|Device||• Simple to use, affordable and low maintenance for low-resource settings.|
• A temperature-controlled gas circuit may reduce the risk of hypothermia especially in extremely low-birthweight babies.
|• Efficacy may be limited to mild to moderate respiratory distress and less effective with severe cases.|
|Training and staffing||• Regular and interactive training with intermittent refresher trainings.|
• Clinical mentorship with training on how to train others to use bubble CPAP.
• Investing in nurses dedicated to the nursery.
• Clinicians that stay longer term in the nursery.
• Combination of external consultant with local clinicians as trainers.
• Health facility management that prioritized neonatal care.
|• Understaffed neonatal units limit the capacity for care.|
• Staffing shortages exacerbated by healthcare provider strikes in some locations.
• High turnover of nurses and doctors necessitated repeated training of new staff.
• Lack of motivation and accountability.
• Gaps in training as many nurses and doctors are untrained in bubble CPAP.
• Communication barriers between doctors and nurses.
|Initiation||• Decision-making aided by clinical algorithm that is clearly posted by the machine.||• Gaps in correct identification of early and mild signs of distress.|
• Reluctance of nurses to initiate while short-staffed at night and without consulting a clinician.
• Overtightening the chin strap can lead to facial swelling.
|Monitoring||• Appropriate and regular monitoring.|
• Monitoring with pulse oximetry.
• Monitoring respiratory distress with respiratory severity score.
|• Complications such as CPAP belly syndrome and mucosal drying require regular monitoring and actions to prevent.|
|Weaning||None discussed.||• Knowing when to wean, especially when resources are limited.|
• A need to monitor closely after weaning to ensure the infant is not desaturating.
|Caregivers||• Peer support from caregivers with positive experiences with bubble CPAP use on their own newborns.||• Local beliefs that the oxygen led to poor outcomes.|
• Poorly providing information to caregivers and gaps in consenting parents before starting bubble CPAP.
• Bubble CPAP may complicate mother-infant interaction as mothers were afraid to hold babies, unable to see their infant’s faces and interrupted skin-to-skin contact.
|Supplies and equipment||• Appropriate snug-fitting nasal prongs.|
• Soft nasal prongs.
• Use of locally available materials.
|• Cost of disposable nasal prongs.|
• Oxygen concentrators not always available.
• CPAP machines not always available.
• Different machines cause challenges in training, set up and maintenance.
• Poor equipment maintenance once donors withdraw support.