Customized Bubble Continuous Positive Airway Pressure (BCPAP) Device at the National Hospital Abuja Gives Immediate Clinical Improvement (Respiratory Rate, Grunting and Oxygenation) in Neonates with Respiratory Distress

Background: Prematurity accounts for 25% of Neonatal mortality in Nigeria and Respiratory Distress
Syndrome is responsible for half of these deaths. Introducing continuous positive airway pressure for
the treatment of RDS in Nigeria where health care financing is predominantly out-of-pocket is quite
challenging. It was hypothesized that applying the principle of under-water-seal pressure generation
could convert a simple oxygen delivery system into an effective Bubble CPAP device the National
Hospital Abuja CPAP
Objectives: To provide evidence in support of the immediate clinical effectiveness of the NH ABCPAP
device.
Design/Methods: At the neonatal unit of the National Hospital Abuja, we assembled a circuit of
tubing connecting a gas source (oxygen concentrator or cylinder) through an interface (nasal prongs)
to the baby and this was further connected through an expiratory tube to an under-water-seal bottle to
generate CPAP. The device is activated by turning on the oxygen source. The device was applied to
preterm babies with RDS as well as some term babies with respiratory distress admitted into the
neonatal intensive care units. Respiratory rate, SPO2 and other signs of respiratory distress were
monitored before and at 1 hour, 6 hours and 12 hours after the application.
Results: Forty eight newborn babies with respiratory distress were treated with the device out of
whom twenty three (48%) were very low birth weight with respiratory distress syndrome. The mean
respiratory rate dropped from 64.5 (19.2)/min before commencement of CPAP to 59.5(11.6)/min, 56.6
(10.5), and 56.6(10.7) at 1, 6 and 12 hours respectively, p<0.05. The corresponding values for SPO2
were 84.5(14) before and 95.9 (5.3), 95.9(6.5) and 96.9(6.4) at 1, 6 and 12 hours respectively,
p<0.05. The respiratory changes were however less marked among very low birth weight babies.
Conclusion: The simplified customized device produces clinical responses similar to those reported
for the conventional CPAP devices.