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Journal of Tropical Pediatrics Advance Access published online on December 2, 2005
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmi109
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© The Author [2005]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Original Papers

An Evaluation of Bubble-CPAP in a Neonatal Unit in a Developing Country: Effective Respiratory Support That Can Be Applied By Nurses

Lanieta Koyamaibole 1, Joseph Kado 1, Josaia D. Qovu 1, Samantha Colquhoun 2, and Trevor Duke 2 *

1 Colonial War Memorial Hospital, Suva, Fiji
2 Centre for International Child Health, Melbourne University Department of Paediatrics, Royal Children's Hospital, Parkville, 3052, Victoria, Australia

* To whom correspondence should be addressed.
Trevor Duke, E-mail: trevor.duke{at}rch.org.au


  Abstract

To describe the implementation of bubble-CPAP in a referral hospital in a developing country and to investigate: the feasibility of nurses implementing bubble-CPAP and the impact of bubble-CPAP on need for mechanical ventilation and mortality. Retrospective evaluation of prospectively collected data from two time periods: 18 months before and 18 months after the introduction of bubble-CPAP. The introduction of bubble-CPAP was associated with a 50 per cent reduction in the need for mechanical ventilation; from 113 of 1106 (10.2 per cent) prior to bubble-CPAP to 70 of 1382 (5.1%) after introduction of CPAP ({chi}2, p<0.001). In the 18 months prior to bubble-CPAP there were 79 deaths (case fatality of 7.1 per cent). In the 18 months after bubble-CPAP there were 74 deaths (CF 5.4 per cent), relative risk: 0.75 (0.55-1.02, {chi}2, p=0.065). Nurses could safely apply bubble-CPAP after 1-2 months of on-the-job training. Equipment for Bubble-CPAP cost 15 per cent of the cost of the cheapest mechanical ventilator. The introduction of bubble-CPAP substantially reduced the need for mechanical ventilation, with no difference in mortality. In models of neonatal care for resource-limited countries, bubble-CPAP may be the first type of ventilatory support that is recommended. Its low cost and safety when administered by nurses makes it ideal for this purpose. Bubble-CPAP has the potential for being available at even lower cost than the current commercially available bubble systems used in this study.


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