Neonatal Continuous Positive Airway Pressure Research Articles

Implementation of neonatal continuous positive airway pressure in a low-resource setting: Technology is not enough.

Implementation of neonatal continuous positive airway pressure in a low-resource setting: Technology is not enough.

Low-Cost SpO2 Integrated Neonatal CPAP Device for Low Resource Setting.

More than 60% of preterm births take place in South Asia and sub-Saharan Africa, making prematurity a primary cause of neonatal mortality. Even though continuous positive airway pressure (CPAP) is a popular treatment for respiratory distress syndrome (RDS) and is safe, practicable, and efficient for use in LMICs, it is crucial to ensure that neonates receive the full benefits of the therapy by monitoring their blood oxygen level. A centrifugal fan, power source, control system, and sensors are all included in our design. A centrifugal fan was created to provide air at positive pressure in the range of approximately 4 cmH2O to 20 cmH2O utilizing revolving blades (impeller), a DC motor, and a fixed component. The control unit contains a microcontroller to handle sensor data. The proportional-integral (PI) controller board's external potentiometer is used to set the pressure level. To ascertain whether the prototype satisfies the design requirements, it was constructed and put through several iterations and testing. The proposed device's prototype was tested for accuracy, affordability, and usability. The centrifugal fan speed measurement was accurate to within 94.5%, while the oxygen concentration sensor reading was accurate to within 98.5%. The design investigates viability of a straightforward, inexpensive, portable SpO2 integrated neonatal CPAP device for use in the delivery room in low-resource countries and to evaluates methods for measuring flows during CPAP treatment by monitoring the level of oxygen in the blood and pressure level delivered by the device using the lowest and safest setting that yields useful results.

CORRELATION BETWEEN INITIAL PRESSURE AND DURATION ON BUBBLE CPAP IN NEONATES WITH RESPIRATORY DISTRESS ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE CENTRE

Background: Continuous Positive airway pressure (CPAP) is a non-invasive form of respiratory support, which is safe and effective in neonates with respiratory distress. The purpose of this study is to predict the length of stay on bubble CPAP in neonates by correlating the initial pressure and duration on it with respect to gestational age, birth weight and respiratory distress scores. Objective: To correlate the initial pressure and duration on bubble CPAP in neonates with respiratory distress thereby predicting the length of stay on it and analyzing the factors responsible for bubble CPAP failure. Materials and Methods: A prospective longitudinal study was conducted over a period of 2 years in neonates with respiratory distress requiring bubble CPAP. Applying Pearsoncoefficient, the initial pressure and duration on bubble CPAP was correlated with respect to different variables. The statistical analysis was performed using SPSS (Version 20.0). P value of <0.05 was considered as statistically significant. Results: Out of 246 neonates enrolled, 211(85.77%) neonates were successfully treated with bubble CPAP, with mean birth weight of 1.66 kg and mean duration of stay on bubble CPAP was 32.64 hours. Applying Pearson co- efficient on initial pressure and duration on bubble CPAP there was negative correlation, which was statistically significant. 35(14.23%) failed bubble CPAP. The predictors of failure were prematurity (51.43%), birth asphyxia (8.6%), age at initiation of bubble CPAP, sepsis (8.57%), Downes score and Silverman Anderson score of more than 6. Other maternal and neonatal variables did not influence the need of mechanical ventilation. Conclusion: The duration of stay on bubble CPAP and the initial pressure set are negatively correlated that is, higher the initial pressure there is significant reduction in duration on bubble CPAP thereby the length of stay can be predicted by initial pressure set.

Evaluation of Nurses' Practice about Neonatal Continuous Positive Airway Pressure (CPAP) Nasal Injuries at Neonatal Intensive Care Unit

Background: Preterm birth (PTB) is a worldwide health problem and remains the leading cause of prenatal morbidity and mortality. In industrialized countries, preterm delivery is responsible for 70% of mortality and 75% of morbidity cases during the neonatal period, contributing to significant long-term neurodevelopment problems, pulmonary dysfunction, and visual impairment. Objective: Evaluation of nurses' practice about Neonatal Continuous Positive Airway Pressure (CPAP) Nasal Injuries at Neonatal Intensive Care Unit. Methodology: A Descriptive cross-sectional study, quantitative research has been carried throughout the present study to evaluate their management about nasal injury related to CPAP at neonates’ intensive care units in hospitals of Medical City director in Baghdad and it examined the type of relationship between variables. During the period from 3rd October 2021 to 15th May 2022. Results of the study: Results that observed responses of high evaluated generally assigned, and they are accounted 9(45.0%) items, while leftover items were assigned moderate evaluation 7(35.0%), and low evaluation 4(20.0%). Conclusion: Practices in concerning nursing management about neonatal continuous positive airway pressure (CPAP) nasal injuries at neonatal intensive care unit does not came at the level in which that achieving goal of this study. Recommendations: Continuous follow-up of nurses' practices on caring for a newborn with continuous positive air pressure.

Breath-dependent pressure fluctuations in various constant- and variable-flow neonatal CPAP devices.

In continuous positive airway pressure(CPAP) devices, pressure can be generated by two different mechanisms: either via an expiratory valve or by one or more jets. Valved CPAP devices are referred to as constant-flow devices, and jet devices are called variable-flow devices. Constant-flow CPAP devices are said to reduce the imposed work of breathing due to lower breath-dependent pressure fluctuations. The present study investigates the performance of various constant-and variable-flow CPAP devices in relation to breath-dependent pressure fluctuations. Experimental study comparing the pressure fluctuations incurred by seven neonatal CPAP devices attached to an active neonatal lung model. Spontaneous breathing was simulated using a tidal volume of 6 ml at pressure levels of 5, 7, and 9 mbar. The main outcomes were respiratory pressure fluctuations, tidal volume, and end-expiratory pressure. All CPAP devices tested showed respiratory pressure fluctuations, varying from 0.631to 3.466 mbar. The generated tidal volume correlated significantly with the pressure fluctuations (r = -0.947; p = 0.001) and varied between 5.550and 6.316 ml. CPAP devices with jets showed no advantage over CPAP devices with expiratory valves. End-expiratory pressure in the nose deviated from the set pressure between -1.305and 0.644 mbar and varied depending on whether the pressure was measured in the device or in the tube extending to the nose. During standard spontaneous breathing, breath-dependent pressure fluctuations in constant-and variable-flow devices are comparable. Pressure measurements taken in the tubing system can lead to a considerable deviation of the applied pressure.

Assessment of Nurses' knowledge about Neonatal Continuous Positive Airway Pressure (CPAP) Nasal Injuries at Neonatal Intensive Care Unit

Background: One of the most unpleasant and painful NCPAP related complication is the risk of nasal skin breakdown. It commonly occurs on areas under high pressure of nasal interface, mostly on the nasal bridge but can take place at any area under pressure of mask or prong which are used to connect the ventilation system to the patient’s nose. Objective: Evaluation of nurses' knowledge about Neonatal Continuous Positive Airway Pressure (CPAP) Nasal Injuries at Neonatal Intensive Care Unit. Methodology: A Descriptive cross-sectional study, quantitative research has been carried throughout the present study to evaluate their management about nasal injury related to CPAP at neonates’ intensive care units in hospitals of Medical City director in Baghdad and it examined the type of relationship between variables. During the period from 3rd October 2021 to 15th May 2022. Results of the study: Results that observed responses of high evaluated generally assigned, and they are accounted 27(81.82%) items, while leftover items were a assigned moderate evaluation 5(15.15%), and low evaluation 1(3.03%). Conclusion: In concerning nursing management about neonatal continuous positive airway pressure (CPAP) nasal injuries at neonatal intensive care unit are assigned at the established level in which that achieving goal of this study. Recommendations: Training courses to increase nurses' knowledge and practices about working on the continuous positive air pressure device. Keywords: Nurses' Knowledge, Neonatal Continuous Positive Airway Pressure (CPAP), Nasal Injuries, Neonatal Intensive Care Unit.

The Efficacy of CPAP in Neonates with Meconium Aspiration Syndrome: A Systematic Review and Meta-Analysis.

Background: In neonates with meconium aspiration syndrome (MAS), continuous positive airway pressure (CPAP) may be more beneficial compared to endotracheal intubation (ETI). We evaluated the efficacy of CPAP in neonates with MAS. Methods: Four engines were used to search randomized clinical trials (RCTs). We used relative risk (RR) and mean difference (MD) with 95% confidence intervals (95%CI) to assess the effect on dichotomous and continuous outcomes, respectively. In addition, we used the Paule–Mandel (PM) random effects model due to the anticipated lack of events. Results: Three RCTs were included (n = 432). No significant difference was found in mortality (RR = 0.82; 95%CI = 0.54–1.25; I2 = 71%; p = 0.36), need for ventilation (RR = 0.49; 95%CI = 0.15–1.56; I2 = 71%; p = 0.57), and incidence of pneumothorax (RR = 1.24; 95%CI = 0.30–5.12; I2 = 0%; p = 0.77) in the CPAP group compared to the ETI group. Regarding secondary outcomes, compared to the ETI group, no significant differences were found in APGAR at one minute (MD = −1.01; 95%CI −2.97 to 0.94; I2 = 98%; p = 0.31), APGAR at 5 min (MD = −1.00; 95%CI = −2.96 to 0.95; I2 = 99%; p = 0.32), days of hospitalization (MD = −0.52; 95%CI = −1.46 to 0.42; I2 = 94%; p = 0.28), and cord pH (MD = 0.003; 95%CI = −0.01 to 0.02; I2 = 0%; p = 0.79). Conclusions: In patients with MAS, there is no significant effect of CPAP use compared to ETI on primary, specifically on mortality, need for ventilation, the incidence of pneumothorax, and secondary outcomes.

Human bone marrow-derived mesenchymal stem cells rescue neonatal CPAP-induced airway hyperreactivity

Continuous positive airway pressure (CPAP) is a primary non-invasive mode of respiratory support for preterm infants. However, emerging evidence suggests CPAP could be an underlying contributor to the unintended pathophysiology of wheezing and associated airway hyperreactivity (AHR) in former preterm infants. The therapeutic benefits of mesenchymal stem cells (MSCs) have been demonstrated in a variety of animal models and several clinical trials are currently underway to assess their safety profiles in the setting of prematurity and bronchopulmonary dysplasia (BPD). In the present study, using a mouse model of neonatal CPAP, we investigated whether conditioned medium harvested from cultures of human bone-marrow derived mesenchymal stem cells (hMSC) could rescue the CPAP-induced AHR, based upon previous observations of their anti-AHR properties. Newborn mice (male and female) were fitted with a custom-made mask for delivery of daily CPAP 3 h/day for the first 7 postnatal days. At postnatal day 21 (two weeks after CPAP ended), lungs were removed, precision-cut lung slices were sectioned and incubated for 48 h in vitro in conditioned medium collected from cultures of three different hMSC donors. As expected, CPAP resulted in AHR to methacholine compared to untreated control mice. hMSC conditioned medium from the cultures of all three donors completely reversed AHR. These data reveal potential therapeutic benefits of hMSC therapy, which may be capable of rescuing the long-term adverse effects of neonatal CPAP on human airway function.

Comparison of Saans neonatal continuous positive airway pressure against standard of care for intra-hospital transport of neonates with respiratory distress syndrome

Background: CPAP (continuous positive airway pressure) therapy, effective in managing neonates with respiratory distress. While CPAP therapy is indicated right from birth, existing CPAP systems are designed for/installed in, NICUs. As a result, most neonates with RD (respiratory distress) are managed with only oxygen therapy during transportation in low resource settings. This study compares a novel, low-cost, portable neonatal CPAP system for use in transport from the labor room to the NICU, against conventional oxygen therapy in low resource settings.Methods: This was an open-label, 2 arm study with a treatment arm (low-cost indigenous CPAP device for therapy) and a control group (oxygen therapy). A total of 132 neonates were assigned with 66 in (matched-control study), in each group.Results: Both arms (CPAP and oxygen) had similar gestational age. gender distributions and initial SAS scores. The CPAP group had higher use of antenatal steriods (38 versus 26) compared to oxygen group and a lower need for surfactant (28 versus 40). Also, a larger number of neonates required ventilation in oxygen group (42) versus CPAP group (15), with the p=0.000561 the result is significant at p<0.05.Conclusions: CPAP therapy induced in labor room measurably improves neonates health and reduces respiratory distress. The indigenous low-cost CPAP device (Saans) used in this study effectively provides CPAP therapy to neonates during transport from the labor room to the NICU, reducing respiratory distress and the need for mechanical ventilation, making useful addition to labor rooms.

CPAP-induced airway hyper-reactivity in mice is modulated by hyaluronan synthase-3.

Background:Continuous positive airway pressure (CPAP) is a primary mode of respiratory support for preterm infants. Animal studies have shown long-term detrimental effects on lung/airway development, particularly airway (AW) hyper-reactivity, as an unfortunate consequence of neonatal CPAP. Since the hyaluronan (HA) synthesizing enzyme hyaluronan synthase-3 (HAS3) is involved in various adult pulmonary disorders, the present study used a neonatal mouse model to investigate the role of HAS3 in CPAP-induced AW hyper-reactivity.Methods:Male and female neonatal mice were fitted with a custom-made mask for delivery of daily CPAP 3 h/day for 7 days. At postnatal day 21 (two weeks after CPAP ended), airway (AW) hyper-reactivity and HAS3 expression were assessed with and without in vitro HAS3 siRNA treatment.Results:MRIs of 3-day-old mice confirmed that CPAP increased lung volume with incrementing inflation pressures. CPAP increased AW reactivity in both male and female mice, which was associated with increased airway smooth muscle and epithelial HAS3 immunoreactivity. CPAP did not affect HA accumulation, but HAS3 siRNA reversed CPAP-induced AW hyper-reactivity and reduced HAS3 expression.Conclusions:These data in mice implicate a role for HAS3 in long-term effects of CPAP in the developing airway in the context of preterm birth and CPAP therapy.

National scale of neonatal CPAP to district hospitals in Malawi improves survival for neonates weighing between 1.0 and 1.3 kg

ObjectiveTo determine whether a national quality improvement programme implementing continuous positive airway pressure (CPAP) at government hospitals in Malawi improved outcomes for neonates prioritised by an algorithm recommending early CPAP...

Interface leakage during neonatal CPAP treatment: a randomised, cross-over trial

ObjectiveTo determine leakage for two neonatal continuous positive airway pressure (CPAP) interfaces and evaluate leak-corrective manoeuvres.DesignThe ToNIL (Trial of NCPAP Interface Leakage) study was a randomised, clinical, cross-over trial with...

Calcium-sensing receptor and CPAP-induced neonatal airway hyperreactivity in mice.

Background:Continuous positive airway pressure (CPAP) in preterm infants is initially beneficial, but animal models suggest longer term detrimental airway effects towards asthma. We used a neonatal CPAP mouse model and human fetal airway smooth muscle (ASM) to investigate the role of extracellular calcium sensing receptor (CaSR) in these effects.Methods:Newborn wild type and smooth muscle-specific CaSR−/− mice were given CPAP for 7 days via a custom device (mimicking CPAP in premature infants), and recovered in normoxia for another 14 days (representing infants at 3–4 years). Airway reactivity was tested using lung slices, and airway CaSR quantified. Role of CaSR was tested using NPS2143 (inhibitor) or siRNA in WT mice. Fetal ASM cells stretched cyclically with/without static stretch mimicking breathing and CPAP were analyzed for intracellular Ca2+ ([Ca2+]i) responses, role of CaSR and signaling cascades.Results:CPAP increased airway reactivity in WT but not CaSR−/− mice, increasing ASM CaSR. NPS2143 or CaSR siRNA reversed CPAP effects in WT mice. CPAP increased fetal ASM [Ca2+]I, blocked by NPS2143, and increased ERK1/2 and RhoA suggesting two mechanisms by which stretch increases CaSR.Conclusions:These data implicate CaSR in CPAP effects on airway function with implications for wheezing in former preterm infants.

Caffeine versus Aminophylline for Apnea of Prematurity: A Randomized Clinical Trial

Background: Apnea of prematurity is often found in preterm neonates with gestational age less than 34-37 weeks or birth weight (BW) less than 1000 grams. The American Academy of Pediatrics defines apnea as a respiratory halt lasting at least 20 seconds, with bradycardia or cyanosis. Methylxanthines reduce the incidence of apnea. The purpose of this study was to compare the effect of caffeine and aminophylline on the incidence of apnea in premature neonates. 
 Methods: This randomized clinical trial study was conducted on 80 premature neonates at ShahidSadoughihospital in Yazd. The first group received the initial dose of 5 mg /kg aminophylline diluted in 5% dextrose with a maintenance dose of 2 mg /kg every 8 hours, while the second group received 30mg/kg of caffeine diluted in 5% dextrose with a 24-hour maintenance dose of 10 mg/kg. 
 Results: The frequency of apnea was less in caffeine group but it was not significantly different between intervention groups (Pvalue=0.121). Although there was a significant difference in respiratory status between the two groups; so in caffeine group, oxyhood was less necessary for neonates (Pvalue=0.012). Using continuous positive airway pressure (CPAP) was significantly less in aminophylline group (Pvalue=0.012). 
 Conclusion: The frequency of apnea was less in the caffeine group, but there was no significant difference between the two groups (P=0.121). Aminophylline treatment in comparison with caffeine can reduce the need for CPAP in neonates with apnea.

Flows and function of the Infant Flow neonatal continuous positive airway pressure device investigated with computational fluid dynamics.

The first dedicated neonatal continuous positive airway pressure (CPAP) device using variable flow was the Infant Flow. The system was pressure stable with a low resistance to breathing. The aim of this study was to describe the flow and function of the Infant Flow geometry using simulated breathing and computational fluid dynamics. The original Infant Flow geometry was used with simulated term infant breathing at three levels of CPAP. The large eddy simulation methodology was applied in combination with the WALE sub-grid scale model. The simulation fully resolved the flow phenomena in the Infant Flow geometry. The main flow feature during inspiration was support by gas entrainment and mixing. During expiration, the jet deflected towards the outlet with unstable impingement of the jet at the opposing edge. The proposed mechanism has previously been based on theoretical reasoning, and our results present the first detailed description of the Infant Flow. The pressure stability was based on a jet supporting inspiration by gas entrainment and then being deflected during exhalation. This confirmed previously assumed principles of function and flows within the geometry and provided a base for further developments.

Changes in HAS3 and CaSR Expression Following Daily Neonatal CPAP in Mice

Continuous positive airway pressure (CPAP) is a common mode of respiratory support for preterm infants. Recent studies from our lab, however, have shown that CPAP may contribute to the pathophysiology of airway hyperreactivity (AHR) associated with wheezing disorders in former preterm infants. The long‐term effects of CPAP on lung‐development, however, still remain largely unknown. Both hyaluronan synthase 3 (HAS3) and the calcium‐sensitive receptor (CaSR) have been associated with various respiratory morbidities. In the present study, we used a neonatal mouse model of daily CPAP treatment to investigate whether the long‐term effects on AHR are associated with changes in airway HAS3 and CaSR expression. Neonatal mice were exposed to CPAP (6cm H2O) for 3 hours per day for the first 7 postnatal days. Control animals experienced the same conditions as experimental animals only with no CPAP. On postnatal day 21, the lungs from these animals were harvested for either real time rt‐PCR or immunohistochemistry to assess changes in HAS3 and CaSR expression. We observed increased expression of multiple genes involved in hylauraonan synthesis, most notably has3, as well as increased CaSR expression, in the lungs of mice two weeks after CPAP ended when compared to control mice. The increased gene expression of has3 and CaSR was also reflected in increased protein expression as confirmed by immunohistochemistry. HAS3 was expressed predominantly in airway epithelium and the increased CaSR expression correlated with increased αSM actin. To further investigate the role of CaSR in CPAP‐induced AHR, CaSR KO mice (CaSR(−/−)) were exposed to CPAP and airway reactivity to methacholine challenge was assessed two weeks later (P21 days). Compared to control mice, AHR was not expressed in CaSR(−/−) mice suggesting resistance to CPAP treatment. These data suggest increased airway HAS3 and CaSR may be important modulators of CPAP‐induced AHR and remodeling.Support or Funding InformationHLR01138402HLR01056470

Availability and use of continuous positive airway pressure (CPAP) for neonatal care in public health facilities in India: a cross-sectional cluster survey

ObjectivesTo determine the availability of continuous positive airway pressure (CPAP) and to provide an overview of its use in neonatal units in government hospitals across India.SettingCross-sectional cluster survey of a...

Effectiveness of bubble continuous positive airway pressure as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome at district level tertiary care hospital

Background: Continuous positive airway pressure (CPAP) has become a useful modality in the management of respiratory distress in preterm babies. CPAP when applied to preterm infants with respiratory distress syndrome (RDS) is associated with benefits in terms of reduced respiratory failure and reduced mortality. Objectives: The objectives of the study were to evaluate the efficacy of bubble CPAP in preterm neonates with RDS requiring respiratory support and to study the risk factors associated with its failure. Materials and Methods: A prospective observational study was done on 243 preterm neonates (gestational age [GA] 28 to ?37 weeks) with a diagnosis of RDS admitted from January 2016 to November 2017. All the eligible preterm neonates were started on bubble CPAP with binasal prongs. Surfactant was administered when indicated. Results: A total of 243 preterm neonates were enrolled in this study with a mean GA of 32.40 weeks and birth weight of 1831.49 g. One hundred and fifty-one (62.1%) were male and 92 (37.9%) were female. The mean age of starting of CPAP was 13.44 h of life and antenatal steroid coverage was 3.2% only. Of the 243 neonates, 195 neonates were successfully weaned off CPAP. Among the 48 neonates who failed CPAP, 27 neonates were ventilated, of which 20 (74.1%) survived. The predictors of CPAP failure were GA <32 weeks, birth weight <1.5 kg, and delayed initiation of CPAP. Conclusion: The efficacy of CPAP in neonates with mild-to-moderate RDS in preterm neonates is very well demonstrated despite the low usage of antenatal steroids, surfactant, and delayed initiation of CPAP. Extreme preterm, very low birth weight neonates with severe RDS on chest X-ray are at risk of failure of CPAP.

Using a peer mentorship approach improved the use of neonatal continuous positive airway pressure and related outcomes in Malawi.

This study evaluated whether peer mentorship was an effective and sustainable way of improving and maintaining knowledge and skills on neonatal continuous positive airway pressure (CPAP) in a low-resource setting with a high turnover of healthcare providers. The Malawi Ministry of Health recruited five nurses with considerable CPAP experience and provided them with mentorship training from July to August 2014. The mentors then provided 1-week on-site mentorship for 113 colleagues at 10 secondary and one tertiary hospital where gaps in neonatal CPAP use had been identified. CPAP competencies and outcomes were compared 3months before and after each mentorship. In the 3months before and after mentorship, the average CPAP competency score increased from 32±4% to 97±2%, while CPAP usage increased from 7% to 23% among eligible neonates. Survival following CPAP mentorship increased from 23% to 35%, but this was not significant due to the small sample size. Both mentees and mentors reported useful transfers of knowledge and skills when using CPAP. Mentorship effectively bridged the knowledge and skills gaps among health workers and increased CPAP use, competency scores and survival rates.

Neonatal CPAP for Respiratory Distress Across Malawi and Mortality

Our aim in this observational study was to monitor continuous positive airway pressure (CPAP) usage and outcomes in newborn wards at 26 government hospitals in Malawi after the introduction of CPAP as part of a quality-improvement initiative. CPAP was implemented in 3 phases from 2013 through 2015. Survival to discharge was analyzed for neonates treated with nasal oxygen and/or CPAP with admission weights of 1 to 2.49 kg at 24 government hospitals with transfer rates <15%. This analysis includes neonates admitted with respiratory illness for 5.5 months before (621 neonates) and 15 months immediately after CPAP implementation (1836 neonates). A follow-up data analysis was completed for neonates treated with CPAP at all hospitals during an additional 11 months (194 neonates). On implementation of CPAP, survival to discharge improved for all neonates admitted with respiratory distress (48.6% vs 54.5%; P = .012) and for those diagnosed with respiratory distress syndrome (39.8% vs 48.3%; P = .042). There were no significant differences in outcomes for neonates treated with CPAP during the implementation and follow-up periods. Hypothermia on admission was pervasive and associated with poor outcomes. Neonates with normal mean temperatures during CPAP treatment experienced the highest survival rates (65.7% for all neonates treated with CPAP and 60.0% for those diagnosed with respiratory distress syndrome). A nurse-led CPAP service can improve outcomes for neonates in respiratory distress in low-resource settings. However, the results show that real-world improvements in survival may be limited without access to comprehensive newborn care, especially for small and sick infants.