Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review

Martin, Simone; Duke, Trevor; Davis, Peter

doi:10.1136/archdischild-2013-305519

Cited by 129Neonatal Respiratory Health ResearchRespiratory Support and MechanismsNeuroscience of respiration and sleep

Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review

Martin, Simone, Duke, Trevor, Davis, Peter·2014·Archives of Disease in Childhood - Fetal and Neonatal Edition

DOI 10.1136/archdischild-2013-305519

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Abstract

Introduction: Forty per cent of global child deaths occur in the neonatal period. Low and middle income countries need effective and simple methods to improve hospital-based neonatal care. Bubble continuous positive airway pressure (CPAP) may have a role in improving the quality of respiratory support in hospitals in low and middle income countries. Aim: To examine the evidence for the efficacy and safety of bubble CPAP in neonates with respiratory distress in low and middle income settings. Method: A systematic search (1946–March 2014) was performed of Pubmed, Ovid MEDLINE, Web of Science, Google Scholar and the references of relevant articles. Articles meeting inclusion criteria (CPAP for respiratory distress in infants <28 days of age in hospitals in low and middle income countries) were assessed using Grading of Recommendations, Assessment, Development and Evaluation and Newcastle-Ottawa Quality Assessment Scale methodology. Outcomes included need for mechanical ventilation, complications and mortality. Results: In three studies, the initial use of bubble CPAP compared with oxygen therapy, followed by mechanical ventilation if required, reduced the need for mechanical ventilation by 30%–50%. In another three trials comparing bubble CPAP with ventilator CPAP, mortality and complication rates were similar, while meta-analysis of CPAP failure in these same trials showed a lower failure rate in the bubble CPAP groups (p <0.003). Conclusions: There is evidence that bubble CPAP is safe and reduces the need for mechanical ventilation. Further research into the efficacy of bubble CPAP in low-income and middle-income countries is needed.

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Limited healthcare infrastructure, including lack of equipment and skilled personnel, may compromise effective use of bubble CPAP in neonatal nurseries.
“Limited healthcare infrastructure, including lack of equipment and skilled personnel, may compromise effective use of bubble CPAP in neonatal nurseries [6,12,13,15].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [12]
High-quality research on effective, safe, and sustainable implementation of bubble CPAP in LMICs is required.
“High-quality research studies on effective, safe, and sustainable implementation of bubble CPAP in LMICs are required [6,12].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [12]
Bubble CPAP is a simple and relatively inexpensive form of CPAP that may be safe and cost-effective for delivering CPAP and reducing neonatal mortality in LMICs.
“Bubble CPAP is a simple and relatively inexpensive form of CPAP [8,11].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [12]

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Authors: Martin, S., Duke, T., & Davis, P.
Affiliations: Royal Children's Hospital (AU)
Royal Women's Hospital (AU)
Corresponding author: Martin, Simone
ORCID: Martin, Simone
Duke, Trevor
Davis, Peter
Venue: Archives of Disease in Childhood - Fetal and Neonatal Edition
Publisher: BMJ
Published: 2014-08-01
Volume: 99
Issue: 6
Pages: F495-F504
ISSN: 1359-2998 (ISSN-L)
1468-2052
DOI: 10.1136/archdischild-2013-305519
OpenAlex: W2148922604
Cited by: 129
References: 55
Citations by year: 2026: 2 · 2025: 9 · 2024: 4 · 2023: 8 · 2022: 17 · 2021: 9 · 2020: 23 · 2019: 15 · 2018: 12 · 2017: 8 · 2016: 10 · 2015: 10 · 2014: 1 · 2013: 1
FWCI: 1.66
Type: journal article
Language: en
Open access: closed
Locations: Archives of Disease in Childhood Fetal & Neonatal (publishedVersion)
PubMed (publishedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords: bubble CPAP, neonatal respiratory distress, neonatal respiratory support, mechanical ventilation reduction, CPAP failure, CPAP complications, neonatal mortality, low- and middle-income countries, oxygen therapy
MeSH terms: Humans, Infant, Newborn, Infant, Premature, Oxygen Inhalation Therapy, Research Design, Respiratory Distress Syndrome, Newborn, Intensive Care, Neonatal, Continuous Positive Airway Pressure

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Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review

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