Developing and testing a clinical care bundle incorporating caffeine citrate to manage apnoea of prematurity in a resource-constrained setting: a mixed methods clinical feasibility study protocol.

Autor: Irimu G; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya. GIrimu@kemri-wellcome.org.; Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya. GIrimu@kemri-wellcome.org., Okwaro F; Department of Paediatrics, Aga Khan University, Nairobi, Kenya., Coleman J; The University of British Columbia, Vancouver, Canada., Waiyego M; Division of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya., Murila F; Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya., Chomba D; Department of Paediatrics, Aga Khan University, Nairobi, Kenya., Parsimei M; Department of Paediatrics, Aga Khan University, Nairobi, Kenya., Shitote C; Department of Paediatrics, Aga Khan University, Nairobi, Kenya., Ochieng R; Department of Paediatrics, Aga Khan University, Nairobi, Kenya., Shah J; Department of Paediatrics, Aga Khan University, Nairobi, Kenya., Ogero M; London School of Hygiene and Tropical Medicine, London, UK., Ginsburg AS; University of Washington, Seattle, WA, USA., Ansermino JM; The University of British Columbia, Vancouver, Canada., Macharia W; Department of Paediatrics, Aga Khan University, Nairobi, Kenya.
Jazyk: angličtina
Zdroj: Implementation science communications [Implement Sci Commun] 2023 Jul 17; Vol. 4 (1), pp. 80. Date of Electronic Publication: 2023 Jul 17.
DOI: 10.1186/s43058-023-00455-x
Abstrakt: Background: Apnoea of prematurity (AOP) is a common condition among preterm infants. Methylxanthines, such as caffeine and aminophylline/theophylline, can help prevent and treat AOP. Due to its physiological benefits and fewer side effects, caffeine citrate is recommended for the prevention and treatment of AOP. However, caffeine citrate is not available in most resource-constrained settings (RCS) due to its high cost. Challenges in RCS using caffeine citrate to prevent AOP include identifying eligible preterm infants where gestational age is not always known and the capability for continuous monitoring of vital signs to readily identify apnoea. We aim to develop an evidence-based care bundle that includes caffeine citrate to prevent and manage AOP in tertiary healthcare facilities in Kenya.
Methods: This protocol details a prospective mixed-methods clinical feasibility study on using caffeine citrate to manage apnoea of prematurity in a single facility tertiary-care newborn unit (NBU) in Nairobi, Kenya. This study will include a 4-month formative research phase followed by the development of an AOP clinical-care-bundle prototype over 2 months. In the subsequent 4 months, implementation and improvement of the clinical-care-bundle prototype will be undertaken. The baseline data will provide contextualised insights on care practices within the NBU that will inform the development of a context-sensitive AOP clinical-care-bundle prototype. The clinical care bundle will be tested and refined further during an implementation phase of the quality improvement initiative using a PDSA framework underpinned by quantitative and qualitative clinical audits and stakeholders' engagement. The quantitative component will include all neonates born at gestation age < 34 weeks and any neonate prescribed aminophylline or caffeine citrate admitted to the NBU during the study period.
Discussion: There is a need to develop evidence-based and context-sensitive clinical practice guidelines to standardise and improve the management of AOP in RCS. Concerns requiring resolution in implementing such guidelines include diagnosis of apnoea, optimal timing, dosing and administration of caffeine citrate, standardisation of monitoring devices and alarm limits, and discharge protocols. We aim to provide a feasible standardised clinical care bundle for managing AOP in low and middle-income settings.
(© 2023. The Author(s).)
Databáze: MEDLINE
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