Table 3. Studies on safety of CPAP therapy in LMIC settings.
| Author, year | Country | Setting | Study design | Study population | CPAP strategy | Results | Comments |
|---|---|---|---|---|---|---|---|
| CPAP and pneumothorax | |||||||
| Kawaza, 201418 | Malawi | Referral hospital | Prospective observational study with two groups – CPAP with Hudson prongs vs standard care (oxygen with nasal cannulae) | Neonates weighing 1000 g and presenting with severe respiratory distress | Low-cost bCPAP system delivered by Hudson nasal prongs | No pneumothorax reported | |
| Hendrik, 201023 | South Africa | Secondary level unit | No comparison | Mean birth weight: 1166 g Mean gestational age: 31 weeks Male: 22/34 (65%) | CPAP protocol clearly delineated, case series | No pneumothorax reported | |
| Heuvel, 201125 | Malawi | Secondary care unit | Case series of 11 infants | Weight 1000–2500 g | CPAP considered for infants with respiratory distress | No pneumothorax reported | |
| Kirsten, 201226 | South Africa | Tertiary care NICU | Observational study | Preterm neonates 500 –1000 g ⩾25 weeks | Clear protocol; started at 4-6 cm of water. FiO2 titrated based on oxygen concentration | No pneumothorax reported | |
| Boo, 200027 | Malaysia | NICU | Case–control study | 97 preterm infants <37 weeks | CPAP started for infants with respiratory distress; and given with either bCPAP or ventilator CPAP | Pneumothorax reported for 7/97 babies: 7.2%(5/37 in CPAP failure group and 2/60 in CPAP success group) | |
| Urs, 200928 | India | NICU, teaching hospital | Prospective observational Study | All neonates diagnosed with RDS (n=50) CPAP failure (n=10) CPAP success (n=40) Overall 33 neonates (1000–1500 g), 4 (⩽999 g), 13 (1501–2000 g) | CPAP considered for neonates with FiO2 requirement >0.40 to maintain PaO2>60 mmHg with pH <7.25, PaCO2 >50 mm and Downes' score >4 | No baby developed pneumothorax | |
| Koti, 200930 | India | Level III NICU | Prospective observational study | 56 inborn preterm infants (gestation 28 to 34 weeks) with respiratory distress and chest x- ray suggestive of RDS | BCPAP with bi-nasal prongs (Fisher and Paykel Healthcare, New Zealand) started at 5 cm of water and adjusted to minimize chest retractions. FiO2 adjusted to maintain SpO2between 87% and 95% | Two babies had pneumothorax but both stabilized on bCPAP and required neither ventilation nor chest tube drainage | |
| Bassiouny, 199431 | Oman | NICU | Prospective observational study | 44 preterm infants with RDS enrolled | CPAP delivered using Beneveniste's valve and silastic nasal prongs | No pneumothorax reported | |
| Rego, 200232 | Brazil | NICU level 3 | Randomized controlled clinical trial | 99 neonates ⩽2500 g | Randomized to Hudson or Argyle nasal prongs | No pneumothorax reported | |
| CPAP and nasal trauma | |||||||
| Rego, 200232 | Brazil | NICU level 3 | Randomized controlled clinical trial | 99 neonates ⩽2500 g | Randomized to Hudson or Argyle nasal prongs | Argyle nasal prongs associated with more hyperemia No cases of pneumothorax reported in either group | Comparison of two CPAP delivery methods |
| Yong, 200533 | Malaysia | NICU level 3 | Randomized controlled clinical trial | 89 neonates <1500 g | 41 randomized to mask group and 48 to prong group | No significant trauma difference in the two groups Almost all neonates developed trauma | Comparison of two CPAP delivery methods |
| Do Nascimento, 200934 | Brazil | Neonatal unit maternity hospital | Quantitative, descriptive, cross sectional | 147 neonates of which 123 (83.7%) <37 weeks | No mention of duration, CPAP settings or other details Nasal protection observed in 142 (96.6%). 100% received humidification while 127 (86.4%) were heated | 117 neonates had mild (hyperemia), 29 had moderate (bleeding with erosion) and 1 had necrosis in addition to bleeding and erosion | No mention of duration, CPAP settings, or other details |
| CPAP and ROP | |||||||
| Hakeem Abdel, 201236 | Egypt | NICU | Prospective observational study | Preterm neonates <32 weeks and <1500 g Infants whose gestational age >32 weeks or birth weight >1500 g included if exposed to oxygen therapy for> 7 days | Perinatal risk factors for ROP assessed using univariate and multivariate analyses | No association of CPAP therapy with ROP (P>0.05) | No mention of duration, CPAP settings, or other details |
| Kumar, 201137 | India | NICU level 3 | Retrospective evaluation of prospectively collected data | Neonates with gestation ⩽32 weeks or birth weight ⩽1500 g screened. Infants with birth weight of 1501-1800 g or gestation of 33-34 weeks also screened in the presence of additional risk factors | Perinatal risk factors for ROP assessed using univariate and multivariate analyses | CPAP associated with severe ROP on univariate analysis but not on multivariate analysis | No mention of duration, CPAP settings, or other details |
Abbreviations: CPAP, continuous positive airway pressure; LMIC, low- and middle-income countries; NICU, neonatal intensive care unit; ROP, retinopathy of prematurity.