623 - Vayu Bubble Continuous Positive Airway Pressure (vbCPAP) with a Blender is associated with improvement in Physiologic and Clinical Parameters in Premature Infants with Respiratory Distress Syndrome
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 623 Publication Number: 623.315
Emily Ahn, New York-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Matei John. mselle, kilimanjaro christian medical university college, Kilimanjaro, Kilimanjaro, Tanzania; Anna Denis. Sechu, Kilimanjaro christian medical center, Moshi, Kilimanjaro, Tanzania; Aisa Mamuu. Shayo, Kilimanjaro Christian Medical Center and Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Kilimanjaro, Tanzania; Jeffrey Perlman, Weill Cornell Medicine, New York, NY, United States
Neonatology Fellow New York-Presbyterian Komansky Children’s Hospital New York, New York, United States
Background: Respiratory distress syndrome (RDS) is common in infants < 2000g and can cause respiratory failure if untreated. Early oxygen toxicity related to high oxygen exposure potentiates many NICU morbidities including chronic lung disease (CLD). CPAP and reduced oxygen exposure has been shown to modulate RDS and CLD. Vayu (VIA Global Health) developed a novel bubble CPAP (vbCPAP) system with an ambient/oxygen blender. It is ideal for low-resource settings (LRS) as it is compact, simple to administer, and does not require electricity or medical air. Objective: To determine whether vbCPAP is associated with improvement in physiologic and clinical parameters and if it modifies the clinical course of premature infants with RDS in the LRS. Design/Methods: This is an ongoing physiologic/feasibility study conducted at Kilimanjaro Christian Medical Centre in Tanzania with data presented from March-November 2022. Premature infants < 2000g with RDS are eligible for vbCPAP. Pulse oximetry is available. Data collected pre/post vbCPAP included heart rate (HR), respiratory rate (RR), fraction of inspired oxygen (FiO2), oxygen saturation, and Silverman score (SS), a marker of respiratory distress. Measurements were repeated at 1, 6, 12 and 24 hours. Data were analyzed using paired and student’s t-test and Fisher’s exact test. Results: To date 64 infants have been evaluated. Mean birthweight (BW) and gestational age (GA) were 1423 ± 515g and 31.2 ± 2.6 weeks. Infants on vbCPAP had a significant reduction in HR, RR, and SS and a significant increase in oxygen saturation after 1 hour of treatment (Table 1). These differences were amplified at 24 hours with an additional significant reduction in FiO2. Infants who died (n=20) were of lesser BW, comparable GA, and had a lower initial temperature than survivors (Table 2). There was no difference between inborn and out-born mortality (P=0.39); 50% of deaths were sepsis related. Mortality was unchanged compared to the prior six months. FiO2 management improved over time with reduced blended oxygen delivery (57 ± 15% vs 46 ± 13%, P=0.003) when comparing the initial 32 to the latter 32 patients.
Conclusion(s): vbCPAP was associated with significant improvement in physiologic and clinical parameters within an hour of initiation and progressive improvement over 24 hours. Provider use of blended oxygen was optimized over time decreasing potential risk of oxygen toxicity. Mortality risk did not increase with vbCPAP initiation. While vbCPAP improves initial respiratory status a comprehensive care bundle, i.e. avoiding hypothermia, is necessary to have an impact on neonatal mortality.
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