Bubble NCPAP vs. Bubble NIPPV for Preterm Infants in Respiratory Distress
Stephen John, MD, BSE
BACKGROUND: Infant respiratory distress is a leading cause of under-5 mortality worldwide, leading to over one million infant deaths every year with 99% of these deaths in low to middle income countries. Conventional ventilation equipment costs $10,000+ and requires continuous electricity and highly trained operators, leaving infants in resource-constrained settings without access to life saving treatment. GAP: By validating a non-electric and visually intuitive bubble NIPPV (Nasal Intermittent Positive Pressure Ventilation) device which allows clinicians to independently set the upper level of pressure, lower level of pressure and rate (cycles/min), we seek to provide clinicians in resource-constrained settings with an additional technology for management of infants with respiratory distress beyond bubble NCPAP. HYPOTHESIS: In preterm infants with respiratory distress, there will be less treatment failure, defined as the need for intubation within 72 hours, with bubble NIPPV in comparison with bubble NCPAP. METHODS: Preterm infants with a clinical diagnosis of respiratory distress syndrome without contraindications to noninvasive positive pressure ventilation will be randomized to bubble NCPAP vs. bubble NIPPV at major academic medical centers in India. RESULTS: Pending. IMPACT: If bubble NIPPV is shown to reduce treatment failure in comparison with bubble NCPAP at medical centers in India, bubble NIPPV could be implemented across resource-constrained settings to save hundreds of thousands of infant lives worldwide.