Project Details
Early Career
Status: Funded - Open
Bubble NCPAP vs. Bubble NIPPV for Preterm Infants in Respiratory Distress
Tina Slusher, MD
Summary
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 the feasibility of using a non-electric and visually intuitive bubble NIPPV (Non Invasive Positive Pressure Ventilation) device the NeoVent 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 neonates with respiratory distress, using bubble NIPPV provided by the NeoVent will be feasible and demonstrate a similar safety profile as bubble NCPAP. METHODS: Neonates with a clinical diagnosis of respiratory distress syndrome without contraindications to noninvasive positive pressure ventilation were allocated to receive bubble NIPPV using the NeoVent in a resource constrained nursery in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. RESULTS: A total of 20 healthcare providers including 16 physicians and 4 nurses were assessed for their ability to use the device on 100 neonates with respiratory distress. Overall, all doctors and nurses were able to operate the device successfully, with only a few minor challenges observed. The most common issue was confusion regarding the machine rate setting, which was noted in two doctors and two nurses, and was resolved with clarification; failure to connect the pressure gauge tube by one nurse; challenges connecting the heater sensor to the gas tubing by one nurse; and failure to connect the pressure tube connection from the machine to the patient breathing circuit by one doctor. All identified issues were promptly corrected at the time of discovery during the six-hour period, and no persistent difficulties with device use were reported. Only 2 neonates had minor complications during the study period (1 neonate with mild nasal distention and 1 neonate with minor abdominal distention). IMPACT: Additional studies to determine the efficacy to NIPPV using the NeoVent should be undertaken now that the device has been shown to be both safe and feasible in a resource constrained setting. Further testing comparing NIPPV using the NeoVent to bCPAP and then commercial NIPPV are needed. If NIPPV using the NeoVent is shown to be first superior to bCPAP and then non-inferior to commercial NIPPV in neonates with moderate-severe respiratory distress it could be implemented across resource-constrained settings to save hundreds of thousands of infant lives worldwide.
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