Vol. 7, Issue 1, Part C (2025)

Respiratory distress syndrome (RDS) remains a leading cause of morbidity in preterm neonates, despite advances in surfactant therapy and bubble CPAP (bCPAP). This study evaluates the efficacy, complications, and predictors of failure of these interventions in a tertiary care setting A prospective observational study was conducted on 150 preterm neonates (<37 weeks) with RDS, assessing outcomes based on surfactant timing (early vs. late rescue), bCPAP failure predictors, and associated complications. Early surfactant administration (≤2 hours) showed significantly lower failure rates (32.23% vs. 66.67%, p<0.001) and pneumothorax incidence (3.23% vs. 9.80%) compared to late rescue. Major complications included pulmonary hemorrhage (15.85%), apnea (17.07%), and sepsis (12.20%). bCPAP failure was strongly associated with extreme prematurity (84.85%, p=0.0001), birth weight <1 kg (86.67%, p=0.0045), and sepsis (94.12%, p=0.0003). Interface-related complications (skin abrasions: 25.33%) were frequent with bCPAP. Early surfactant therapy and optimized bCPAP strategies significantly improve RDS outcomes. Gestational age, birth weight, and sepsis are critical predictors of treatment failure, warranting tailored approaches. These findings support protocolized early surfactant use and refined non-invasive support to reduce complications in preterm neonates.