The Politeoxygen splitter system (PSS) – a frugal LMIC oxygen delivery technology that expands the utility by up to 700%

Abstract

Background: Oxygen therapy is indispensable in neonatal care requiring prompt commencement when prescribed. This is often hampered by limited availability of oxygen cylinders or concentrators at busy SCBUs in Nigeria. Where available, these two items of oxygen sources overcrowd the SCBU creating movement barriers leading to injuries, neonatal infections from high traffic of dirty cylinders and noise pollution from many concentrators. This presents the urgent need for a low-cost technique that could help to make oxygen easily administered to as many neonates as the need arises simultaneously. Aim: To describe an oxygen splitter system and compare outcomes of oxygen prescription in neonates pre and post-system installation. Methods: Politeoxygen® Splitter System (PSS), a novel oxygen distribution system was designed to eliminate oxygen concentrator and cylinder adverse effects whilst enabling only one oxygen source to support up to eight neonates, simultaneously. Following ethical clearance from Research Ethics Committee of Niger State Ministry of Health, Nigeria, five sets of the device were installed and applied. Records of newborns who received oxygen therapy, pre-PSS installation and post-PSS were retrieved. Time delays to oxygen commencement following prescription were assessed in both groups. Incidences of cylinder falls and obstructions were noted. Results: PSS supported multiple numbers of neonates using one oxygen-source with patient independent humidification and variable flowrates, sharing total flow up to 15 LPM amongst needy neonates as individually required. Six of 105 (6%) newborns received oxygen within 10 minutes of prescription pre-PSS installation, whereas 96% (72/75) post-PSS. The median (range) time delay to commencing oxygen therapy post-PSS was 0(0–90) minutes whereas pre- PSS was 74(0–1110). Conclusion: Unlike pre-PSS group, 100% of post-PSS neonates received oxygen as soon as this was prescribed, leading to prompt therapy initiation and many of them survived. It is author’s opinion that the PSS is recommended to enhance prompt far-reaching oxygen to neonates in poor settings.