ORIGINAL

Niger J Paed 2013; 40 (3): 275 –277

Audu L I

Customized bubble continuous

positive airway pressure (BCPAP)

device at the National Hospital

Abuja for the treatment of

Otuneye AT

Mukhtar MY

Mairami AB

Mshelia LJ

Garu M

respiratory distress syndrome (RDS)

DOI:http://dx.doi.org/10.4314/njp.v40i3,14

Accepted: 9th February 2013

Abstract Using the principle of

under-water-seal pressure, we

assembled a circuit to produce an

effective Bubble Continuous Posi-

tive Airway Pressure device at the

National Hospital. The device is

reasonably inexpensive and is suit-

able for use at secondary and terti-

ary health institutions for the care

of the preterm infant with RDS.

(

)

Audu LI

Otuneye AT, Mukhtar MY

Mairami AB, Mshelia LJ

Department of Paediatrics, National

Hospital, Garki Abuja

Email: drauduli@yahoo.com

Tel: +2348037209631

Garu M

Department of Nursing Services,

National Hospital, Abuja

Introduction

apply. Its superiority over ventilator-derived CPAP in

the management of preterm infants with RDS was dem-

1

2

Prematurity is a m_-a₂jor cause of neonatal deaths in devel-

onstrated by Bahman-Bijari et al . In Bubble CPAP, an

oscillatory pressure is generated by the flow of gas

through an under-water seal system. In addition to the

pressure generated, mechanical vibrations similar to

those of high frequency ventilation are transmitted to the

chest.

1

oping Countries. It accounts for 25% of neonatal

3

deaths in Nigeria. Respiratory distress resulting from

surfactant deficiency accounts for a significant propor-

tion of deaths among preterm babies globally. Invasive

respiratory support is fraught with several short and long

term complications including pneumothorax and bro-

chopulmonary dysplasia Its application is capital inten-

sive and also requires specialized technical support

which limits its use in most resource poor countries.

4

5

Commercially available Bubble CPAP devices are quite

expensive and most health institutions in resource con-

strained countries may not be able to afford them. The

effectiveness of locally adapted Bubble CPAP devices

Prematurity is a major cause of_-₂_,n₃eonatal deaths particu-

1

14

larly in developing countries.

A significant propor-

has been documented . To meet the increasing demand

tion of preterm deaths worldwide are caused by respira-

tory illnesses requiring assisted ventilation. Tradition-

for a simple respiratory support for preterm babies in

our institution, we modified the existing Bubble CPAP

devise using readily available but far less expensive

materials. The resultant product is cheap, easily assem-

bled and can be applied by both doctors and nurses after

a short training. The aim of this initial communication is

to describe the devise which can be used in both tertiary

and secondary health institutions in the management of

RDS with the ultimate goal of reducing neonatal

mortality in the country.

4

ally, respiratory support is invasive and is fraught with

several short and long term complications including

5

pneumothorax and brochopulmonary dysplasia. Its ap-

plication is capital intensive and also requires special-

ized technical support which limits its use in most

resource poor countries. There is currently, a global shift

towards the use of non invasive respiratory support for

preterm babies with RDS, the hallmark of which is the

applicatio₆_-n₇of continuous positive airway pressure

(

respiratory distress syndrome are well documented

CPAP). The benefits of CPAP in the management of

8-10

.

Materials and Methods

Different devices are used for the delivery of CPAP in-

cluding conventional ventilators, variable-flow infant

CPAP and the Bubble CPAP. The essential components

of a CPAP device include a pres₁sure generator, the

The infant oxygen delivery tubes with binasal prongs

(manufactured by Jiangsu Yada Technology Group Co

Ltd China, fig 1) essentially serve as the CPAP

circuit, providing the inspiratory limb, the interface

(nasal prongs) and the proximal part of the expiratory

1

CPAP circuit and airway interface. Bubble CPAP has

an edge over the others because it is cheap and easy to

2

76

limb. The proximal end of the inspiratory limb connects

the humidified oxygen source (oxygen cylinder, oxygen

concentrator or wall-piped oxygen) through the interface

to the baby. It is interesting to note that these tubes are

available in most tertiary institutions where they are

traditionally used to deliver intranasal oxygen to infants

in the neonatal and paediatric wards.

Fig 3: Shows the set –up of the bubble cpap

Oxygen

source

Humidifier

CPAP

Interface

with Nasal-

prongs

Fig 1: CPAP circuit (oxygen delivery tube)

Bubble CPAP

Generator

Expiratory limb:

connect to

With the oxygen flow rate set at 6-8l/min and the expira-

tory limb of the tube immersed to a depth of 5cm, bub-

bles are immediately generated. Chest auscultation is

essential to confirm presence of bubbling sounds; its

absence may suggest a leak along the tubing or at the

interface (nasal prongs) or that the baby's mouth is open

The initial response includes a significant improvement

CPAP

Inter-

Inspira-

tory

Nasal

prong

2

in the SPO and a noticeable reduction in the baby’s

work of breathing. It is important to pass a nasogastric

tube for intermittent gastric decompression to take care

of attendant gaseous distension.

Connect to

Oxygen source

This has been in use since November 2011 in the new-

born unit of our hospital for preterm babies with respira-

tory distress syndrome. A total of 89 babies most of

whom were preterm, very low birth weight with respira-

tory distress syndrome have been treated with this de-

vice.

The nasal prong (which is a component of the oxygen

delivery tube) comes in different sizes. It is firmly ap-

plied to the nostrils by gently adjusting the strap around

the baby’s head. These prongs are soft and therefore do

not cause pressure induced ischaemic damage to the

nasal septum as reported with the nasal prongs that

come with commercially available CPAP devices. The

CPAP generator is a cylindrical, transparent bottle filled

to predetermined level with distilled water. The expira-

tory limb of the circuit is immersed in this bottle and the

depth of immersion in centimeters below the water

Conclusion

This is a simple and easily affordable technology that

promises to save the lives of preterm babies with the

ultimate goal of reducing neonatal mortality in our sub-

region. The average cost of the disposable components

of the device is N2, 000 ($12). The average cost of pro-

viding the consumables for the nasal flow CPAP

2

surface corresponds to the desired CPAP in cmH 0.

The tube is carefully secured with an adhesive plaster to

ensure that the length immersed in water remains

constant. Figs 2 and 3 show the assembled device.

(

0

devise is that the nasal prongs are soft and do not cause

ischaemic damage to the nasal septum.

corrugated tubes, nasal prongs, head caps) is about N8,

00($48=) per patient. Another major advantage of our

Fig 2: Components of the bubble cpap device

Oxygen flow

meter

Oxygen

source

Authors’ Contributions

Audu LI, Otuneye AT: Conceptualization and design of

the device and Manuscript write-up

Mukhtar MY, Mairami AB, Mshelia LJ, Garu M proof

reading and editing of manuscript.

Humidifier

Bubble CPAP

Generator

CPAP Interface

with Nasal-

prongs

Conflict of interests: None

Funding: National Hospital Abuja

Acknowledgement

We are grateful to Professor Dawodu A and Dr Akinbi

H both of the Cincinnati Children’s Hospital and

Medical Center, Ohio, USA for initiating the use of

non-invasive ventilation in our newborn Unit.

2

77

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