title: An evaluation of bubble-CPAP in a neonatal unit in a developing country: effective respiratory support that can be applied by nurses.
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 1,106 (10.2 per cent) prior to bubble-CPAP to 70 of 1,382 (5.1%) after introduction of CPAP (chi2, 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, chi2, 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.
authors.affiliation: Colonial War Memorial Hospital, Suva, Fiji.
authors.forename: Lanieta
authors.initials: L
authors.lastname: Koyamaibole
authors.forename: Joseph
authors.initials: J
authors.lastname: Kado
authors.forename: Josaia D
authors.initials: JD
authors.lastname: Qovu
authors.forename: Samantha
authors.initials: S
authors.lastname: Colquhoun
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods / Q000451:nursing*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000451:nursing / Q000628:therapy*; D009359:Neonatology / Q000379:methods