Impact of the systematic introduction of low-cost bubble nasal CPAP in a NICU of a developing country: a prospective pre- and post-intervention study

Abstract

BackgroundThe use of Nasal Continuous Positive Airway Pressure Ventilation (NCPAP) has begun to increase and is progressively replacing conventional mechanical ventilation (MV), becoming the cornerstone treatment for newborn respiratory distress syndrome (RDS). Howerver, NCPAP use in Lower-Middle Income Countries (LMICs) is poor. Moreover, bubble NCPAP (bNCPAP), for efficacy, cost effectiveness, and ease of use, should be the primary assistance technique employed in newborns with RDS.Objective: To measure the impact on in-hospital newborn mortality of using a bNCPAP device as the first intervention on newborns requiring ventilatory assistance.MethodsDesign: Prospective pre-intervention and post-intervention study.Setting: The largest Neonatal Intensive Care Unit (NICU) in Nicaragua.Participants: In all, 230 (2006) and 383 (2008) patients were included.Intervention: In May 2006, a strategy was introduced to promote the systematic use of bNCPAP to avoid intubation and MV in newborns requiring ventilatory assistance. Data regarding gestation, delivery, postnatal course, mortality, length of hospitalisation, and duration of ventilatory assistance were collected for infants assisted between May and December 2006, before the project began, and between May and December 2008, two years afterwards.Outcome measures: The pre- vs post-intervention proportion of newborns who died in-hospital was the primary end point. Secondary endpoints included rate of intubation and duration of NICU stay.ResultsSignificant differences were found in the rate of intubation (72 vs 39%; p < 0.0001) and the proportion of patients treated exclusively with bNCPAP (27% vs 61%; p <0.0001). Mortality rate was significantly reduced (40 vs 23%; p < 0.0001); however, an increase in the mean duration of NICU stay was observed (14.6 days in 2006 and 17.5 days in 2008, p = 0.0481).The findings contribute to the evidence that NCPAP, particularly bNCPAP, is the first-line standard of care for efficacy, cost effectiveness, and ease of use in newborns with respiratory distress in LMICs.ConclusionsThis is the first extensive survey performed in a large NICU from a LMICs, proving the efficacy of the systematic use of a bNCPAP device in reducing newborn mortality. These findings are an incentive for considering bNCPAP as an elective strategy to treat newborns with respiratory insufficiency in LMICs.

Availability and use of continuous positive airway pressure (CPAP) for neonatal care in public health facilities in India: a cross-sectional cluster survey

“…The case fatality rate for neonates treated with CPAP in this study is in line with reports from India,9 38–43 Iran11 and South Africa,8 44–46 but other countries, such as Fiji,6 Latin American countries7 47 48 and high-income countries13 have reported lower mortality rates. The reported rate of pneumothorax in this study is similar to other studies from India9 38–40 42 and South Africa,44 but lower than in Latin America7 47 and Iran 12.…”

Improved referral and survival of newborns after scaling up of intensive care in Suriname

“…Introduction of nasal CPAP at a NICU in Nicaragua reduced mortality amongst total newborns receiving ventilation assistance (i.e. either mechanical ventilation or CPAP) [ 8 ]. Improvement (i.e., new equipment, refurbishment and training of personnel) of a newborn unit to a Level III NICU at a teaching hospital in Ghana led to significant reduction of mortality amongst newborns with a BW < 2500 g, mostly secondary to significantly reduced incidence of perinatal asphyxia [ 9 ].…”

Clinical Profile and Outcome of Mechanically Ventilated Neonates in a Tertiary Level Hospital

“…It was administered by INSURE technique following which neonates were kept under bubble CPAP. Only those who had persistent distress on bubble CPAP or developed some complica ons were mechanically ven lated 7,8,9 . In this study, 8 preterm neonates weighing 1250 -2250 grams (mean 1650 grams) of gesta on 26-34 weeks (mean 30 weeks) were administered surfactant.…”