Background
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.
Methods
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.
Results
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.
Conclusion
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.