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Efficacy of a Low-Cost Bubble CPAP System in Treatment of Respiratory Distress in a Neonatal Ward in Malawi
Open accessAbstract
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 [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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“The Pumani bubble CPAP system does not have a built in humidifier, which required regular nasal saline drops [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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Nasal CPAP or Intubation at Birth for Very Preterm Infants
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Early CPAP versus Surfactant in Extremely Preterm Infants
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3.6 Million Neonatal Deaths—What Is Progressing and What Is Not?
Lawn, J. E., Kerber, K. J., Enweronu-Laryea, C. C., & Cousens, S. N. (2010) · Seminars in Perinatology · doi:10.1053/j.semperi.2010.09.011 · Cited by 441
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Newborn survival in low resource settings—are we delivering?
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Cited by
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Bhutta, Z. A., Das, J. K., Bahl, R., Lawn, J. E., Salam, R. A., Paul, V. K., Sankar, M. J., Blencowe, H., Rizvi, A., Chou, V. B., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60792-3 · Cited by 1,367
Born Too Soon: Care for the preterm baby
Lawn, J. E., Davidge, R., Paul, V. K., von Xylander, S. R., Johnson, J., Costello, A. M. D. L., Kinney, M. V., Segrè, J., & Molyneux, L. (2013) · Reproductive Health · doi:10.1186/1742-4755-10-s1-s5 · Cited by 326
Martin, S., Duke, T., & Davis, P. (2014) · Archives of Disease in Childhood - Fetal and Neonatal Edition · doi:10.1136/archdischild-2013-305519 · Cited by 129
Efficacy and safety of CPAP in low-and middle-income countries
Thukral, A., Sankar, M. J., Chandrasekaran, A., Agarwal, R., & Paul, V. K. (2016) · Journal of Perinatology · doi:10.1038/jp.2016.29 · Cited by 114
Neonatal sepsis in low-income countries: epidemiology, diagnosis and prevention
Popescu, C. R., Amundsen, M. M. M., Tembo, B., Chiume, M., Lufesi, N., Goldfarb, D. A., Kissoon, N. “., & Lavoie, P. M. (2020) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2020.1732818 · Cited by 116
Metadata
- 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.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-01-29
- Volume
- 9
- Issue
- 1
- Pages
- e86327
- ISSN
- 1932-6203 (ISSN-L)
- 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
- FWCI
- 9.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- 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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