Having trained the nurses and set criteria for candidate babies, we were ready to start CPAP in the neonatal special care ward this week. We eagerly set up the machine on Monday at the position where the old machine was located. The tubing wasn’t long enough to reach the resuscitation unit where the baby would be, so we had to use tubing from the backup CPAP. The pressure system—for the water bottle to bubble only when the prongs are occluded—is delicate. With the extra tubing, we had to adjust the pressure hole (i.e. tape over the hole and enlarge a new hole until the ideal result is obtained). The next model which is slated to have a knob-adjustable hole that would definitely be more convenient, as tubing needs to be added or subtracted depending on the setting.

Unfortunately, over this week, we did not have a good candidate for CPAP. There was a wave of babies with severe asphyxia that we must exclude because they had not developed enough to know how to breathe. CPAP is not a ventilator; it can only help babies breathe easier and with less effort, not teach them. Since the inclusion criteria consider babies over 1200g, low-birth weight babies are excluded as well because they simply don’t have a good statistical survival rate regardless of the intervention. We had one potential candidate of a baby of 30-week gestation age and six-days old, weighing around 1200g. He showed a chest recession and had a 88-91% oxygen saturation. The test for CPAP was whether his oxygen saturation stat would improve if he was put on an oxygen concentrator. He did, which was great. However, his situation reveals the difficulty of testing the CPAP device. Babies with a decent weight usually mean that they are developed enough and are resilient enough to live without too much help; these babies would mostly likely improve on oxygen concentrators. From our previous mini-mortality study though, babies between 1200-1500g still have a mortality percentage around 50%. We are hopeful that CPAP can make a substantial dent to this number.

Meanwhile, I have been trying to fix the bilirubin phototherapy units that unfortunately, all have some sort of problem preventing use. The neonatal care ward, where they are mostly been used, is currently using newly donated phototherapy units like the ones seen in US hospitals. However, the doctors and nurses I have talked to admit that it is troublesome to obtain the right irradiance from the advanced phototherapy machines. We have built a simple irradiance meter that works by measuring the current produced from a solar cell powered by the light of interest and correlates the current to an irradiance measurement. Nurses are sometimes just too busy to constantly adjust the height of the phototherapy stands as the units are moved amongst the incubators. They would actually prefer to use the phototherapy units I built because they can be placed on top of the acrylic cover of the incubators (hot cots). Since the incubators are uniform, the irradiance of the phototherapy units does not need to be constantly adjusted. If they do, a simple knob can adjust the level of brightness from each LED.

I mainly face two problems from the phototherapy units. For the first generation I built in my freshman year, the socket for the adapter is pushed in because it did not fit the adapter head completely. So, nurses or medical student nurses would try to jam it in, loosening the glue and damaging the soldered wire in the electric box. Luckily, Liz and I have found a wonderful department called Physical Assets that is solely responsible for all the equipment in the hospital. The department is a giant warehouse of broken machines and scattered parts that are either in storage or in the process of being fixed. I found loose parts I needed and more importantly, a soldering iron that I could borrow.

For the second generation I build last year, all of the units work and all the soldered wire connections are holding well because of the improved circuit board design. However, because the power box and the LED strips are in one unit for ease of use ( a change from the older version), the heat produced by the power components after continual days of use has melted the glue holding some of the parts together—such as the sticker strips from protoboards where the LEDs are connected to. Fortunately, plastic c-shaped couplings found in the flea market can go around the protoboards and be nailed onto the wooden floor of the device, securing the protoboards. Overall, I was glad to find the units in good condition; I am relieved and happy to know that I did not had to do anything major to fix the units.