Status: Funded - Closed
Advancement of modified bubble CPAP for use in children in low resource settings: A study of safety
Ashley Bjorklund, MD
BACKGROUND: Worldwide an estimated 1.1 million children under the age of five years die from pneumonia each year. Respiratory support is a key factor in decreasing mortality from pneumonia, however, in low resource areas, affordable respiratory support devices for children are lacking.
GAP: The global health community has appropriately focused much attention on vaccines, breastfeeding, and early symptom recognition as ways to decrease the high mortality associated with pneumonia, however there has been minimal focus on respiratory support devices. Bubble Continuous Positive Airway Pressure (bCPAP) is a simple affordable form of respiratory support that has been used to decrease mortality from neonatal respiratory distress, but it has yet to be studied outside of the neonatal period. This study investigated modified bCPAP use outside of the neonatal period as an affordable respiratory support device for children with pneumonia/respiratory distress.
HYPOTHESIS: Development of an inexpensive bCPAP kit with modified nasal prongs for use in infants/children will provide hospitals in low resource countries with a safe respiratory support option not otherwise available.
METHODS: We designed a modified bCPAP device, for effective and comfortable respiratory support for infants and children in developing countries that could be assembled on site by the local medical staff. We enrolled patients 1 month to 5 years of age admitted to Gulu Regional Referral Hospital (GRRH) with respiratory distress whom the medical officer/provider felt might benefit from respiratory support with bCPAP. Data was collected evaluating the safety of the device and comparing outcomes to historical data.
RESULTS: Historical data was collected on 49 patients with respiratory distress treated with standard therapy. 87 patients were enrolled to receive therapy with BCPAP over the course of 11 months. 4 patients were excluded from data analysis due to meeting exclusion criteria of diagnosis of chronic lung disease or cyanotic heart disease. Of the 83 patients analyzed, there were no significant complications or mortalities attributable to use of the modified BCPAP device. There were 5 “grade I” events, 4 patients developed mild erythema of the nares and 1 patient had abdominal distension that resolved with nasogastric decompression.
Mortality rate in the pretrial patients was 12.2% (6/49). Mortality rate in the patients treated with BCPAP was 9.6% (8/83). P= 0.639. Trial patients had a higher severity of illness than pretrial patients ( BCPAP 77.1% severe vs pretrial 24.5% severe), P<0.001. Adjusting for the difference in severity of illness, odds of death with use of BCPAP were less compared to that of the pretrial patients, OR=0.25, P=0.065. The odds of severe illness at time 2 adjusted for time 1 illness severity were decreased for BCPAP patients compared to the pretrial patients, OR= 0.19, P=0.022.
IMPACT: Low resources settings have minimal access to life-saving respiratory support devices for the millions of children who die each year from pneumonia. BCPAP has been shown to improve outcomes in neonates. With modification of the nasal seal, this inexpensive, easily assembled bCPAP device is safe for use with older children. Preliminary data are encouraging that the device will provide respiratory support that will improve outcomes in older children in these low resource areas lessening the morbidity and mortality from respiratory distress.
University of Minnesota
United States, Uganda