Impact of introduction of bubble CPAP on neonatal mortality in Tajikistan

BackgroundPreterm infants with respiratory distress are at high risk of mortality in low-resource settings due to limited access to advanced respiratory support. Bubble Continuous Positive Airway Pressure (bCPAP) improves outcomes in preterm infants with respiratory distress but generally requires significant infrastructure (electricity and blended oxygen). We hypothesized that introduction of a novel bCPAP device (Vayu) that does not require electricity or a pressurized air source would improve survival of moderately preterm infants.MethodsIn this pilot observational cohort study, demographic and mortality data were collected for 2 months prior to and 14 months following introduction of Vayu bCPAP in 2024 at three hospitals in Tajikistan. Similar data were collected following introduction of bCPAP in four additional hospitals and compared to historical mortality data for those same hospitals from 2023. Finally, mortality was compared for all seven hospitals following introduction of bCPAP to historical data from 2023.ResultsFollowing introduction of bCPAP, survival improved in the three initial hospitals for infants with birth weight of 1000-1499 g and 1500-2499 g. In the second group of four hospitals, improved survival was seen in infants with birth weight of 500-999 g compared to historical data. Combined data from all seven hospitals showed improvement in mortality for infants with birth weight of 500-999 g and 1000-1499 g.ConclusionsbCPAP that does not require electricity or a pressurized air source was associated with improved survival in very preterm infants. Our data suggest feasibility and benefit in a central Asian country. Further studies of bCPAP in low-middle income countries are warranted.