Feasibility of bubble continuous positive airway pressure in secondary facilities in low and middle income countries

Abstract

Background: Newborn respiratory distress is a leading cause of neonatal morbidity and mortality in developing countries. While there have been considerable reductions in child mortality in low and middle income countries (LMIC) in recent years, reductions in neonatal mortality have not been as substantial. Bubble CPAP (bCPAP), mechanical CPAP, and mechanical ventilation are all used to treat respiratory distress syndrome and other pulmonary complications in newborns. Methods: This study reviews the evidence for the efficacy, safety, and feasibility of bCPAP in neonates with respiratory distress in secondary facilities in LMIC. A systematic search (January 2014–January 2018) was performed of MEDLINE (PubMed), Cochrane, Embase, CINAHL, and Google Scholar. Articles reporting on bCPAP for respiratory distress in infants <28 days of age in hospitals in LMIC were included in the qualitative synthesis. Results: Three studies reported on bCPAP in secondary hospitals. The majority of infants given bCPAP survived to discharge. The most commonly reported complication of bCPAP was nasal irritation. CPAP and bCPAP use is increasing in LMIC, but appears limited to urban tertiary care centers. There is a paucity of information in the medical literature regarding bCPAP use in secondary settings. Conclusion: There is evidence that bCPAP, when used in tertiary care settings in LMIC is feasible, safe, effective, reduces the need for mechanical ventilation and ventilator CPAP, and may improve survival. There is very limited evidence supporting the feasibility of bCPAP use in secondary facilities in LMIC. Key words: bubble CPAP, respiratory distress, tertiary setting, low and middle income countries