Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review

Arch Dis Child Fetal Neonatal Ed. 2014 Nov;99(6):F495-504. doi: 10.1136/archdischild-2013-305519. Epub 2014 Aug 1.


Introduction: Forty per cent of global child deaths occur in the neonatal period. Low and middle income countries need effective and simple methods to improve hospital-based neonatal care. Bubble continuous positive airway pressure (CPAP) may have a role in improving the quality of respiratory support in hospitals in low and middle income countries.

Aim: To examine the evidence for the efficacy and safety of bubble CPAP in neonates with respiratory distress in low and middle income settings.

Method: A systematic search (1946-March 2014) was performed of Pubmed, Ovid MEDLINE, Web of Science, Google Scholar and the references of relevant articles. Articles meeting inclusion criteria (CPAP for respiratory distress in infants <28 days of age in hospitals in low and middle income countries) were assessed using Grading of Recommendations, Assessment, Development and Evaluation and Newcastle-Ottawa Quality Assessment Scale methodology. Outcomes included need for mechanical ventilation, complications and mortality.

Results: In three studies, the initial use of bubble CPAP compared with oxygen therapy, followed by mechanical ventilation if required, reduced the need for mechanical ventilation by 30%-50%. In another three trials comparing bubble CPAP with ventilator CPAP, mortality and complication rates were similar, while meta-analysis of CPAP failure in these same trials showed a lower failure rate in the bubble CPAP groups (p <0.003).

Conclusions: There is evidence that bubble CPAP is safe and reduces the need for mechanical ventilation. Further research into the efficacy of bubble CPAP in low-income and middle-income countries is needed.

Keywords: Neonatology; Respiratory.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Continuous Positive Airway Pressure / adverse effects
  • Continuous Positive Airway Pressure / methods*
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care, Neonatal / methods*
  • Oxygen Inhalation Therapy
  • Research Design
  • Respiratory Distress Syndrome, Newborn / mortality
  • Respiratory Distress Syndrome, Newborn / therapy*