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

Overview

Journal Malawi Med J

Specialty General Medicine

Date 2016 Nov 30

PMID 27895847

Citations 14

Authors

Kondwani Kawaza

Heather E Machen

Jocelyn Brown

Zondiwe Mwanza

Suzanne Iniguez

Al Gest

E OBrian Smith

Maria Oden

Rebecca R Richards-Kortum

Elizabeth Molyneux

Affiliations

Soon will be listed here.

Abstract

Background: Respiratory 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.

Methods: We 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.

Findings: 87 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.

Interpretation: Use 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.

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References

Kamath B, MacGuire E, McClure E, Goldenberg R, Jobe A . Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics. 2011; 127(6):1139-46. PMC: 9923778. DOI: 10.1542/peds.2010-3212. View

Schmolzer G, Kumar M, Pichler G, Aziz K, OReilly M, Cheung P . Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ. 2013; 347:f5980. PMC: 3805496. DOI: 10.1136/bmj.f5980. View

Pieper C, Smith J, Maree D, Pohl F . Is nCPAP of value in extreme preterms with no access to neonatal intensive care?. J Trop Pediatr. 2003; 49(3):148-52. DOI: 10.1093/tropej/49.3.148. View

Rehan V, Laiprasert J, Nakashima J, Wallach M, McCool F . Effects of continuous positive airway pressure on diaphragm dimensions in preterm infants. J Perinatol. 2002; 21(8):521-4. DOI: 10.1038/sj.jp.7210587. View

Nowadzky T, Pantoja A, Britton J . Bubble continuous positive airway pressure, a potentially better practice, reduces the use of mechanical ventilation among very low birth weight infants with respiratory distress syndrome. Pediatrics. 2009; 123(6):1534-40. DOI: 10.1542/peds.2008-1279. View

Brown J, Machen H, Kawaza K, Mwanza Z, Iniguez S, Lang H . A high-value, low-cost bubble continuous positive airway pressure system for low-resource settings: technical assessment and initial case reports. PLoS One. 2013; 8(1):e53622. PMC: 3553107. DOI: 10.1371/journal.pone.0053622. View

Buckmaster A, Arnolda G, Wright I, Foster J, Henderson-Smart D . Continuous positive airway pressure therapy for infants with respiratory distress in non tertiary care centers: a randomized, controlled trial. Pediatrics. 2007; 120(3):509-18. DOI: 10.1542/peds.2007-0775. View

van den Heuvel M, Blencowe H, Mittermayer K, Rylance S, Couperus A, Heikens G . Introduction of bubble CPAP in a teaching hospital in Malawi. Ann Trop Paediatr. 2011; 31(1):59-65. DOI: 10.1179/1465328110Y.0000000001. View

Sweet D, Bevilacqua G, Carnielli V, Greisen G, Plavka R, Saugstad O . European consensus guidelines on the management of neonatal respiratory distress syndrome. J Perinat Med. 2007; 35(3):175-86. DOI: 10.1515/JPM.2007.048. View

10.

Finer N, Carlo W, Walsh M, Rich W, Gantz M, Laptook A . Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010; 362(21):1970-9. PMC: 3071534. DOI: 10.1056/NEJMoa0911783. View

11.

Koyamaibole L, Kado J, Qovu J, Colquhoun S, Duke T . An evaluation of bubble-CPAP in a neonatal unit in a developing country: effective respiratory support that can be applied by nurses. J Trop Pediatr. 2005; 52(4):249-53. DOI: 10.1093/tropej/fmi109. View

12.

Clair C, Norwitz E, Woensdregt K, Cackovic M, Shaw J, Malkus H . The probability of neonatal respiratory distress syndrome as a function of gestational age and lecithin/sphingomyelin ratio. Am J Perinatol. 2008; 25(8):473-80. PMC: 3095020. DOI: 10.1055/s-0028-1085066. View

13.

Urs P, Khan F, Maiya P . Bubble CPAP - a primary respiratory support for respiratory distress syndrome in newborns. Indian Pediatr. 2009; 46(5):409-11. View

14.

de Klerk A, de Klerk R . Nasal continuous positive airway pressure and outcomes of preterm infants. J Paediatr Child Health. 2001; 37(2):161-7. DOI: 10.1046/j.1440-1754.2001.00624.x. View

15.

Blencowe H, Kerac M, Molyneux E . Safety, effectiveness and barriers to follow-up using an 'early discharge' Kangaroo Care policy in a resource poor setting. J Trop Pediatr. 2009; 55(4):244-8. DOI: 10.1093/tropej/fmn116. View

16.

Lawn J, Kerber K, Enweronu-Laryea C, Massee Bateman O . Newborn survival in low resource settings--are we delivering?. BJOG. 2009; 116 Suppl 1:49-59. DOI: 10.1111/j.1471-0528.2009.02328.x. View

17.

DiBlasi R . Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respir Care. 2009; 54(9):1209-35. View

18.

Morley C, Davis P, Doyle L, Brion L, Hascoet J, Carlin J . Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008; 358(7):700-8. DOI: 10.1056/NEJMoa072788. View

19.

Lawn J, Kerber K, Enweronu-Laryea C, Cousens S . 3.6 million neonatal deaths--what is progressing and what is not?. Semin Perinatol. 2010; 34(6):371-86. DOI: 10.1053/j.semperi.2010.09.011. View

20.

Gnanaratnem J, Finer N . Neonatal acute respiratory failure. Curr Opin Pediatr. 2000; 12(3):227-32. DOI: 10.1097/00008480-200006000-00009. View