A Randomized Clinical Trial Evaluating Nasal Continuous Positive Airway Pressure for Acute Respiratory Distress in a Developing Country

SummaryObjective: To study the effectiveness of locally assembled low-cost version for continuous positive airway pressure (CPAP) delivery. Patients: Babies with respiratory distress from two contiguous periods, one with CPAP therapy and the other without, were compared for following parameters: birth weight, gestational age, severity of respiratory distress, as assessed by Silverman-Anderson retraction score (SARS), maximum SARS, days taken for score to become 0, duration of oxygen therapy, hospital stay and the outcome. Results: The profile of subjects was comparable in two groups. Severity of respiratory distress (SARS) was significantly higher in post-CPAP group. Time taken for SARS to become 0 and number of deaths were significantly lower, and the duration of oxygen administration and hospital stay were significantly higher in post-CPAP group. The cost of an individual disposable CPAP unit was Rs 160 (USD 3). Conclusion: A low-cost and locally assembled CPAP delivery system may reduce neonatal mortality among babies with respiratory distress.

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“…Glass bottle with wide bore needle. developing countries [10]. Therefore, our CPAP system may find wider application in pediatric care as well.…”

Section: Resultsmentioning

confidence: 99%

Home-Made Continuous Positive Airways Pressure Device may Reduce Mortality in Neonates with Respiratory Distress in Low-Resource Setting

Daga

Mhatre

Borhade

et al. 2014

Journal of Tropical Pediatrics

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“…These studies have either included older children [16], examined immediate improvements in clinical endpoints rather than survival to hospital discharge [16], or been small, observational studies [20], [29].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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BackgroundRespiratory 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.MethodsWe 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.Findings87 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.InterpretationUse 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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“…23 Lastly, a variety of qualifying articles were published focusing on pediatric resuscitation, including studies examining the threshold at which to initiate blood transfusions, 24 the use of continuous positive airway pressure therapy, 25 and the utility of the Broselow tape in pediatric resuscitation. 26 …”

Section: Discussionmentioning

confidence: 99%

Publishing Trends in the Field of Pediatric Emergency Medicine From 2004 to 2013

Rixe¹,

Rixe²,

Glick³

et al. 2016

Pediatr Emer Care

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Objective To identify publishing trends within the field of Pediatric Emergency Medicine between 2004 and 2013. Methods We conducted a MEDLINE search of Pediatric Emergency Medicine articles, filtered by clinical trial, published between 2004 and 2013 in ten journals from the fields of Pediatrics, Emergency Medicine, General Medicine, and Pediatric Emergency Medicine. Each article was classified by journal type, study design, results (positive or negative/equivocal), age/type of subjects, and major topic (based on the objective of the study). Articles were stratified by publication time period (2004–2008 or 2009–2013) to analyze trends. Results A total of 464 articles were analyzed. The majority of articles were described as randomized controlled trials (47%) with negative/equivocal findings (70%). The most common major topics were pain management, asthma, sedation, bronchiolitis, resuscitation, simulation, and ultrasound. Over time, the percentage of articles published in Pediatrics and Pediatric Emergency Medicine journals increased (p=0.0499) and the percentage for all study designs increased except for randomized controlled trials (p=0.0089). There were no differences between the two publication time periods when stratified by results, age/type of subjects, and major topic. Conclusions By identifying these trends, we hope to encourage researchers to perform studies in the field of Pediatric Emergency Medicine where deficiencies lie and to guide pediatric health care professionals to where published, evidence-based studies can be found in the medical literature.

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A Randomized Clinical Trial Evaluating Nasal Continuous Positive Airway Pressure for Acute Respiratory Distress in a Developing Country

Cited by 53 publications

References 12 publications

Home-Made Continuous Positive Airways Pressure Device may Reduce Mortality in Neonates with Respiratory Distress in Low-Resource Setting

Home-Made Continuous Positive Airways Pressure Device may Reduce Mortality in Neonates with Respiratory Distress in Low-Resource Setting

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

Publishing Trends in the Field of Pediatric Emergency Medicine From 2004 to 2013

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