H. Aly and M. Mohamed in their 2020 article in Pediatrics Research described a bubble CPAP bundle that is associated with a consistently low incidence of chronic lung disease over 16 years. This bundle included specific protocol for delivery room management, early use of bubble CPAP, judicious use of surfactant, criteria for bubble CPAP failure, protocol for the care of airway, weaning off CPAP, use of caffeine, monitoring oxygen saturation, fluid and nutrition management, and transfusion practices. They reported their results of 773 infants (median GA = 28 weeks, average BW = 995 g), where 24.5% of them were intubated in delivery room and 11.7% in the first day of life. Their CLD incidence was 6.4% that remained consistent over four chronological epochs (7.6%, 7.5%, 5.8% and 5%). They concluded that it is feasible and sustainable to administer similar bubble CPAP bundles to decrease CLD.
Aly, H., Mohamed, M.A. An experience with a bubble CPAP bundle: is chronic lung disease preventable?. Pediatr Res (2020)