By Debbie Lester, Clinical Programmes and USA Country Director, Adara Development
Last September, through an amazing partnership with the University of Washington (UW), Seattle Children’s Hospital (SCH) and PATH and through a grant from Saving Lives at Birth, we held a two day workshop at Kiwoko Hospital. 60 clinicians with a common passion to save newborn lives travelled from all over east Africa and beyond. The mission was to discuss a lifesaving therapy for newborns with respiratory distress called Continuous Positive Airway Pressure (CPAP).
In the developed world, this therapy has evolved into a sophisticated treatment delivered by fancy medical machines. But in low resource settings, the treatment is attempted to be delivered as an improvised set up called bubble CPAP (bCPAP). Historically, CPAP was delivered via this mechanism and if administered correctly it continues to be a lifesaving therapy. When I started out on my journey 25 years ago, bCPAP was a common method used to deliver CPAP.
2.7 million deaths or roughly 45% of all under-five deaths, occur during the neonatal period (the first 28 days of life). Of these, almost 1 million deaths occur on the day of birth and 2 million in the first week of life. Pre-term birth and respiratory distress syndrome (RDS) are some of the leading causes of neonatal deaths across the globe. CPAP is one of the therapies used to treat RDS and it saves lives (WHO 2015).
Although bCPAP is a very effective treatment, what we have learned over the years is that oxygen given in high quantities can damage the immature vessels in a premature infant’s eyes, leading to a condition called Retinopathy of Prematurity (ROP) which can lead to blindness. So, the gold standard of treatment is to titrate a mixture of air and oxygen during delivery of CPAP to deliver optimal levels and to prevent any chance of disability.
Delivering safe and effective bCPAP is a huge worldwide challenge, particularly in low resource settings. That is why Adara has come together with PATH, Kiwoko Hospital, UW and Seattle Children’s to tackle this issue as a large team with the overall goal that every infant worldwide will have access to safe and effective treatment. One of the many outcomes from the workshop last September is that expensive equipment and technology is still not accessible to most, and there will continue to be a huge reliance on improvised bCPAP.
So with continued conviction and passion in our mission, our PATH/UW/SCH/Kiwoko team are back together and working to perfect a low cost bCPAP kit with air and oxygen blending capabilities that will not only be offered at very low cost but be available to infants in need in low resource settings all across the world. Our teams are back to the drawing board and the second phase of the Saving Lives at Birth grant has been submitted. Our hope and plan is to run a feasibility study on the kit we develop in Uganda in 2017 and then to implement the training package and therapy in a setting that has never used bCPAP before.
Our colleagues and partners at Kiwoko hospital are a shining example of the lifesaving benefits and affect this treatment offers newborns when delivered in a safe and effective manner.