Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi

Kawaza, Kondwani; Machen, Heather E.; Brown, Jocelyn; Mwanza, Zondiwe; Iniguez, Suzanne; Gest, Al; Smith, E. O'Brian; Oden, Maria; Richards-Kortum, Rebecca R.; Molyneux, Elizabeth

doi:10.1371/journal.pone.0086327

Cited by 149Neonatal Respiratory Health ResearchRespiratory Support and MechanismsInfant Development and Preterm Care

Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi

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Kawaza, Kondwani, Machen, Heather E., Brown, Jocelyn, Mwanza, Zondiwe, Iniguez, Suzanne, Gest, Al, Smith, E. O'Brian, Oden, Maria +2 more·2014·PLoS ONE

DOI 10.1371/journal.pone.0086327PMC PMC3906032

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Abstract

BACKGROUND: Respiratory failure is a leading cause of neonatal mortality in the developing world. Bubble continuous positive airway pressure (bCPAP) is a safe, effective intervention for infants with respiratory distress and is widely used in developed countries. Because of its high cost, bCPAP is not widely utilized in low-resource settings. We evaluated the performance of a new bCPAP system to treat severe respiratory distress in a low resource setting, comparing it to nasal oxygen therapy, the current standard of care. METHODS: We conducted a non-randomized convenience sample study to test the efficacy of a low-cost bCPAP system treating newborns with severe respiratory distress in the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi. Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled inclusion criteria received nasal bCPAP if a device was available; if not, they received standard care. Clinical assessments were made during treatment and outcomes compared for the two groups. FINDINGS: 87 neonates (62 bCPAP, 25 controls) were recruited. Survival rate for neonates receiving bCPAP was 71.0% (44/62) compared with 44.0% (11/25) for controls. 65.5% (19/29) of very low birth weight neonates receiving bCPAP survived to discharge compared to 15.4% (1/13) of controls. 64.6% (31/48) of neonates with respiratory distress syndrome (RDS) receiving bCPAP survived to discharge, compared to 23.5% (4/17) of controls. 61.5% (16/26) of neonates with sepsis receiving bCPAP survived to discharge, while none of the seven neonates with sepsis in the control group survived. INTERPRETATION: Use of a low-cost bCPAP system to treat neonatal respiratory distress resulted in 27% absolute improvement in survival. The beneficial effect was greater for neonates with very low birth weight, RDS, or sepsis. Implementing appropriate bCPAP devices could reduce neonatal mortality in developing countries.

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Many preterm neonates develop respiratory distress and subsequent respiratory failure, contributing to high neonatal mortality.
“Many preterm neonates develop respiratory distress and subsequent respiratory failure, contributing to high neonatal mortality [5,6].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [5]
Pumani was initially trialed at QECH in Malawi in 2012 and scaled from 2012 to 2017 to all 28 central and district hospitals and eight mission hospitals.
“The Pumani was initially trialed at Queen Elizabeth Central Hospital (QECH) in Malawi in 2012 [5] and from 2012 to 2017, scaled to all 28 central and district hospitals across the country, followed by eight mission hospitals.”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [5]
Time is a key factor in the outcome of the neonate in a critical situation.
“Rigid roles and responsibilities leads to delays in initiation of bubble CPAP and time is a key factor in the outcome of the neonate in a critical situation.”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [5]
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 [5]
Kawaza and colleagues showed that initiation delays were associated with longer stays in the hospital and twice as long on treatment in comparison to those who received bubble CPAP earlier.
“Kawaza and colleagues showed that initiation delays were associated with longer stays in the hospital and twice as long on treatment in comparison to those who received bubble CPAP earlier [5].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [5]

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Research Article ( PLOS ONE ) Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi
Kawaza, K., Machen, H. E., Brown, J., Mwanza, Z., Iniguez, S., Gest, A., Smith, E. O., Odén, M., Richards-Kortum, R. R., & MOLYNEUX, E. M. (2016) · Malawi Medical Journal · Cited by 18 · see citing works
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Outcomes of patients with respiratory distress treated with bubble CPAP on a pediatric ward in Malawi
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An assessment of improved outcomes using low-cost bubble CPAP in very low birthweight neonates in a Nigerian tertiary hospital
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Efficacy of Indigenous Bubble CPAP in Neonates withRespiratory Distress
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A High-Value, Low-Cost Bubble Continuous Positive Airway Pressure System for Low-Resource Settings: Technical Assessment and Initial Case Reports
Brown, J., Machen, H., Kawaza, K., Mwanza, Z., Iniguez, S., Lang, H., Gest, A., Kennedy, N., Miros, R., Richards-Kortum, R., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0053622 · Cited by 72 · see citing works
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Authors: Kawaza, K., Machen, H. E., Brown, J., Mwanza, Z., Iniguez, S., Gest, A., Smith, E. O., Oden, M., Richards-Kortum, R. R., & Molyneux, E.
Affiliations: Queen Elizabeth Central Hospital (MW)
Baylor College of Medicine (US)
Rice University (US)
Texas Children's Hospital (US)
Corresponding author: Richards-Kortum, Rebecca R.
ORCID: Kawaza, Kondwani
Mwanza, Zondiwe
Richards-Kortum, Rebecca R.
Molyneux, Elizabeth
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2014-01-29
Volume: 9
Issue: 1
Pages: e86327
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0086327
PMC: PMC3906032
OpenAlex: W2052883659
Cited by: 149
References: 30
Citations by year: 2026: 5 · 2025: 8 · 2024: 4 · 2023: 5 · 2022: 16 · 2021: 12 · 2020: 28 · 2019: 20 · 2018: 14 · 2017: 12 · 2016: 9 · 2015: 9 · 2014: 5 · 2013: 2
FWCI: 9.34
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Bioline International (Bioline International) (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Figshare (submittedVersion, cc-by)
Rice Research Repository (Rice University) (submittedVersion, cc-by)
Funders: United States Agency for International Development (AIDOAAA1300014)
Bill and Melinda Gates Foundation (AID-OAA-A-13-00014)
World Bank Group
Texas Children's Hospital
Rice University
Grand Challenges Canada (AID-OAA-A-13-00014)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
Keywords: bubble CPAP, neonatal respiratory distress, low-cost medical device, neonatal survival, respiratory distress syndrome, neonatal sepsis, very low birth weight infants, nasal oxygen therapy, resource-limited settings, neonatal mortality, Malawi
MeSH terms: Developing Countries, Female, Humans, Infant, Infant, Newborn, Infant, Premature, Malawi, Male, Oxygen Inhalation Therapy, Respiratory Distress Syndrome, Newborn, Survival Analysis, Treatment Outcome, Infant, Very Low Birth Weight, Continuous Positive Airway Pressure

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Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi

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About these checks