Bubble CPAP to support preterm infants in rural Rwanda: a retrospective cohort study
Open accessAbstract
BACKGROUND: Complications from premature birth contribute to 35% of neonatal deaths globally; therefore, efforts to improve clinical outcomes of preterm (PT) infants are imperative. Bubble continuous positive airway pressure (bCPAP) is a low-cost, effective way to improve the respiratory status of preterm and very low birth weight (VLBW) infants. However, bCPAP remains largely inaccessible in resource-limited settings, and information on the scale-up of this technology in rural health facilities is limited. This paper describes health providers' adherence to bCPAP protocols for PT/VLBW infants and clinical outcomes in rural Rwanda. METHODS: This retrospective chart review included all newborns admitted to neonatal units in three rural hospitals in Rwanda between February 1st and October 31st, 2013. Analysis was restricted to PT/VLBW infants. bCPAP eligibility, identification of bCPAP eligibility and complications were assessed. Final outcome was assessed overall and by bCPAP initiation status. RESULTS: There were 136 PT/VLBW infants. For the 135 whose bCPAP eligibility could be determined, 83 (61.5%) were bCPAP-eligible. Of bCPAP-eligible infants, 49 (59.0%) were correctly identified by health providers and 43 (51.8%) were correctly initiated on bCPAP. For the 52 infants who were not bCPAP-eligible, 45 (86.5%) were correctly identified as not bCPAP-eligible, and 46 (88.5%) did not receive bCPAP. Overall, 90 (66.2%) infants survived to discharge, 35 (25.7%) died, 3 (2.2%) were referred for tertiary care and 8 (5.9%) had unknown outcomes. Among the bCPAP eligible infants, the survival rates were 41.8% (18 of 43) for those in whom the procedure was initiated and 56.5% (13 of 23) for those in whom it was not initiated. No complications of bCPAP were reported. CONCLUSION: While the use of bCPAP in this rural setting appears feasible, correct identification of eligible newborns was a challenge. Mentorship and refresher trainings may improve guideline adherence, particularly given high rates of staff turnover. Future research should explore implementation challenges and assess the impact of bCPAP on long-term outcomes.
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Previous work in sub-Saharan Africa largely examined barriers and enablers as issues that emerged from efficacy and safety studies.
“Previous work in sub-Saharan Africa largely examined barriers and enablers as issues that emerged from efficacy and safety studies [5,13,21,22].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [22]
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- Authors
- Nahimana, E., Ngendahayo, M., Magge, H., Odhiambo, J., Amoroso, C. L., Muhirwa, E., Uwilingiyemungu, J. N., Nkikabahizi, F., Habimana, R., & Hedt-Gauthier, B. L.
- Affiliations
- Partners In Health (US)
- Ministry of Health (RW)
- Brigham and Women's Hospital (US)
- Corresponding author
- Nahimana, Evrard
- Venue
- BMC Pediatrics
- Published
- 2015-09-24
- Volume
- 15
- Issue
- 1
- Pages
- 135-135
- ISSN
- 1471-2431 (ISSN-L)
- PMC
- PMC4582629
- OpenAlex
- W2130620173
- Cited by
- 43
- References
- 21
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 6 · 2020: 13 · 2019: 3 · 2018: 5 · 2017: 4 · 2016: 1
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pediatrics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- bubble continuous positive airway pressure, preterm infants, very low birth weight infants, neonatal respiratory support, guideline adherence, health professions education, neonatal mortality, rural health facilities, resource-limited settings, Rwanda
- MeSH terms
- Female, Follow-Up Studies, Humans, Infant, Newborn, Infant, Premature, Male, Respiratory Distress Syndrome, Newborn, Retrospective Studies, Rural Population, Rwanda, Incidence, Survival Rate, Infant, Very Low Birth Weight, Continuous Positive Airway Pressure
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