Most of us are using indigenoud bCPAP since long time in resource poor setting. We also know that itz very useful in this scenario. But are there any meta analysis comparing it with machine CPAP??
there is a 2016 meta-analysis on this topic.
J Perinatol. 2016 May;36 Suppl 1:S21-8. doi: 10.1038/jp.2016.29.
Efficacy and safety of CPAP in low- and middle-income countries.
Thukral A1, Sankar MJ1, Chandrasekaran A1, Agarwal R1, Paul VK1.
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Abstract
We conducted a systematic review to evaluate the (1) feasibility and efficacy and (2) safety and cost effectiveness of continuous positive airway pressure (CPAP) therapy in low- and middle-income countries (LMIC). We searched the following electronic bibliographic databases-MEDLINE, Cochrane CENTRAL, CINAHL, EMBASE and WHOLIS-up to December 2014 and included all studies that enrolled neonates requiring CPAP therapy for any indication. We did not find any randomized trials from LMICs that have evaluated the efficacy of CPAPtherapy. Pooled analysis of four observational studies showed 66% reduction in in-hospital mortality following CPAP in preterm neonates (odds ratio 0.34, 95% confidence interval (CI) 0.14 to 0.82). One study reported 50% reduction in the need for mechanical ventilation following the introduction of bubble CPAP (relative risk 0.5, 95% CI 0.37 to 0.66). The proportion of neonates who failed CPAP and required mechanical ventilation varied from 20 to 40% (eight studies). The incidence of air leaks varied from 0 to 7.2% (nine studies). One study reported a significant reduction in the cost of surfactant usage with the introduction of CPAP. Available evidence suggests that CPAP is a safe and effective mode of therapy in preterm neonates with respiratory distress in LMICs. It reduces the in-hospital mortality and the need for ventilation thereby minimizing the need for up-transfer to a referral hospital. But given the overall paucity of studies and the low quality evidence underscores the need for large high-quality studies on the safety, efficacy and cost effectiveness of CPAP therapy in these settings.
recommend also the check the citations of this paper, since its seems that research is ongoing
- Evaluating the efficacy of Seattle-PAP for the respiratory support of premature neonates: study protocol for a randomized controlled trial.[Trials. 2019]
- Short term evaluation of respiratory effort by premature infants supported with bubble nasal continuous airway pressure using Seattle-PAP and a standard bubble device.[PLoS One. 2018]
@Karel Allegaert, the study you have mentioned is about bubble CPAP, not indigenous CPAP. In Indigenous CPAP generally no blender or humidifier is used. So baby receives unregulated cold O2. And detrimental effect of hyperoxia in preterm neonates is already established. So this type of study is not possible ethically.
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