Resuscitation of preterm infants in the Philippines: a national survey of resources and practice

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 105; no. 2; pp. 209 - 214
• Main Authors: Hayden, Dean, Villanueva-Uy, Maria Esterlita, Mendoza, Maria Katrina, Wilkinson, Dominic
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2020; BMJ Publishing Group
• Subjects: Babies; Christianity; Developing Countries; Gestational Age; Health Care Rationing - standards; Health Care Rationing - statistics & numerical data; Health Expenditures; Hospitals, Private - standards; Hospitals, Private - statistics & numerical data; Hospitals, Public - standards; Hospitals, Public - statistics & numerical data; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Intensive care; Intensive Care Units, Neonatal - standards; Intensive Care Units, Neonatal - statistics & numerical data; Low income groups; Neonatal care; Newborn babies; Original Research; Pediatrics; Philippines; Practice Patterns, Physicians; Premature babies; Premature birth; Pulmonary Surfactants - administration & dosage; Religion; Respiration, Artificial - standards; Respiration, Artificial - statistics & numerical data; Resuscitation - standards; Resuscitation - statistics & numerical data; Socioeconomic Factors; Surfactants; Survival Analysis; Ventilators; Philippines; resuscitation; neonatology; intensive care; paediatric practice
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/archdischild-2019-316951

ObjectiveThere is a high incidence of preterm birth in low-income and middle-income countries where healthcare resources are often limited and may influence decision making. We aimed to explore the interplay between resource limitations and resuscitation practices for extremely preterm infants (EPIs) in neonatal intensive care units (NICUs) across the Philippines.MethodsWe conducted a national survey of NICUs in the Philippines. Institutions were classified according to sector (private/public), region and level. Respondents were asked about unit capacity, availability of ventilators and surfactant, resuscitation practices and estimated survival rates for EPIs of different gestational ages.ResultsRespondents from 103/228 hospitals completed the survey (response rate 45%). Public hospitals reported more commonly experiencing shortages of ventilators than private hospitals (85%vs23%, p<0.001). Surfactant was more likely to be available in city hospitals than regional/district hospitals (p<0.05) and in hospitals classified as Level III/IV than I/II (p<0.05). The financial capacity of parents was a major factor influencing treatment options. Survival rates for EPIs were estimated to be higher in private than public institutions. Resuscitation practice varied; active treatment was generally considered optional for EPIs from 25 weeks’ gestation and usually provided after 27–28 weeks’ gestation.ConclusionOur survey revealed considerable disparities in NICU resource availability between different types of hospitals in the Philippines. Variation was observed between hospitals as to when resuscitation would be provided for EPIs. National guidelines may generate greater consistency of care yet would need to reflect the variable context for decisions in the Philippines.