Is Continuous Positive Airway Pressure a Feasible Treatment Modality for Neonates with Respiratory Distress Syndrome in a Rural District Hospital?

Abstract

nCPAP for neonatal respiratory distress at the district hospital is feasible, safe and offers the potential for significant cost savings.

Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review

“…Several studies addressed secondary outcomes (reduction in need for mechanical ventilation via an endotracheal tube,37–39 and safety and efficacy of bubble CPAP compared with ventilator-driven CPAP35 40 41), while the largest number were case-series describing practical experience with CPAP, both bubble-based or via other systems 31 32 34 42–48. All studies described the use of CPAP in hospitals, with no studies describing home CPAP.…”

“…Among 571 neonates treated with CPAP of any kind with the potential for mechanical ventilation access (either in the same hospital or via transfer to nearby referral hospitals), the mortality rate was 83/571 (14.5%) 31 32 34 42–44 46–48. Of the 343 neonates for whom CPAP failure data are available, 110 (32.1%) failed CPAP therapy and required mechanical ventilation 31 32 34 42 43 47. Due to small numbers, it was difficult to determine the effect of birth weight on failure rate and mortality.…”

“…Six studies from three countries described implementation of CPAP in settings with few or no intensive care nursing staff 31 33 36 38 45 48. Despite the lack of previous CPAP experience, in all cases (total 252 neonates) there were no major adverse events directly attributable to poor management of CPAP administration.…”

“…Although only small numbers and heterogeneous contexts, the results were suggestive of better outcomes in neonates with birth weight (BW) >1000 g (CPAP failure rate 24/106 (22.6%)) than neonates <1000 g (CPAP failure: 11/24 (45.8%)) 31 32 42. Outcomes also appeared to be better in those with mild to moderate respiratory distress (CPAP failure: 16/109 (14.5%)) compared to neonates with more severe disease (CPAP failure: 25/41 (60.9%)) 32 42 43…”

Outcome of very-low-birth-weight babies managed with nasal continuous positive airway pressure, with or without surfactant, in a high-care nursery

“…[10] Recently a report from a district hospital showed that managing patients outside a NICU is possible, improves outcomes and gives an opportunity to offer support while waiting for transport for transfer to a facility with NICU. [16] This suggests that CPAP can be safely used in resource-limited settings as the first line of therapy, with great benefits. Forty-eight percent of patients who were managed with NCPAP in this report also required exogenous surfactant.…”