Purpose: Acute respiratory failure is a critical feature of the most common causes of death and disability of newborns worldwide, the majority of which occurs in low resource settings. Bubble Continuous Positive Airway Pressure (bCPAP) is highly effective in addressing newborn respiratory failure, however high cost and the need for electricity and compressed air are barriers to access and scale. This study examines the outcomes of a novel ultra-low-cost bCPAP package with an innovative blender, called Every Second Matters-Newborn and Infant Respiratory Bundle (ESM-NIRB), to overcome these barriers. Methods: The authors designed, and in May of 2017, deployed across four hospitals in Maharashtra, India, the ESM-NIRB package: an ultra-low-cost and electricity independent bCPAP device with innovative oxygen blender, novel device-patient interface, hospital grade pulse oximeter, didactic and field training, clinical pathway wall chart and safety checklist. Hourly respiratory severity scores (RSS), vitals, mortality, length of time on bCPAP, patient demographics, outcomes, cointerventions, adverse events and severe adverse events were reported with each use. Results: From May 26, 2017 to March 22, 2018, 78 newborns were placed on the ESM-NIRB bCPAP device for impending respiratory failure. 41 (43.6%) of the 78 were premature and 63 (80.8%) survived to discharge. Diagnoses included hyaline membrane disease (32%), respiratory distress (30.8%), transient tachypnea of the newborn (12.8%), neonatal sepsis (9.0%), birth asphyxia (6.4%), congenital heart disease (2.6%), meconium aspiration syndrome (2.6%), pneumonia (2.6%) and hypoglycemia (1.3%). Among newborns with initial RSS between 4 and 8, the RSS decreased on average by 1.31 [95% CI 0.88, 1.75; p-value 0.000139] after 6 hours of treatment with the ESM-NIRB bCPAP device. One newborn with meconium aspiration syndrome incurred a pneumothorax while on the device and was successfully treated and weaned to room air without further escalation of care. No severe adverse events have occurred from the ESM-NIRB bCPAP device. Conclusion: Implementation of an ultra-low cost ESM-NIRB package that does not require electricity or pressurized air was possible across all four hospitals in India. The authors are conducting a qualitative study on provider experiences with the package to enhance its feasibility in these settings, with possible future implementation in primary health centers and rural areas of India.
Outcomes of newborns and infants associated with use of an innovative, ultra-low-cost, bubble Continuous Positive Airway Pressure (CPAP) package, with a novel blender and pulse oximeter, in Mahaarashtra, India
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Revathi Ravi, Thomas Burke, Suraj Bhagat, Mohit Kurundwadkar, Alice Won, Kamyar Moghaddam, Lorraine Garg, Manish Jain; Outcomes of newborns and infants associated with use of an innovative, ultra-low-cost, bubble Continuous Positive Airway Pressure (CPAP) package, with a novel blender and pulse oximeter, in Mahaarashtra, India. Pediatrics August 2019; 144 (2_MeetingAbstract): 561. 10.1542/peds.144.2MA6.561
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