Nasal Continuous Positive Airway Pressure Therapy in a Non-Tertiary Neonatal Unit: Reduced Need for Up-Transfers

Kiran, Sai; Murki, Srinivas; Oleti, Tejo Pratap; Kandraju, Hemasree; Reddy, Anupama

doi:10.1007/s12098-014-1484-6

Cited by 24 publications

(14 citation statements)

References 13 publications

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“…Implementation of home-made bCPAP in India reduced mortality from 10.7 to 2.4% [11]. In another study in India, introduction of CPAP reduced up-transfers from 74 to 37% [13]. Findings were similar in South Africa, with up-transfers reduced from 16.7 to 5.1% [12].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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 g) 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 < 1500 g were compared before and after the introduction of bCPAP. Results The admission records of 377 VLBW neonates < 1500 g were obtained. One hundred fifty-eight 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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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…15,16 When applied early, NCPAP is a safe option to manage infants with MAS and to prevent up-transfers to already overburdened level III and/or tertiary care centers and also reduce cost of care. 17 However, dependence on imported NCPAP devices, lack of an ideal interface, nonavailability of round-the-clock air or oxygen supply, backup ventilation, lack of awareness and expertise among physicians, and inadequately trained nursing staff are the major challenges. 18 Exclusion of infants with severe perinatal asphyxia and preponderance of inborn newborns may be reasons for lesser mortality in our study cohort compared with that reported by others.…”

Section: Discussionmentioning

confidence: 99%

Effect of Nasal Continuous Positive Airway Pressure on Infants With Meconium Aspiration Syndrome

et al. 2018

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IMPORTANCE Nasal continuous positive airway pressure (NCPAP) as a primary respiratory therapy in meconium aspiration syndrome (MAS) has not been studied extensively. Nasal continuous positive airway pressure, when applied in newborns with MAS, may resolve atelectasis by sufficiently expanding partially obstructed small airways and stabilizing the collapsing terminal airways to enhance oxygen exchange. OBJECTIVE To compare NCPAP vs standard care in neonates with moderate to severe respiratory failure due to MAS in reducing the need for invasive ventilation. DESIGN, SETTINGS, AND PARTICIPANTSThis multicenter open-label, parallel-group (1:1 ratio) randomized clinical trial was conducted from August 5, 2014, to May 26, 2016. Data were collected from 3 tertiary care neonatal intensive care units. All infants admitted with respiratory distress, defined as Downe score greater than 4 and peripheral capillary oxygen saturation less than 90%, were assessed for study eligibility if the chest radiograph was suggestive of MAS and they met the other inclusion criteria: gestation longer than 35 weeks, a birth weight greater than 2000 g, and born through meconium-stained amniotic fluid.INTERVENTIONS Infants were randomly assigned to either NCPAP or standard care (5-10 L/min hood oxygen). MAIN OUTCOMES AND MEASURESThe primary outcome was the need for mechanical ventilation in the first 7 days of life.RESULTS After excluding 14 infants, 67 infants were randomized to bubble NCPAP and 68 infants to standard care. Baseline characteristics were similar between the 2 groups. Infants randomized to the bubble NCPAP group needed mechanical ventilation less frequently in the first 7 days of life compared with standard care (2 [3.0%] vs 17 [25.0%]); odds ratio, 0.09; 95% CI, 0.02-0.43; P = .002). The need for surfactant (3 [4.5%] vs 11 [16.2%]; odds ratio, 0.24; 95% CI, 0.05-0.87) and culture-positive sepsis (4 [6.0%] vs 13 [19.0%]; odds ratio, 0.28; 95% CI, 0.09-0.93) were higher in the standard care group. There was an increased duration of oxygen therapy (median [interquartile range], 45.5 [28.0-78.3] vs 26 [20.0-48.0] hours; P = .001) in the standard care group. In the NCPAP group vs standard care group, incidence of persistent pulmonary hypertension (9 [13%] vs 19 [28%]; odds ratio, 0.42; 95% CI, 0.17-1.01) and duration of hospital stay (median [interquartile range], 5.0 [4.0-8.8] vs 4.0 [4.0-6.0] days; P = .14) were similar.CONCLUSIONS AND RELEVANCE Bubble NCPAP in comparison with standard care for infants with MAS reduces the need for mechanical ventilation in the first 7 days of life.

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“…We utilized an opportunity where in our subsidiary low risk obstetric unit with level II SNCU facilities , we introduced 29 Volume 31 I Issue I & II I January -June 2017 CPAP and audited the respiratory and non-respiratory outcomes before and after its introduction in the unit. (8) Five hundred and fifty infants were admitted to the level II SNCU , with 252 infants admitted 1 year before the introduction of CPAP services and the rest 1 year after. Introduction of CPAP reduced the overall up-transfers (33% reduction) and more so in the VLBW infants (50% reduction).…”

Section: Cpapfor Meconium Aspiration Syndromementioning

confidence: 99%

CPAP for Respiratory Distress in Newborns: A Decade of Experience

Murki¹,

Kandraju²,

Oleti³

et al. 2017

Journal of Neonatology

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Nasal Continuous Positive Airway Pressure Therapy in a Non-Tertiary Neonatal Unit: Reduced Need for Up-Transfers

Abstract: Introduction of n-CPAP services in a non-tertiary care neonatal unit, significantly reduced the need for up-transfers, especially in VLBW and preterm infants.

Cited by 24 publications

References 13 publications

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

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

Effect of Nasal Continuous Positive Airway Pressure on Infants With Meconium Aspiration Syndrome

CPAP for Respiratory Distress in Newborns: A Decade of Experience

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