Background: Respiratory distress in newborn is one of the commonest causes of neonatal mortality and morbidity in many developing countries. The early initiation of Bubble Continuous Positive Airway Pressure, a low-cost and simple technique can treat respiratory distress in an effective manner. We compared and studied the outcome of initiating bubble CPAP, by the 1 st hour of birth in neonates with respiratory distress. Bubble CPAP was a success amongst neonates who were of gestational age more than 32 weeks, weighing more than 1200gms and with Downes' score of less than 7. Methods: The study was conducted in a rural tertiary care hospital amongst 150 neonates admitted in intramural (in born) and extramural (out born) neonatal intensive care units. The study was done over a period 18 months. The primary outcome of the study was to compare the proportion of success or failure on early initiation of bubble CPAP. Results: In our study 94% of babies admitted with respiratory distress and started on Bubble CPAP survived while by early initiation in the 1 st hour, 80.9% of babies were treated successfully. Conclusion: Bubble CPAP has a high percentage of success when initiated early in neonates with mild and moderate respiratory distress
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