UAB-led team modifies adult device to breathe life into children

Modified oxygen delivery device can provide safe, cost-effective life-saving therapy to infants and children in developing nations where pneumonia is the leading killer.



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Wally Carlo

Pneumonia is the leading cause of infant deaths worldwide, but pediatric researchers at the University of Alabama at Birmingham have developed an effective, inexpensive way to help breathe life into children in developing countries.

A paper in the July 4, 2011, edition of the journal Pediatrics by UAB neonatologist Wally Carlo, M.D., and colleagues at other institutions, describes a modified device for adults that can safely be used for low-cost, low-maintenance, low-concentration oxygen therapy in infants and small children.  

In some parts of Sub-Saharan African and Southeast Asia the death rate from pneumonia in children under 5 can be 10 times higher than in the United States. Many infants and children with pneumonia and other respiratory conditions need oxygen therapy to survive.

“In the developed world, oxygen is delivered to these patients with devices that blend compressed oxygen and compressed air to provide accurate and precise concentrations and flow rates,” Carlo says. “Use of these blenders in developing countries is hindered by multiple factors, including cost, maintenance and lack of local availability of compressed air. These devices are expensive and somewhat complex, which further limits their use in developing countries.

“This novel system developed at UAB allows delivery of the exact oxygen concentration by pulling air from the environment using a commercially available device,” Carlo says.

The researchers tested a device in a laboratory setting to determine the necessary concentrations and flows of oxygen suitable for therapy for infants and small children using three oxygen delivery systems – a nasal cannula, oxygen hood and oxygen mask.

“We found that using a mask resulted in the delivery of oxygen concentrations that was accurate to the flow the entrainment device showed it was delivering,” Carlo says. “The hood produced a similar profile of concentrations and flow rates but with even greater accuracy but the cannula did not deliver accurate oxygen concentrations.”

Carlo says the findings are important because for the first time these experiments demonstrate that air-blending devices can accurately and precisely deliver set oxygen concentrations at flows lower than those for which they are nominally designed, but only if used with the proper delivery

systems.

Prolonged treatment with higher-than-needed concentrations of oxygen is not appropriate early in life because of the potential risk of blindness, death, cerebral palsy and other conditions.

“It is important to have an oxygen therapy like the one outlined in this paper in these low-tech environments to have a source of oxygen with adjustable concentrations ranging from near atmospheric to pure oxygen concentrations, at varying flow rates, to be able to save the thousands of children in developing countries who each year contract pneumonia and other conditions.”

The investigators are planning clinical trials to give oxygen to infants and children with pneumonia in an attempt to reduce mortality.

This work was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women’s and Children’s Health Research.

Carlo’s co-authors on the paper are Matthew Coghill, B.S.N.R.E., and Namasivayam Ambalavanan, M.D., of UAB; Robert L. Chatburn, MHHS, RRT-NPS of the Cleveland Clinic, and Patricia L. Hibberd, M.D. of Massachusetts General Hospital; and Linda L. Wright, M.D of the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women’s and Children’s Health Research.

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