Reducing preterm mortality in eastern Uganda: the impact of introducing low-cost bubble CPAP on neonates <1500 g

• Published in: BMC pediatrics Vol. 19; no. 1; p. 311
• Main Authors: Okello, F, Egiru, E, Ikiror, J, Acom, L, Loe, Ksm, Olupot-Olupot, P, Burgoine, K
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.09.2019; BioMed Central; BMC
• Subjects: Africa; Antibiotics; Bubble CPAP; Complications and side effects; Continuous positive airway pressure; Continuous Positive Airway Pressure - economics; Continuous Positive Airway Pressure - instrumentation; Continuous Positive Airway Pressure - statistics & numerical data; Data collection; Developing Countries; Female; Health aspects; Hospitalization - statistics & numerical data; Hospitals; Hospitals, Public; Humans; Infant mortality; Infant, Newborn; Infant, Very Low Birth Weight; Low-income country; Male; Mortality; Neonate; Newborn babies; Newborn infants; Odds Ratio; Oxygen therapy; Pediatrics; Preterm; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - mortality; Respiratory Distress Syndrome, Newborn - therapy; Retrospective Studies; Surfactants; Survival Rate; Time Factors; Uganda - epidemiology; Ventilators; Uganda; United Kingdom > UK; Low-income country; Bubble CPAP; Neonate; Respiratory distress syndrome; Africa; Preterm
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-019-1698-x

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. 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. 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. 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.