Implementation of Bubble CPAP in a Rural Ugandan Neonatal ICU
Open accessAbstract
BACKGROUND: Respiratory distress is a leading cause of neonatal death in low-income and middle-income countries. CPAP is a simple and effective respiratory support modality used to support neonates with respiratory failure and can be used in low-income and middle-income countries. The goal of this study was to describe implementation of the Silverman-Andersen respiratory severity score (RSS) and bubble CPAP in a rural Ugandan neonatal NICU. We sought to determine whether physicians and nurses in a low-income/middle-income setting would assign similar RSS in neonates after an initial training period and over time. METHODS: We describe the process of training NICU staff to use the RSS to assist in decision making regarding initiation, titration, and termination of bubble CPAP for neonates with respiratory distress. Characteristics of all neonates with respiratory failure treated with bubble CPAP in a rural Ugandan NICU from January to June 2012 are provided. RESULTS: Nineteen NICU staff members (4 doctors and 15 nurses) received RSS training. After this, the Spearman correlation coefficient for respiratory severity scoring between doctor and nurse was 0.73. Twenty-one infants, all < 3 d of age, were treated with CPAP, with 17 infants starting on the day of birth. The majority of infants (16/21, 76%) were preterm, 10 (48%) were <1,500 g (birthweight), and 13 (62%) were outborn. The most common diagnoses were respiratory distress syndrome (16/21, 76%) and birth asphyxia (5/21, 24%). The average RSS was 7.4 ± 1.3 before starting CPAP, 5.2 ± 2.3 after 2–4 h of CPAP, 4.9 ± 2.7 after 12–24 h of CPAP, and 3.5 ± 1.9 before CPAP was discontinued. Duration of treatment with CPAP averaged 79 ± 43 h. Approximately half (11/21, 52%) of infants treated with CPAP survived to discharge. CONCLUSIONS: Implementing bubble CPAP in a low-income/middle-income setting is feasible. The RSS may be a simple and useful tool for monitoring a neonate's respiratory status and for guiding CPAP management.
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Preterm and term newborns with respiratory distress can often be effectively supported with CPAP, avoiding the need for intubation and mechanical ventilation.
“Preterm and term newborns with respiratory distress can often be effectively supported with Continuous Positive Airway Pressure (CPAP), avoiding the need for intubation and mechanical ventilation [6,9,10].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [9]
Our findings on shortage of neonatal staff are in line with previous research on bubble CPAP in sub-Saharan Africa where understaffed neonatal units and high turnover of nurses and doctors limited capacity for care.
“Our findings on shortage of neonatal staff are in line with previous research on bubble CPAP in sub-Saharan Africa where understaffed neonatal units and high turnover of nurses and doctors limited capacity for care [9,24,25,33,34].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [9]
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- Authors
- McAdams, R. M., Hedstrom, A. B., DiBlasi, R. M., Mant, J. E., Nyonyintono, J., Otai, C. D., Lester, D. A., & Batra, M.
- Affiliations
- Seattle Children's Hospital (US)
- York Hospital (GB)
- Kiwoko Hospital (UG)
- The ISIS Foundation, Edmonds, Washington.
- Venue
- Respiratory Care
- Publisher
- SAGE Publications
- Published
- 2014-11-11
- Volume
- 60
- Issue
- 3
- Pages
- 437-445
- ISSN
- 0020-1324 (ISSN-L)
- OpenAlex
- W2082833330
- Cited by
- 74
- References
- 22
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 4 · 2023: 9 · 2022: 6 · 2021: 5 · 2020: 17 · 2019: 6 · 2018: 11 · 2017: 4 · 2016: 2 · 2015: 2
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Respiratory Care (publishedVersion)
- PubMed (publishedVersion)
- 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, respiratory failure, neonatal intensive care, low-income settings, rural Uganda, employee training, preterm infants, respiratory distress syndrome, neonatal asphyxia, CPAP titration
- MeSH terms
- Equipment Design, Female, Humans, Infant, Newborn, Intensive Care Units, Neonatal, Male, Respiratory Distress Syndrome, Newborn, Retrospective Studies, Socioeconomic Factors, Uganda, Continuous Positive Airway Pressure
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