Improvised bubble continuous positive airway pressure (BCPAP) device at the National Hospital Abuja gives immediate improvement in respiratory rate and oxygenation in neonates with respiratory distress

Abstract

Background: Prematurity accounts for 25% of Neonatal mortality in Nigeria and Respiratory Distress Syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite challenging. It was hypothesized that applying the principle of underwater seal pressure generation could convert a simple oxygen delivery system into an effective Bubble CPAP device. Objectives: To provide evidence in support of the immediate clinical effectiveness of the NH-BCPAP device. Design/Methods: At the neonatal unit of the National Hospital Abuja, we assembled a circuit of tubing connecting a gas source (oxygen concentrator or cylinder) through an interface (nasal prongs) to the baby and this was further connected through an expiratory tube to an under-waterseal bottle to generate CPAP. The device is activated by turning on the oxygen source. The device was applied to preterm babies with RDS as well as some term babies with respiratory distress admitted into the neonatal intensive care units. Respiratory rate, SPO2 and other signs of respiratory distress were monitored before and at 1 hour, 6 hours and 12 hours after the application. Results: Forty eight newborn babies with respiratory distress were treated with the device out of whom twenty three (48%) were very low birth weight with respiratory distress syndrome. The mean respiratory rate dropped from 64.5 (19.2)/min before commencement of CPAP to 59.5(11.6)/min, 56.6 (10.5), and 56.6(10.7) at 1, 6 and 12 hours respectively, p<0.05. The corresponding values for SPO2 were 84.5(14) before and 95.9 (5.3), 95.9(6.5) and 96.9(6.4) at 1, 6 and 12 hours respectively, p<0.05. The respiratory changes were however less marked among very low birth weight babies. Conclusion: The simplified customized device produces clinical responses similar to those reported for the conventional CPAP devices.

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

“…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.…”

Postnatal Outcomes and Risk Factors for In-Hospital Mortality among Asphyxiated Newborns in a Low-Resource Hospital Setting: Experience from North-Central Nigeria

“…Such neonates often require positive pressure ventilation either in the form of mechanical ventilation or continuous positive airway pressure (CPAP) ventilation, both of which are not present in the current study location and many low-resource settings. In our setting, we currently provide respiratory support using locally improvised bubble CPAP devices that have been shown to be effective and safe among neonates and older children in similar settings to ours [12,[20][21]. Sustained oxygen supply is critical for appropriate functioning of these devices and this currently represents a challenge in our setting, where oxygen is paid for primarily out-ofpocket by care-givers.…”

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

“…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).…”