, chorioamnionitis, intrauterine hypoxia, congenital and neonatal infections, and respiratory distress syndrome.

CPAP is the first-line respiratory support for preterm infants with spontaneous breathing and signs of distress. It maintains alveolar stability, reduces the work of breathing, and improves gas exchange. Common CPAP methods include Bubble CPAP and Ventilator CPAP. Bubble CPAP generates pressure via a water column, while Ventilator CPAP uses a mechanical ventilator to maintain constant pressure.

Both methods are considered effective and safe, but definitions of CPAP failure vary across studies. This study aims to compare failure rates between Bubble CPAP and Ventilator CPAP as initial respiratory support in preterm infants with respiratory distress.

Research question: Is bubble CPAP more effective than ventilator CPAP for treating respiratory distress in preterm infants?