Bubble devices versus other pressure sources for nasal continuous positive airway pressure in preterm infants

New World Health Organization recommendations for care of preterm or low birth weight infants: health policy

“…This decision was based on evidence of small to moderate benefits of decreased pneumothorax, decreased bronchopulmonary dysplasia, and decreased failed treatment (defined as recurrent apnoea, hypoxia, hypercarbia, increasing oxygen requirement or the need for mechanical ventilation) in trials of preterm infants <37 weeks gestation. 34 Evidence of small harm was also found, consisting of increased nasal injury, defined as ulceration, bleeding, septal injury, scarring, excluding hyperaemia or erythema, mostly minor and of unclear cause. The GDG reccommended that the nasal interface (i.e., prongs and cannulas) used with bubble CPAP machines should be carefully selected and that skilled nursing care of the baby while on prongs and cannulas is needed.…”

“…Seventeen new systematic reviews were commissioned to assess topics not addressed in existing reviews and 21 additional existing systematic reviews and meta analyses were assessed by the GDG ( Supplementary Table S2 ). 7 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 The quality of the scientific evidence for each intervention was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE), 40 and evidence was categorised as high, moderate, low and very low certainty. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) 41 approach was used for qualitative evidence.…”

Non-invasive ventilation in neonates: a review of current literature

“…Underwater bubble CPAP systems are most widely used globally, and more so in low-resource settings. The predominant reasons for their popularity are the low cost and maintenance, simplicity of use coupled with almost equal effectiveness as the other CPAP devices ( 27 – 31 ). Multiple studies have reported that bubble CPAP is as effective as or even better than ventilator-delivered CPAP for delivering effective positive pressure ventilation ( 27 , 28 ).…”

“…for their popularity are the low cost and maintenance, simplicity of use coupled with almost equal effectiveness as the other CPAP devices (27)(28)(29)(30)(31). Multiple studies have reported that bubble CPAP is as effective as or even better than ventilator-delivered CPAP for delivering effective positive pressure ventilation (27,28). A Cochrane review (27) published in 2023 investigated the efficacy and safety of bubble CPAP compared to other forms of CPAP namely, ventilator-driven and variable flow CPAP.…”

“…Multiple studies have reported that bubble CPAP is as effective as or even better than ventilator-delivered CPAP for delivering effective positive pressure ventilation (27,28). A Cochrane review (27) published in 2023 investigated the efficacy and safety of bubble CPAP compared to other forms of CPAP namely, ventilator-driven and variable flow CPAP. The meta-analysis included 15 studies (1437 neonates) and reported that there was a reduced risk of treatment failure with bubble CPAP compared to the other forms [Risk Ration (RR) (95% confidence interval (CI)): 0.76 (0.60-0.95)].…”