Approximately 15 million babies are born prematurely each year, and preterm birth complications are the leading cause of neonatal mortality worldwide.i Over 60 percent of all preterm births occur in Africa and South Asia, but preterm birth rates are increasing in nearly every country across the globe.ii A serious complication of preterm birth is respiratory distress due to insufficient lung development. Of the numerous interventions for respiratory distress syndrome (RDS) that have been introduced over the past 60 years, the greatest declines in RDS-specific neonatal mortality in high-income countries have been due to the use of oxygen and CPAP.iii
Although advances in mechanical ventilation have greatly reduced mortality rates for preterm infants, evidence indicates that mechanical ventilation contributes to chronic lung disease.iv Research has shown that CPAP reduces the need for assisted ventilation in infants less than 28 weeks gestation and the need to transfer infants less than 32 weeks gestation to neonatal intensive care units.ii
CPAP technology delivers pressurized gas (blended air/oxygen) to the airway, through a mask or nasal cannula interface. For added benefit, the pressurized gas is humidified and warmed. Devices can be categorized into continuous flow and variable flow. The continuous flow devices provide a fixed flow of gases, and therefore pressure, regardless of the phase of expiration, while the variable flow devices exert a lower pressure during the expiratory cycle so that the infant does not need to exhale against a continuous flow of gases.v Bubble CPAP, a type of continuous flow device, uses a column of water to create continuous, end-expiratory pressures that are accompanied by fluctuations arising from the bubbling of air exiting the expiratory limb tubing.iv Research suggests that the vibrations that result from the bubbling help contribute to gas exchange and reduce the infant’s work of breathing.vi When comparing the impact of CPAP devices, bubble CPAP has been demonstrated to be superior in terms of reduced complications, cost, and duration of hospital stay.vi
Because of the high level of technology involved in CPAP devices, they are generally used at tertiary care facilities by skilled operators, but recent studies in low-resource settings show that nurses can safely operate a bubble 2 CPAP device after training.vii,viii While a current commercially available bubble CPAP can cost just 15 percent of the cost of the cheapest mechanical ventilator,ix they can still be prohibitively expensive. Further, CPAP devices often require the ongoing purchase of accessories, such as nasal prongs, caps, and masks. Many clinics have opted to assemble improvised devices. Unfortunately, the oxygen blender is not easily improvised. This increases the risk to the neonate due to the delivery of 100% oxygen. A number of university research programs and independent, small businesses are working to develop improved and lower-cost CPAP devices for low-resource settings.
This booklet contains a sample of the CPAP devices that are on the market today.