Reducing Preterm Mortality in Eastern Uganda: the Impact of Introducing Low-cost Bubble CPAP on Neonates <1500 g

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2019 Sep 6

PMID 31484567

Citations 17

Authors

F Okello

E Egiru

J Ikiror

L Acom

Ksm Loe

P Olupot-Olupot

K Burgoine

Affiliations

Soon will be listed here.

Abstract

Background: Complications of prematurity are the leading cause of deaths in children under the age of five. The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods.

Methods: This was a retrospective study of VLBW neonates (weight < 1500 g) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates < 1500 g were compared before and after the introduction of bCPAP.

Results: The admission records of 377 VLBW neonates < 1500 g were obtained. One hundred fifty-eight were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P = 0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36-0.86, P = 0.01). There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups.

Conclusion: Specialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths. The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.

Citing Articles

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Impact of early continuous positive airway pressure in the delivery room (DR-CPAP) on neonates < 1500 g in a low-resource setting: a protocol for a pilot feasibility and acceptability randomized controlled trial.

Burgoine K, Ssenkusu J, Nakiyemba A, Okello F, Napyo A, Hagmann C Pilot Feasibility Stud. 2024; 10(1):126.

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Prevalence and Missed Cases of Respiratory Distress Syndrome Disease Amongst Neonatal Deaths Enrolled in the Kenya Child Health and Mortality Prevention Surveillance Network (CHAMPS) Program Between 2017 and 2021.

Owuor H, Akelo V, Murila F, Onyango D, Kuria M, Rogena E Glob Pediatr Health. 2023; 10:2333794X231212819.

PMID: 38073666 PMC: 10699152. DOI: 10.1177/2333794X231212819.

Perceptions, beliefs, and current practices regarding neonatal skin care and emollient use in eastern Uganda: a qualitative study.

Wenani D, Burgoine K, Williams S, Musaba M, Gebremichael T, Clarke A BMC Pediatr. 2023; 23(1):223.

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