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 preterm neonates in pre- and post-CPAP periods.
This was a retrospective study in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. Two study periods were identified. A 14-month study period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period after bCPAP was introduced (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 <1500g were compared before and after the introduction of bCPAP.
The admission records of 377 preterm neonates <1500g were obtained. 158 were admitted in pre-bCPAP period and 219 after. The mortality rate in pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P=0.012) in post-bCPAP period. 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 preterm neonates <1500g resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Implementing bCPAP with adequate training and supervision could significantly reduce preterm mortality in LICs.