Kawaza: Low Cost Bubble CPAP for Managing Neonatal Respiratory Distress in Malawi

7/28/2019 Kawaza: Low Cost Bubble CPAP for Managing Neonatal Respiratory Distress in Malawi

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LOW COST BUBBLE CPAP FOR

MANAGING NEONATAL

RESPIRATORY DISTRESS IN MALAWI

DR K. Kawaza

University of Malawi College ofMedicine


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LOW COST BUBBLE CPAP FOR MANAGING NEONATAL


What is CPAP

Why CPAP not widely available

Work in Malawi on low cost bubble CPAP

Pumani CPAP device + technical evaluation

Clinical trial for efficacy

Bubble CPAP roll out


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Background:

15 million babies born, 10% premature

1.1 million preterm babies die every year

More than 1 million premature babies die

shortly after birth, majority due to RDS or

respiratory distress of other aetiology With inexpensive treatment 75 percent could

survive

Born Too Soon: The Global Action Report on Preterm Birth


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Background Malawi

4

Population: 15.3 million*

Districts :28*

MMR: 675/100,000*

NMR: 31/1,000*

IMR: 58/1,000**

Preterm Birth rate: 18%*

Oxygen from concentrators

No neo ventilators, no CPAP

No walled oxygen

Source: *DHS 2010; ** (2010

stat, WHS 2012)


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CPAP:

CPAP well know effective therapy for respiratory

distress

Seen as intermediate option between simple O2

Rx and mechanical ventilation

Improves oxygenation, reduces work of breathing,

reduces need for ventilation Globally increasing trend in CPAP use


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RESPIRATORY DISTRESS IN MALAWITrend in ventilation and CPAP rates among neonates, NSW(New South Wales) 2001-2008

Roberts et al. BMC Pediatrics 2011, 11:89


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CPAP initiation for neonates > 32 weeks bytype of hospital.

Roberts et al. BMC Pediatrics 2011, 11:89


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Adapted from: Kamath, B.D., et al., Neonatal Mortality From Respiratory Distress Syndrome: Lessons for Low-Resource Countries.

Pediatrics, 2011. 127(6): p. 1139-1146.

Potential for Low Cost bCPAP

to improve mortality


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COST has been the major barrier..


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CPAP

Flow generator

Pressure regulator

Oxygen input

Patient interface


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Previous attempts at bCPAP in Malawi

*Air compressor (WhispairH CMC 90/10, Contimeta,

Utrecht, the Netherlands; 700)



Van Den Heuvel et al, Annals of Tropical Paediatrics 2011.


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Low Cost Bubble CPAP For Reducing Mortality

due to Neonatal Respiratory Distress

Background


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Work in Malawi on low cost bubble

CPAP

Since 2007;

Collaboration COM, RICE University, BCM.

Aim to come up with an effective but low cost,easy to use bCPAP.

RICE provided technical expertise in design

Malawi provided input for the design to adaptto local needs


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RESPIRATORY DISTRESS IN MALAWI> By 2011, a prototype developed and tested against standard systems used at TCH in US


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8 cm H2O

TCH CPAP Rice CPAP

0

24

6

8

10

12

14

16

0 1 2 3 4 5 6 7 8 9 10

Pre

ssure(cmH

2O)

Run Number

0

2

4

6

8

10

12

14

16

0 1 2 3 4 5 6 7 8 9 10

Pressure(cmH

2O)

Run Number

0

2

4

6

810

12

14

16

0 1 2 3 4 5 6 7 8 9 10

Pressure(cm

H2O)

Run Number

0

2

4

6

8

1012

14

16

18

20

0 1 2 3 4 5 6 7 8 9 10

Pressure(cm

H2O)

Run Number

4 cm H2O



Brown et al, 2013


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Brown et al, 2013


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Evaluation of bCPAP use in Neonatal

Respiratory Distress at QECH Prospective, non-randomized convenience sample study.

Objectives of the study

To validate the therapeutic performance of the Rice bCPAPsystem for the Rx of respiratory distress, comparing it to thestandard of care.

Primary outcome: Mortality rate.

Secondary outcomes: weight gain, length of time on respsupport, and length of stay in the hospital.


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Study Inclusion Criteria

Diagnosed with respiratory distress,

Breathing spontaneously,

Weight a minimum of 1000 g

bCPAP treatment is deemed appropriate


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Study Exclusion Criteria

Weight


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Identify neonates with severe respiratory distress who might benefit from CPAP;

Treat with nasal oxygen and evaluate whether subject meets eligibility criteria

Eligible?

Consent granted?No Treat per standard of care

Yes

Is CPAP

available?

No

Monitor clinical progress

on nasal oxygen

CPAP still

needed?

No

Follow outcomes as

nasal oxygen group

Yes Is CPAPavailable?

No

Yes

Yes

Follow outcomes as

CPAP group

Initiate treatment

with CPAP

Transition

to CPAP

Flow chart summarizing study procedure and outcome groups.


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How far have we gone..?

Preliminary analysis suggests significant

improvement in survival

Prelim results shared with Government and

Donors

Final results to be published soon

Funding already provided through USAID SLABgrant to roll out to secondary and tertiary

hospitals



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Trial at QECH:

Ensure equipment

is robust &

effective


MANAGING NEONATAL RESPIRATORY

DISTRESS IN MALAWI


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Low Cost Bubble CPAP For Reducing Mortality

due to Neonatal Respiratory Distress


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bCPAP package



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Each central hospital

rolls out to a

district hospital


MANAGING NEONATAL RESPIRATORY

DISTRESS IN MALAWI


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Acknowledgements

Prof E. Molyneux

Profs R. Kortum and M. Oden

Unicef

Malawi delegation

Organizers and sponsors of the conference



THANK YOU

Documents

Kawaza: Low Cost Bubble CPAP for Managing Neonatal Respiratory Distress in Malawi