G304 Introducing bubble Continuous Positive Airway Pressure (CPAP) for neonatal respiratory support into a low income country – as easy as ABC?

Aims To assess feasibility of introducing bubble CPAP into three neonatal units in a low-income country. We determined if, by regular training visits by UK health professionals, bubble CPAP could be established, and its short-term complications and neonatal outcome. Method A bubble CPAP system was designed using an air compressor, with additional cylinder oxygen. Gases are warmed and humidified, pass via an oxygen analyser to the baby and delivered with nasal prongs or mask. Expiratory circuit contains a water pressure manometer. Circuits are reused, after cleaning. Oxygen saturation monitors were provided for each machine. Eight CPAP machines were provided, six to the university teaching hospitals and two to a large provincial hospital. Regular intensive staff training was provided. Data on babies receiving CPAP was recorded prospectively. Results Between March 2012-September 2013 a total of 482 staff training days were provided; 63 days by 3 neonatologists (6 visits), 172 days by neonatal nurses (18 visits), 17 days by a medical technician (3 visits), 230 days by two paediatric specialist registrars. All were volunteers. 319 babies received CPAP. There were no equipment failures or malfunctions. It was commenced on the first day of birth in 71% of babies, for a median of 2 days. Although surfactant therapy is unavailable, only 16% needed >40% oxygen and none were transferred for ventilator care. No babies developed a pneumothorax, however 13% experienced significant nasal trauma. Retinopathy of prematurity screening was not available. In the university hospitals, 45 babies had a birthweight 2.5 kg (mortality 11%). This contrasted with the provincial hospital where only 8 babies had a birthweight 2.5 kg (mortality 10%). Conclusion Bubble CPAP was established in this low resource country. It provided adequate respiratory support for most babies currently admitted for neonatal care. However, in spite of intensive staff training, nasal trauma was problematic.