A low-cost oxygen-air mixer device extends accessibility of safer neonatal respiratory support in a resource-poor setting

Abstract

Background information: High cost of commercial-grade bubble continuous positive airway pressure (CPAP) machine has led to its limited availability for respiratory support of neonates in resource poor facilities. Most Nigeria facilities resorted to an improvised setup which supplies oxygen at 100% concentration exposing neonates to hyperoxia with possible ROP. PoliteO2blend® is a cheaper device that mixes supplied oxygen with atmospheric air, delivering variable fractions of inspired oxygen (FiO2) to neonates via tracheal tube or nasal prongs extended into a disposable PEEP water bottle as used in the improvised setup. The system microfilters and humidifies the blended gas unlike conventional improvised application. This study evaluated the PoliteO2blend as a standalone device as well as an upgraded version of improvised-CPAP. Methods: Four units of the politeO2blend were installed at the University Teaching Hospital Abakaliki for trialling and were operated by four designated staff after prior training on the modes of application of the device. Forty-five neonates, birthweight ≥1500g were treated following parental consents. The systems were operated as improved improvised-CPAP in 16 neonates of which 18.8% (3/16) were delivered preterm. All patients initially experienced respiratory distress with 75% (12/16) having pre-treatment respiratory rate >60c/m and SPO2 as low as 43% in some. The neonatal impact analyses of continuing usage of the devices at the hospital was evaluated based on the fraction of the total number of needy neonates at the centre who necessarily got treated using the device. Results: The target SPO2 of 90-95% was achieved in all neonates using FiO2 that ranged from 0.21 to 0.6. Duration of improvised setup with PoliteO2blend before successful discharge ranged from 5hrs to 7days. Conclusion: Our target SPO2 was rapidly achieved at a safer FiO2 in most neonates that received respiratory support. Improvised-CPAP application via PoliteO2blend may reduce the incidence of oxygen toxicity owing to conventional use of improvised setup. PoliteO2blend is recommended as safer alternative for facilities lacking sufficient funds.