Efficacy of a Low-Cost Bubble CPAP System in Treatment of Respiratory Distress in a Neonatal Ward in Malawi

Abstract

BackgroundRespiratory failure is a leading cause of neonatal mortality in the developing world. Bubble continuous positive airway pressure (bCPAP) is a safe, effective intervention for infants with respiratory distress and is widely used in developed countries. Because of its high cost, bCPAP is not widely utilized in low-resource settings. We evaluated the performance of a new bCPAP system to treat severe respiratory distress in a low resource setting, comparing it to nasal oxygen therapy, the current standard of care.MethodsWe conducted a non-randomized convenience sample study to test the efficacy of a low-cost bCPAP system treating newborns with severe respiratory distress in the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi. Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled inclusion criteria received nasal bCPAP if a device was available; if not, they received standard care. Clinical assessments were made during treatment and outcomes compared for the two groups.Findings87 neonates (62 bCPAP, 25 controls) were recruited. Survival rate for neonates receiving bCPAP was 71.0% (44/62) compared with 44.0% (11/25) for controls. 65.5% (19/29) of very low birth weight neonates receiving bCPAP survived to discharge compared to 15.4% (1/13) of controls. 64.6% (31/48) of neonates with respiratory distress syndrome (RDS) receiving bCPAP survived to discharge, compared to 23.5% (4/17) of controls. 61.5% (16/26) of neonates with sepsis receiving bCPAP survived to discharge, while none of the seven neonates with sepsis in the control group survived.InterpretationUse of a low-cost bCPAP system to treat neonatal respiratory distress resulted in 27% absolute improvement in survival. The beneficial effect was greater for neonates with very low birth weight, RDS, or sepsis. Implementing appropriate bCPAP devices could reduce neonatal mortality in developing countries.

Implementation of Bubble CPAP in a Rural Ugandan Neonatal ICU

“…18 The use of CPAP is effective for the treatment of respiratory failure in high-income countries, [5][6][7] but there are few reports of the use of CPAP in low-income settings. [10][11][12]19 Bubble CPAP is an attractive device for treating neonates with respiratory distress due to its simple design, low cost, and potential to improve survival rates in settings lacking mechanical ventilation. However, in an effort to provide bubble CPAP to neonates with respiratory distress in low-income and middle-income countries, health-care providers may use untested homemade devices despite uncertainty about the devices' ability to deliver CPAP reliably.…”

“…[10][11][12]21 In a study from South Africa, Pieper et al 21 reported the use of nasal CPAP in 11 extremely lowbirthweight infants with respiratory distress following birth compared with 10 control infants. Infants treated with nasal CPAP had a mean birthweight of 915 g and a mean gestational age of 28.6 weeks.…”

“…An example of this simple noninvasive ventilation method is bubble CPAP, which has been safely and effectively used in low-income and middle-income countries to improve survival in infants with many forms of neonatal respiratory distress. [10][11][12] CPAP applied to immature lungs helps to increase functional residual capacity, improve chest wall stability, and decrease work of breathing, thereby reducing the need for mechanical ventilation and surfactant administration. 13 In high-income settings, deciding which patients will benefit from CPAP is often based on clinical exam, breathing frequency, S pO 2 , blood gas measurements, and chest radiograph.…”

Teamwork en medicina: una necesidad

“…Las acciones dirigidas a mejorar la sobrevida sin secuelas neurológicas en el prematuro menor de 1.500 gramos tendrían un impacto favorable en la salud pública (13) .…”

Noninvasive Ventilatory Support: The Detail Lies in the Interface

“…The benefits have included improved survival, 15 a reduction in the adverse events related to endotracheal intubation, reductions in ICU and hospital stay, and significantly reduced costs to health-care systems and to patients, 16 and in some parts of the world, this technology has provided access to ventilatory support that was simply not available before. 17 In settings such as status asthmaticus, there is a suggestion that some modes of NIV relieve symptoms but may also reduce airway reactivity. 18 However, there remains a paucity of randomized, controlled studies to fully evaluate the impact of NIV, particularly in children.…”