Neonatal CPAP for Respiratory Distress Across Malawi and Mortality
| Autor: | Elizabeth Molyneux, Sara Liaghati-Mobarhan, Rebecca Richards-Kortum, Jennifer Carns, Maria Oden, Norman Lufesi, Aba Asibon, Alfred Chalira, Kondwani Kawaza, Mary K. Quinn |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Malawi medicine.medical_treatment Treatment outcome Hypothermia Kaplan-Meier Estimate Body Temperature 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Medicine Cpap treatment Humans Continuous positive airway pressure Survival rate Newborn care Respiratory Distress Syndrome Newborn Respiratory distress Continuous Positive Airway Pressure business.industry Hospitals Public Infant Newborn Oxygen Inhalation Therapy Quality Improvement respiratory tract diseases Survival Rate Treatment Outcome Pediatrics Perinatology and Child Health Emergency medicine Observational study medicine.symptom business Infant Premature |
| Zdroj: | Pediatrics. 144(4) |
| ISSN: | 1098-4275 |
| Popis: | OBJECTIVES: 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 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|