Neonatal CPAP for Respiratory Distress Across Malawi and Mortality

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dc.citation.articleNumbere20190668
dc.citation.issueNumber4
dc.citation.journalTitlePediatrics
dc.citation.volumeNumber144
dc.contributor.authorCarns, Jennifer
dc.contributor.authorKawaza, Kondwani
dc.contributor.authorLiaghati-Mobarhan, Sara
dc.contributor.authorAsibon, Aba
dc.contributor.authorQuinn, Mary K.
dc.contributor.authorChalira, Alfred
dc.contributor.authorLufesi, Norman
dc.contributor.authorMolyneux, Elizabeth
dc.contributor.authorOden, Maria
dc.contributor.authorRichards-Kortum, Rebecca
dc.date.accessioned2019-10-25T16:54:17Z
dc.date.available2019-10-25T16:54:17Z
dc.date.issued2019
dc.description.abstractOBJECTIVES: Our aim in this observational study was to monitor continuous positive airway pressure (CPAP) usage and outcomes in newborn wards at 26 government hospitals in Malawi after the introduction of CPAP as part of a quality-improvement initiative. CPAP was implemented in 3 phases from 2013 through 2015. METHODS: Survival to discharge was analyzed for neonates treated with nasal oxygen and/or CPAP with admission weights of 1 to 2.49 kg at 24 government hospitals with transfer rates <15%. This analysis includes neonates admitted with respiratory illness for 5.5 months before (621 neonates) and 15 months immediately after CPAP implementation (1836 neonates). A follow-up data analysis was completed for neonates treated with CPAP at all hospitals during an additional 11 months (194 neonates). RESULTS: On implementation of CPAP, survival to discharge improved for all neonates admitted with respiratory distress (48.6% vs 54.5%; P = .012) and for those diagnosed with respiratory distress syndrome (39.8% vs 48.3%; P = .042). There were no significant differences in outcomes for neonates treated with CPAP during the implementation and follow-up periods. Hypothermia on admission was pervasive and associated with poor outcomes. Neonates with normal mean temperatures during CPAP treatment experienced the highest survival rates (65.7% for all neonates treated with CPAP and 60.0% for those diagnosed with respiratory distress syndrome). CONCLUSIONS: A nurse-led CPAP service can improve outcomes for neonates in respiratory distress in low-resource settings. However, the results show that real-world improvements in survival may be limited without access to comprehensive newborn care, especially for small and sick infants.
dc.identifier.citationCarns, Jennifer, Kawaza, Kondwani, Liaghati-Mobarhan, Sara, et al.. "Neonatal CPAP for Respiratory Distress Across Malawi and Mortality." <i>Pediatrics,</i> 144, no. 4 (2019) American Academy of Pediatrics: https://doi.org/10.1542/peds.2019-0668.
dc.identifier.doihttps://doi.org/10.1542/peds.2019-0668
dc.identifier.urihttps://hdl.handle.net/1911/107508
dc.language.isoeng
dc.publisherAmerican Academy of Pediatrics
dc.rightsThis is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by the American Academy of Pediatrics
dc.titleNeonatal CPAP for Respiratory Distress Across Malawi and Mortality
dc.typeJournal article
dc.type.dcmiText
dc.type.publicationpost-print
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