Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi

PLoS One. 2014 Jan 29;9(1):e86327. doi: 10.1371/journal.pone.0086327. eCollection 2014.

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Continuous Positive Airway Pressure / economics
  • Continuous Positive Airway Pressure / instrumentation
  • Continuous Positive Airway Pressure / methods*
  • Developing Countries
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight
  • Malawi
  • Male
  • Oxygen Inhalation Therapy
  • Respiratory Distress Syndrome, Newborn / mortality
  • Respiratory Distress Syndrome, Newborn / pathology
  • Respiratory Distress Syndrome, Newborn / therapy*
  • Survival Analysis
  • Treatment Outcome

Grants and funding

This work was made possible through the generous support of the Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the World Bank. It was prepared by William Marsh Rice University and does not necessarily reflect the views of the Saving Lives at Birth Partners. Funding was also provided by the African Network for Drugs and Diagnostics Innovation (ANDI). 1. USAID Cooperative Agreement Award No. AID-OAA-A-13-00014, www.usaid.gov 2. African Network for Drugs and Diagnostics Innovation (ANDI), www.andi-africa.org. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.