Treatment outcomes of Pumani bubble-CPAP versus oxygen therapy among preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania—Randomised trial

Abstract

Background Respiratory distress syndrome (RDS) is the most common respiratory disease in premature babies and the major cause of morbidity and mortality among preterm babies. Effective treatment of these babies requires exogenous surfactant and/or mechanical ventilation but these are of limited availability in low and middle income countries. A cheaper, simpler and more accessible treatment for preterms with RDS called bubble-continuous positive airway pressure (bCPAP) has been reported to be effective in treating RDS in preterm babies with varying levels of effectiveness ranging from 42% to 85%. We aimed to implement and determine the efficacy of bCPAP and its immediate outcomes as compared to oxygen therapy in preterm babies presenting with respiratory distress at a tertiary hospital in Tanzania. Method A randomized control trial, conducted from December 2016 to May 2017, included all preterm babies admitted at the neonatal care unit presenting with signs of respiratory distress and meeting the inclusion criteria. The primary outcome was survival while the secondary outcomes were treatment duration, duration of hospital stay and treatment complications. Results A total of 824 babies were admitted in the neonatal care unit during the study period. Of these, 187 babies were preterm and 48 babies were recruited and randomized (25 bCPAP vs 23 oxygen). The overall survival to discharge for all eligible participants (n = 48) was

Bubble Nasal Continuous Positive Airway Pressure (bNCPAP): An Effective Low-Cost Intervention for Resource-Constrained Settings

“…In this study, neonates were started on bNCPAP if the Silverman-Andersen Respiratory Severity Score was ≥6, whereas a score of ≤3 for at least 6 hours was considered for weaning off bNCPAP. Neonates who received bNCPAP had higher survival compared to those who received oxygen therapy (77.3% vs. 47.8%), although this difference was not statistically significant [ 43 ].…”

“…Facial, nasal bridge and septal injury are the most common complications, occurring more frequently among preterm infants who require NCPAP for a prolonged duration [ 36 , 37 , 43 – 45 ]. Based on severity, nasal injury is classified into three stages: nonblanching erythema on an otherwise intact skin, superficial erosion, and full thickness necrosis of the skin [ 46 , 47 ].…”

“…Besides ensuring that the equipment is appropriately fitted, neonatal nurses and doctors need to carefully monitor infants receiving bNCPAP by performing continuous assessment of the infant's clinical state and response to therapeutic measures [ 43 , 59 , 70 ]. Serial evaluation of the infant's respiratory, cardiovascular, and neurological status helps detect any serious changes that require immediate intervention, thus minimising bNCPAP failure and complications [ 43 , 71 ]. The Clinical Respiratory Distress Scoring System (Downes score) and Silverman-Andersen Respiratory Severity Score are the two commonly used tools for grading the severity of respiratory distress and for monitoring clinical improvement [ 31 , 72 – 74 ].…”

“…The neonate's head should be elevated by 30° and airway patency maintained by gently suctioning the nostrils, mouth, pharynx, and nasal prongs every 4 hours or as needed to clear the mucous [ 29 , 43 , 71 ]. To prevent hypothermia and damage to the nasal mucosa, the humidifier temperature should be set at 37°C.…”

Effect of early nasal continuous positive airway pressure in preterm neonates with mild-to-moderate hyaline membrane disease in a rural area – An analytic prospective observational study

“…With the above background, there is a global trend favoring noninvasive ventilation and highlighting early CPAP as a primary mode of treatment even in low-income countries. There is a paucity of literature with only few studies addressing the research question [1,8,10,11]. Moreover, the available literature comprises studies done before 2015.…”