Effects of underwater bubble CPAP on very-low-birth-weight preterm newborns in the delivery room and after transport to the neonatal intensive care unit

Abelenda, Vera Lucia Barros; Valente, Tania Cristina Oliveira; Marinho, Cirlene Lima; Lopes, Agnaldo José

doi:10.1177/1367493517752500

Cited by 7 publications

(12 citation statements)

References 38 publications

(48 reference statements)

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“…The survival of VLBW neonates at MRRH-NNU was significantly improved by the introduction of bCPAP for the treatment of RDS. This supports data from similar studies in MICs [11–14, 22, 23].…”

Section: Discussionsupporting

confidence: 90%

“…In Kenya, the survival-to-discharge rate was increased from 61 to 85% after bubble CPAP was implemented [14]. A small retrospective study of VLBW neonates in Brazil showed the introduction of underwater bCPAP reduced the need for resuscitation, surfactant and mechanical ventilation in < 1500 g neonates [22]. In a large neonatal unit in Nicaragua, a new strategy to promote the systematic use of bCPAP significantly reduced the rate of intubation and mortality [23].…”

Section: Discussionmentioning

confidence: 99%

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Reducing preterm mortality in eastern Uganda: the impact of introducing low-cost bubble CPAP on neonates <1500 g

et al. 2019

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Background Complications of prematurity are the leading cause of deaths in children under the age of five. The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods. Methods This was a retrospective study of VLBW neonates (weight < 1500 g) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates < 1500 g were compared before and after the introduction of bCPAP. Results The admission records of 377 VLBW neonates < 1500 g were obtained. One hundred fifty-eight were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P = 0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36–0.86, P = 0.01). There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups. Conclusion Specialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths. The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Reducing preterm mortality in eastern Uganda: the impact of introducing low-cost bubble CPAP on neonates <1500 g

et al. 2019

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“…Ventilation can be adequately provided through several modes of delivery. Various studies in preterm neonates have identified early continuous positive airway pressure (CPAP) use in the immediate postnatal period as beneficial in decreasing the need for and/or the duration of mechanical ventilation and the need for surfactant without evidence of worsening bronchopulmonary dysplasia (BPD) [54][55][56][57]. In a Cochrane review meta-analysis, prophylactic CPAP was compared with supportive care (defined as oxygen therapy delivered by head box or standard nasal cannula) or mechanical ventilation.…”

Section: Ventilation Practices Within Delivery Room Resuscitationmentioning

confidence: 99%

Delivery room handling of the newborn

Marshall

Lång

Perez

et al. 2019

Journal of Perinatal Medicine

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AbstractFor newly born babies, especially those in need of intervention at birth, actions taken during the first minute after birth, the so-called “Golden Minute”, can have important implications for long-term outcomes. Both delivery room handling, including identification of maternal and infant risk factors and provision of effective resuscitation interventions, and antenatal care decisions regarding antenatal steroid administration and mode of delivery, are important and can affect outcomes. Anticipating risk factors for neonates at high risk of requiring resuscitation can decrease time to resuscitation and improve the prognosis. Following a review of maternal and fetal risk factors affecting newborn resuscitation, we summarize the current recommendations for delivery room handling of the newborn. This includes recommendations and rationale for the use of delayed cord clamping and cord milking, heart rate assessment [including the use of electrocardiogram (ECG) electrodes in the delivery room], role of suctioning in newborn resuscitation, and the impact of various ventilatory modes. Oxygenation should be monitored by pulse oximetry. Effects of oxygen and surfactant on subsequent pulmonary outcomes, and recommendations for provisions of appropriate thermoregulatory support are discussed. Regular teaching of delivery room handling should be mandatory.

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“…RDS usually develops in the first 24 hours after birth in premature newborns due to a lack of surfactant within the lungs, and often requires positive pressure ventilation for treatment [ 5 ]. Continuous positive airway pressure (CPAP) is considered to be the gold standard, treatment for preterm neonates experiencing RDS and is recommended by WHO [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Forms of CPAP can vary across a number of factors including the patient interface, sophistication, and how they generate pressure. Bubble continuous positive airway pressure (bCPAP) is a common mode of CPAP delivery for newborns that uses a bubbler instead of a ventilator to generate pressure [ 6 – 8 ]. Since bCPAP systems are considered at least as efficacious and are considerably lower cost than ventilator-derived CPAP devices, they may have significant potential to improve access to non-invasive ventilation in low-resource regions worldwide [ 7 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review

Dada¹,

Ashworth

Sobitschka

et al. 2021

PLoS ONE

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Background Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation. Objective To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings. Methods A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted. Findings 1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP. Conclusion Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration.

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Effects of underwater bubble CPAP on very-low-birth-weight preterm newborns in the delivery room and after transport to the neonatal intensive care unit

Cited by 7 publications

References 38 publications

Reducing preterm mortality in eastern Uganda: the impact of introducing low-cost bubble CPAP on neonates <1500 g

Reducing preterm mortality in eastern Uganda: the impact of introducing low-cost bubble CPAP on neonates <1500 g

Delivery room handling of the newborn

Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review

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