A Cleaned-and-Reused Breathing Device Helped Premature Babies Without Raising Infection Risk

What a 2025 study from the Philippines (Badin and colleagues, Frontiers in Pediatrics) found about safely reusing a low-cost newborn breathing machine

A study of 75 premature babies in the Philippines found that a low-cost breathing device whose parts are cleaned and reused between patients was just as safe as a conventional machine that uses brand-new tubing for every baby — with no increase in infections, breathing failures, or deaths [1]. Because the biggest worry about reusing any medical device is that it might spread germs, this is encouraging news for hospitals in places where buying fresh supplies for every newborn simply isn't possible. It suggests that a smart, reusable design could bring life-saving breathing support to many more babies who currently go without.

Why This Research Matters

When a baby is born too early, one of the first and most dangerous problems is often the lungs. Premature lungs are stiff and underdeveloped, and many newborns struggle to breathe on their own. Around the world, this kind of breathing trouble — doctors call it respiratory distress syndrome — is one of the leading reasons premature babies die, especially in countries where hospitals have fewer resources [2].

For decades, doctors have had an effective, gentle tool for this: CPAP, which stands for continuous positive airway pressure. Instead of pushing air forcefully into a baby the way a full breathing machine (a ventilator) does, CPAP delivers a steady, soft pressure that keeps the tiny air sacs in the lungs from collapsing between breaths. It is a bit like keeping a balloon slightly inflated so it is easier to blow up again. Large reviews of many studies have shown that CPAP helps premature babies breathe, lowers the chance they will need a ventilator, and saves lives [3]. The problem has never been whether CPAP works. The problem is that in much of the world, the standard machines are out of reach.

The Problem Families and Clinicians Used to Face

A conventional CPAP setup needs reliable electricity, tanks of compressed medical air, trained engineers to keep it running, and a steady supply of single-use plastic tubing that gets thrown away after each baby. In wealthy hospitals, none of this is a barrier. But in many low- and middle-income countries, electricity flickers, compressed air is scarce, spare parts are hard to get, and the cost of new tubing for every patient adds up fast. Study after study of bubble CPAP — a simpler version that creates the gentle pressure by bubbling air through water — has confirmed that it can work well in these settings [4], while also pointing to the same stubborn obstacles of cost and supply that keep it from reaching every baby who needs it [5].

For families in these places, the consequences were heartbreakingly concrete: a baby who could have been helped by a machine available a few hundred miles away might not survive because the local hospital could not sustain one. And for the clinicians caring for them, there was a constant tension between wanting to offer the best support and working within the limits of what the hospital could actually keep running. This is the gap that inventors set out to close — and the reason a reusable device became such an appealing idea.

The Device at the Heart of the Study

The breathing system in this study, called the Vayu bubble CPAP, was designed specifically for hospitals with limited resources. It provides the same gentle breathing support without needing electricity or compressed air, and testing has shown it reliably delivers the right pressure and a properly humidified flow of air and oxygen [6]. An earlier study at the very same Philippine hospital had already shown that babies breathed better and survived when treated with it [7], and clinicians and families in other countries, including Bangladesh, have described it as a welcome and practical solution [8].

But the device has one feature that is both its greatest strength and the source of the biggest question: its parts are made to be cleaned, disinfected, and used again. Reusing parts is what makes it affordable enough to reach so many babies. It is also, understandably, the thing that makes doctors and parents nervous. Could reusing a device — even a carefully cleaned one — pass germs from one baby to the next? That single question is what this study was built to answer.

What the Researchers Did

The researchers ran their study in the newborn intensive care unit of a referral hospital in the northern Philippines between May and October of 2022 [1]. Premature babies who needed breathing help were randomly assigned — essentially by a fair coin-toss method using sealed envelopes — to one of two groups. One group was treated with a conventional ventilator-driven CPAP using fresh, single-use tubing for each baby. The other group was treated with the cleaned-and-reused bubble CPAP system. Randomly sorting babies into groups is the fairest way to compare two treatments, because it makes the groups similar in every other respect, so any difference in results can be traced to the device itself.

The main thing the researchers watched for was a combination of two serious outcomes: whether a baby died before going home, or needed to be moved up to stronger breathing support. They also tracked several warning signs of infection, including whether babies got clinically worse, their white blood cell and platelet counts (blood measurements that shift when the body is fighting an infection), and whether their body temperature became unstable. It is worth knowing that the sickest, most fragile newborns — those who needed resuscitation right at birth — were not included, so the results apply to moderately premature babies rather than the most critically ill.

What They Found

Seventy-five babies took part — 37 with the conventional machine and 38 with the reused device — and the two groups looked remarkably similar in their results [1]. The combined measure of death or needing stronger support happened in about 27% of the conventional-machine babies and about 24% of the reused-device babies — a difference small enough to be due to chance. The number of babies who got clinically worse was identical: six in each group. Body temperatures stayed stable in both groups, and the blood measurements that would flag an infection showed no concerning pattern in the reused-device babies. In fact, the one measurement that did differ — a platelet count on day five — was actually higher in the reused-device group, and since infections usually push platelet counts down rather than up, this pointed away from infection, not toward it.

In plain terms: the babies cared for with the cleaned, reused device did just as well as those cared for with all-new equipment, and there was no sign that reusing the device made them sick.

It is also worth understanding how carefully the babies were watched, because that is part of what makes the result trustworthy. Every baby had a blood test drawn and antibiotics started the moment breathing support began, in case an infection was brewing. Their blood was checked again on the third and fifth days, and their temperature was measured every hour, because a temperature that swings too high or too low can be an early hint of infection. Across all of these checkpoints, the babies on the reused device looked just as healthy as the babies on the brand-new equipment. The care team also had clear rules for when to step a baby up to stronger support and when it was safe to ease off — the same rules were used for both groups, so neither group was treated more cautiously than the other.

What This Means for Families

If your baby were cared for with a device like this, the reassuring takeaway from this study is that reusing a properly cleaned breathing system did not put babies at greater risk of infection or breathing failure. This is important because infection is a genuine and serious danger for newborns — worldwide, sepsis (a dangerous, body-wide infection) affects well over a million babies every year and is one of the leading causes of newborn death [9]. Premature babies are especially vulnerable to picking up infections in the hospital [10], which is exactly why the safety of any reused equipment deserves such careful testing.

At the same time, it is honest to say this is an early, fairly small study from a single hospital, and the safety of reuse depends heavily on the device being cleaned properly every single time. Reusing a device is a deliberate, carefully controlled medical practice — backed by strict cleaning routines, staff training, and the kind of infection-prevention steps that good newborn units follow [11] — not a shortcut. Families should feel free to ask their care team how equipment is cleaned and monitored; those are fair and welcome questions.

What Researchers Are Working On Next

The scientists behind this study are careful to call it a first step rather than a final answer. What comes next are larger studies across many different hospitals, including ones caring for the most critically ill babies, to confirm that reusing these devices stays safe under a wide range of real-world conditions. If those bigger studies agree, the payoff could be significant: a durable, affordable way to give gentle breathing support to the many premature babies around the world who still die simply because the equipment to help them isn't there. For now, this study offers a hopeful and carefully-measured piece of good news — that doing more with less, done thoughtfully, may not mean doing worse.

References

  1. Badin S, Roodaki N, Garcia DEC, Abila-Cariaga R, Burke TF. Evaluation of a novel reprocessed bCPAP system on sepsis rates among preterm neonates with respiratory distress: a randomized controlled trial. Front Pediatr. 2025;13:1569437. doi:10.3389/fped.2025.1569437 ↩
  2. Kamath BD, Macguire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics. 2011;127(6):1139–46. doi:10.1542/peds.2010-3212 ↩
  3. Ho JJ, Subramaniam P, Davis PG. Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants. Cochrane Database Syst Rev. 2020;10(10):CD002271. doi:10.1002/14651858.CD002271.pub3 ↩
  4. Martin S, Duke T, Davis P. Efficacy and safety of bubble CPAP in neonatal care in low and middle income countries: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2014;99(6):F495–504. doi:10.1136/archdischild-2013-305519 ↩
  5. Won A, Suarez-Rebling D, Baker AL, Burke TF, Nelson BD. Bubble CPAP devices for infants and children in resource-limited settings: review of the literature. Paediatr Int Child Health. 2019;39(3):168–76. doi:10.1080/20469047.2018.1534389 ↩
  6. Dundek ML, Ng EK, Brazil AM, DiBlasi RM, Poli JA, Burke TF. Evaluation of a bubble CPAP system for low resource settings. Respir Care. 2021;66(10):1572–81. doi:10.4187/respcare.08948 ↩
  7. Rauschendorf P, Bou Saba G, Meara GK, Roodaki N, Conde-Agudelo A, Garcia DEC, et al. Effectiveness of a novel bubble CPAP system for neonatal respiratory support at a referral hospital in the Philippines. Front Pediatr. 2023;11:1323178. doi:10.3389/fped.2023.1323178 ↩
  8. Banik G, Halim MA, Md Abdullah AS, Oishee I, Boyce C, Dey SK, et al. Vayu bubble continuous positive airway pressure is a promising solution with favorable treatment outcomes for respiratory distress syndrome in newborns: a qualitative study in Bangladesh. Front Pediatr. 2024;12:1359406. doi:10.3389/fped.2024.1359406 ↩
  9. Fleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R, et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child. 2021;106(8):745–52. doi:10.1136/archdischild-2020-320217 ↩
  10. Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern Health Neonatol Perinatol. 2017;3:5. doi:10.1186/s40748-017-0043-3 ↩
  11. Johnson J, Akinboyo IC, Schaffzin JK. Infection prevention in the neonatal intensive care unit. Clin Perinatol. 2021;48(2):413–29. doi:10.1016/j.clp.2021.03.011 ↩