A new low-cost commercial bubble CPAP (bCPAP) machine compared with a traditional bCPAP device in Nigeria

Amadi, Hippolite O.; Okonkwo, Ikechukwu Richard; Abioye, Ifeoluwa O.; Abubakar, Amina L; Olateju, Eyinade Kudirat; Adesina, Christiana T; Umar, Sule; Eziechila, Bessie C

doi:10.1080/20469047.2019.1598125

Cited by 26 publications

(41 citation statements)

References 10 publications

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“…1, Table 3). This included six case studies or series of neonates who received bubble CPAP [19,20,22,23,29,34], four observational cohort or cross-sectional studies [26,30,31,33], three uncontrolled before-and-after studies [12,25,32] and four case-control intervention studies that compared novel use of bubble CPAP systems or implementation components with local standards of existing care [5,21,24,28]. All four case-control intervention studies were quasi-experimental and there were no randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 17 studies included in this review, six (35%) used improvised water bottle systems, five (29%) used low-cost standalone systems, two (12%) used commercial bubble CPAP system and four (24%) did not describe the system used or covered a combination of different types of devices. Four out of the five low-cost standalone systems used the Pumani bubble CPAP device, which was developed in Malawi [5,23,24,26], and one study used politeCPAP, which was recently developed in Nigeria [21]. DeVilbiss IntelliPAP [28] and Fisher Paykel [32] bubble CPAP systems were the two commercial versions used.…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

et al. 2020

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Background: Bubble continuous positive airway pressure (CPAP) has been shown to be effective in supporting breathing in newborns with respiratory distress. The factors that influence implementation in resource-constrained settings remain unclear. The objective of this review is to evaluate the barriers and facilitators of CPAP implementation for newborn care at sub-Saharan African health facilities and how different facility levels and types of bubble CPAP systems may impact utilization. Methods: A systematic search (database inception to July 2019) was performed on MEDLINE Ovid, EMBASE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), the WHO Regional Database for Africa, African Index Medicus (AIM), African Journals Online, grey literature and the references of relevant articles. Studies that met the inclusion criteria (primary research, bubble CPAP implementation with neonates ≤ 28 days old at a health facility in sub-Saharan Africa) were included in the review and assessed with National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) quality assessment tools. The review protocol was published to PROSPERO (CRD42018116082). Results: Seventeen studies were included in the review. Reliable availability of equipment, effectively informing and engaging caregivers and staffing shortages were frequently mentioned barriers to the implementation of bubble CPAP. Understaffed neonatal units and high turnover of nurses and doctors compromised effective training. Provider-to-provider clinical mentorship models as well as affordability and cost-effectiveness of innovative bubble CPAP systems were identified as frequently mentioned facilitators of implementation. Conclusions: With a strong recommendation by the World Health Organization for its use with premature infants with respiratory distress, it is important to understand the barriers and facilitators that can inform the implementation of bubble CPAP. More research is needed into health system factors that can support or impede the use of this potentially promising intervention.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

et al. 2020

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“…As an example of a high-resistance interface, the RAM cannula (size Infant, orange) was included 7. The systems made from modified nasal oxygen cannulas (table 18–15) generated too high pressures to be measured in our current setup (without leakage).…”

Section: Methodsmentioning

confidence: 99%

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Baldursdottir

Falk

Donaldsson

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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BackgroundThe original bubble continuous positive airway pressure (bCPAP) design has wide-bore tubing and a low-resistance interface. This creates a stable airway pressure that is reflected by the submersion depth of the expiratory tubing. Several systems with alterations to the original bCPAP design are now available. Most of these are aimed for use in low-income and middle-income countries and have not been compared with the original design.ObjectiveWe identified three major alterations to the original bCPAP design: (1) resistance of nasal interface, (2) volume of dead space and (3) diameter of expiratory tubing. Our aim was to study the effect of these alterations on CPAP delivery and work of breathing in a mechanical lung model. Dead space should always be avoided and was not further tested.MethodsThe effect of nasal interface resistance and expiratory tubing diameter was evaluated with simulated breathing in a mechanical lung model without interface leakage. The main outcome was delivered CPAP and imposed work of breathing.ResultsHigh-resistance interfaces and narrow expiratory tubing increased the work of breathing. Additionally, narrow expiratory tubing resulted in higher CPAP levels than indicated by the submersion depth.ConclusionOur study shows the significant effect on CPAP delivery and imposed work of breathing when using high-resistance interfaces and narrow expiratory tubing in bCPAP systems. New systems should include low-resistance interfaces and wide-bore tubing and be compared with the original bCPAP. Referring to all systems that bubble as bCPAP is misleading and potentially hazardous.

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“…(8) Attempts at improvised CPAP are often made in LICs but this can be risky. (9) Due to their simplicity and affordability, low-cost bCPAP devices have been introduced in many neonatal units in LMICs. (10) However, there have been no randomized trials conducted in LMICs investigating the efficacy of bCPAP.…”

Section: Introductionmentioning

confidence: 99%

Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates <1500g

Okello

Egiru

Ikiror

et al. 2019

Preprint

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Background: Complications of prematurity are the leading cause of deaths in children under the age of five.The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods. Methods: This was a retrospective study of VLBW neonates (weight <1500 grams) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates <1500g were compared before and after the introduction of bCPAP. Results: The admission records of 377 VLBW neonates <1500g were obtained. 158 were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P =0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36-0.86, P = 0.01).There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups. Conclusion: Specialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths.The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.

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A new low-cost commercial bubble CPAP (bCPAP) machine compared with a traditional bCPAP device in Nigeria

Cited by 26 publications

References 10 publications

Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates <1500g

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A new low-cost commercial bubble CPAP (bCPAP) machine compared with a traditional bCPAP device in Nigeria

Cited by 26 publications

References 10 publications

Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review

Basic principles of neonatal bubble CPAP: effects on CPAP delivery and imposed work of breathing when altering the original design

Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates &lt;1500g

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Product

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Reducing preterm mortality in eastern Uganda: The impact of introducing low-cost bubble CPAP on neonates <1500g