Implementation of a novel bubble continuous positive airway pressure system with a blender in preterm infants in a low resource setting | Journal of Perinatology

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To determine if a novel CPAP system is associated with physiologic improvement in premature infants in a low resource setting and if the introduction of blended oxygen would reduce FiO2.

Feasibility study of infants ≤2000 g or ≤32 weeks gestational age with early respiratory distress who were placed on Vayu CPAP with continuous pulse oximetry. Physiologic parameters were recorded prior to initiation and through the first 24 h.

Seventy-six infants of birthweight 1360 ± 324 g and gestational age 31.2 ± 2.5 weeks were included. Compared to baseline, heart rate, respiratory rate, FiO2, and Silverman Anderson score significantly decreased while oxygen saturations significantly increased at one hour with persistence through 24 h.

Utilization of Vayu CPAP in premature infants with respiratory distress was associated with immediate improvement in physiologic parameters. Use of blended oxygen coupled with pulse oximetry facilitates reduction in delivered oxygen.

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Fraser J, Walls M, McGuire W. Respiratory complications of preterm birth. BMJ. 2004;329:962–5.

Article PubMed PubMed Central Google Scholar

Warren JB, Anderson JM. Core concepts: respiratory distress syndrome. NeoReviews. 2009;10:c351–c61.

Article Google Scholar

Silverman WA, Andersen DH. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics. 1956;17:1–10.

CAS PubMed Google Scholar

WHO recommendations for care of the preterm or low-birth-weight infant. Geneva: World Health Organization; 2022.

Deuber C, Terhaar M. Hyperoxia in very preterm infants a systematic review of the literature. J Perinat Neonatal Nurs. 2011;25:268–74.

Article PubMed Google Scholar

Carlo WA, Finer NN, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med. 2010;362:1959–69.

Article CAS PubMed Google Scholar

Askie LM, Darlow BA, Finer N, Schmidt B, Stenson B, Tarnow-Mordi W, et al. Association between oxygen saturation targeting and death or disability in extremely preterm infants in the neonatal oxygenation prospective meta-analysis collaboration. JAMA. 2018;319:2190.

Article CAS PubMed PubMed Central Google Scholar

Herrod SK, Stevenson A, Vaucher YE, Lambert SR, Isenberg SJ, Yap VL, et al. Oxygen management among infants in neonatal units in sub-Saharan Africa: a cross-sectional survey. J Perinatol. 2021;41:2631–8.

Article CAS PubMed PubMed Central Google Scholar

Tooke L, Ehret DEY, Okolo A, Dlamini-Ngeketo S, Joolay Y, Minto’o S, et al. Limited resources restrict the provision of adequate neonatal respiratory care in the countries of Africa. Acta Paediatr. 2021;111:275–83.

Article PubMed Google Scholar

Breathing for Babies: Vayu Global Health Innovations; [November 6, 2023]. Available from: https://vayuinnovations.org/vayu-bcpap-system/.

Dundek ML, Ng EK, Brazil AM, Diblasi RM, Poli JA, Burke TF. Evaluation of a bubble CPAP system for low resource settings. Respir Care. 2021;66:1572–81.

Article Google Scholar

Kawaza K, Machen HE, Brown J, Mwanza Z, Iniguez S, Gest A, et al. Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi. PLoS ONE. 2014;9:e86327.

Article PubMed PubMed Central Google Scholar

Shayo A, Mlay P, Ahn E, Kidanto H, Espiritu M, Perlman J. Early neonatal mortality is modulated by gestational age, birthweight and fetal heart rate abnormalities in the low resource setting in Tanzania – a five year review 2015–2019. BMC Pediatr. 2022;22:313.

Article PubMed PubMed Central Google Scholar

Ho JJ, Subramaniam P, Davis PG. Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants (Review). Cochrane Database Syst Rev. 2020;10:CD002271.

PubMed Google Scholar

Okello F, Egiru E, Ikiror J, Acom L, Loe K, Olupot-Olupot P, et al. Reducing preterm mortality in eastern Uganda: the impact of introducing low-cost bubble CPAP on neonates <1500 g. BMC Pediatr. 2019;19:311.

Article CAS PubMed PubMed Central Google Scholar

Rauschendorf P, Bou Saba G, Meara GK, Roodaki N, Conde-Agudelo A, Garcia DEC, et al. Effectiveness of a novel bubble CPAP system for neonatal respiratory support at a referral hospital in the Philippines. Front Pediatrics. 2023;11:1323178.

Article Google Scholar

Tayler A, Ashworth H, Bou Saba G, Wadhwa H, Dundek M, Ng E, et al. Feasibility of a novel ultra-low-cost bubble CPAP (bCPAP) System for neonatal respiratory support at Muhimbili National Hospital, Tanzania. PLoS ONE. 2022;17:e0269147.

Article CAS PubMed PubMed Central Google Scholar

Dada S, Ashworth H, Sobitschka A, Raguveer V, Sharma R, Hamilton RL, et al. Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: a scoping review. PLoS ONE. 2021;16:e0252718.

Article CAS PubMed PubMed Central Google Scholar

Poletto S, Trevisanuto D, Ramaswamy VV, Abubacar Seni AH, Ouedraogo P, Dellacà RL, et al. Bubble CPAP respiratory support devices for infants in low-resource settings. Pediatr Pulmonol. 2023;58:643–52.

Article PubMed Google Scholar

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We would like to thank all of the pediatric staff at Kilimanjaro Christian Medical Centre for their dedication and enthusiastic care of the infants in our study.

This work was supported in part by Bloomberg Philanthropies. Vayu Global Health Innovations donated the continuous positive airway pressure machines. Both Vayu Global Health Innovations and Bloomberg Philanthropies had no involvement in study design, data collection, data analysis, or decision for publication submission.

Division of Neonatology, NewYork-Presbyterian-Weill Cornell Medicine, New York, NY, USA

Emily Ahn & Jeffrey Perlman

Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania

Aisa Shayo, Matei Mselle & Anna Sechu

Kilimanjaro Christian Medical University College, Moshi, Tanzania

Aisa Shayo

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Drs. Ahn and Perlman conceptualized and designed the study, supervised study implementation and data collection, were responsible for data curation, performed formal data analysis, and drafted the initial manuscript. Drs. Mselle and Shayo and Nurse Sechu assisted with study design, acquisition of data, and manuscript revisions. All authors critically reviewed the manuscript for important intellectual content, revised the manuscript and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Correspondence to Emily Ahn.

The authors declare no competing interests.

This project was approved by the KCMC ethics committee (No 2622) and the National Institute of Medical Research (NIMR/HQ/R.8a/Vol.1X/4561) in Tanzania and included a data transfer agreement. All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from the parents.

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Ahn, E., Shayo, A., Mselle, M. et al. Implementation of a novel bubble continuous positive airway pressure system with a blender in preterm infants in a low resource setting. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02153-5

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Received: 12 June 2024

Revised: 04 October 2024

Accepted: 08 October 2024

Published: 15 October 2024

DOI: https://doi.org/10.1038/s41372-024-02153-5

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