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Bubble - Continuous positive airway pressure (CPAP) has been reported to be effective, cheaper, simpler and more accessible compared to mechanical ventilator and surfactant treatment for preterms with respiratory distress syndrome in the neighbouring countries. This study aims to implement and determine the effectiveness of bCPAP and its immediate outcomes compared to oxygen therapy in preterm babies presenting with respiratory distress syndrome (RDS).
Effective treatment of preterm babies with RDS requires exogenous surfactant and/or mechanical ventilation but these are of limited availability in developing countries.
bCPAP is generated by exhalation against a constant opening pressure that produces positive end-expiratory pressure. This in-turn helps in maintaining lung volume at the end of expiration, preventing atelectasis, improving oxygenation, reducing respiratory fatigue and eventually preventing respiratory failure. bCPAP (Rice 360â—¦c low cost bCPAP device) consisting of 3 components: : (i)An air compressor connected to an oxygen concentrator with a gas flow fate of 3-4 L/min; (ii) A nasal interface (short nasal prongs) connecting the baby's airway to a two limb circuit i.e the inspiratory limb connected to the bCPAP machine and the expiratory limb connected to the water bottle and; (iii) An expiratory limb with the distal end submerged 6 cm in water to generate an end expiratory pressure
At the neonatal unit at Kilimanjaro Christian Medical Center (KCMC), the standard of care for Preterm babies with RDS is receiving oxygen therapy via nasal prongs from oxygen cylinders.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| bCPAP Arm. | Experimental | Babies randomized to receive bCPAP were started (by principle investigator assisted by a clinician) on bCPAP (Rice 360â—¦c low cost bCPAP device) consisting of 3 components: (i) An oxygen concentrator with a gas flow fate of 3-4L/min, (ii) A nasal interface (short nasal prongs) connecting the baby's airway to a two limb circuit i.e the inspiratory limb connected to the bCPAP machine and the expiratory limb connected to the water bottle and (iii) An expiratory limb with the distal end submerged 6cm in water to generate an end expiratory pressure as seen in appendix 7. adopted from suppliers of the pumani bCPAP machine in Kenya. |
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| Oxygen Arm | Other | Preterms on the control arm and those whose parents didn't consent received the standard treatment for RDS i.e pure oxygen via nasal prongs from the oxygen cylinders. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| bCPAP Arm | Device | bCPAP (Rice 360â—¦c low cost bCPAP device) |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Comparing the number of babies that survived with bCPAP treatment versus Oxygen therapy | The proportion of babies discharged alive in the bCPAP arm versus the oxygen therapy arm. | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Treatment duration | The time spent on the allocated treatment arm till RDS symptoms (tachypnea (>60breaths/min), intercostal and subcostal recessions, nasal flaring, grunting and cyanosis) resolve. | 6 months |
| Duration of hospital stay |
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Inclusion Criteria:
Exclusion Criteria:
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24489715 | Result | Kawaza K, Machen HE, Brown J, Mwanza Z, Iniguez S, Gest A, Smith EO, Oden M, Richards-Kortum RR, Molyneux E. Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi. PLoS One. 2014 Jan 29;9(1):e86327. doi: 10.1371/journal.pone.0086327. eCollection 2014. |
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De-identified participant data will be shared as per the local country guidelines.
Data will be made available 12 months after study completion.
Persons requesting data will be asked to sign a data transfer agreement as well as provide evidence of ethical clearance.
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Jun 15, 2020 | |
| Reset | Jul 2, 2020 | |
| Release | Aug 30, 2021 | |
| Reset | Sep 23, 2021 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Jun 15, 2020 | Jul 2, 2020 | |||
| Aug 30, 2021 |
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| Oxygen Arm |
| Other |
Oxygen therapy from oxygen cylinders |
|
Time from admission into the neonatal ward to discharge (dead or alive).
| 6 months |
| Treatment complications | Whilst the subject is receiving treatment, the following complications will be observed and recorded; like pneumothorax, nasal bleeding, injury to the skin, nose or eye, aspiration pneumonia, vomiting and any other complication considered related to the treatment as per the principal investigator's clinical judgement. | 6 months |
| Sep 23, 2021 |