Novel Low Cost Bubble CPAP as an Alternative Respiratory Support in Low Resource Setting

Novel Low Cost Bubble CPAP as an Alternative Non-invasive Respiratory Support Among Preterm Infants With Respiratory Distress Syndrome

This is a single-blind randomized controlled trial done in a Level III neonatal intensive care unit. Preterm newborns with RDS were randomized to receive oxygen therapy through bubble CPAP vs ventilator-derived CPAP. Differences in arterial blood gases, oxygen saturation, number of surfactant and CPAP failure rate between study groups were analyzed.

Background and Objective: Respiratory distress syndrome (RDS) among premature infants is one of the major causes of neonatal death. The use of continuous positive airway pressure (CPAP) has become a standard of care for preterm newborns with RDS. In countries faced with the challenge of improving neonatal care, cost-effective innovations for respiratory support are a promising intervention. This study determined the efficacy of a low-cost bubble CPAP as an alternative non-invasive oxygen therapy for newborn infants with RDS.

METHODS: This is a single-blind randomized controlled trial done in a Level III neonatal intensive care unit. Preterm newborns with RDS were randomized to receive oxygen therapy through bubble CPAP vs ventilator-derived CPAP. Differences in arterial blood gases, oxygen saturation, number of surfactant and CPAP failure rate between study groups were analyzed.

Inclusion Criteria:

• Included are preterm neonates less than 36 weeks (WHO definition)
• admitted at NICU
• APGAR scores of > 7 in the 1st and 5th minute of life
• in respiratory distress at birth,
• radiologic findings of RDS
• Respiratory Severity Score (RSS) or Downe's score > 4 at 10-15 minutes after hooking to CPAP
• requiring CPAP or more than 40% FiO2

Exclusion Criteria:

• Infants requiring neonatal resuscitation such as bag mask ventilation, chest compression or intubation at birth
• with comorbidities such as facial anomalies, tracheoesophageal fistulas, congenital heart disease, and other congenital anomalies which may interfere with the interface of both devices.