Hendriks Hans, Kirsten Gert F, Voss Miranda, Conradie Hofmeyer
Ceres District Hospital, P/Bag x54, Ceres 8635, Republic of South Africa
Division of Neonatology, Department of Paediatrics, University of Stellenbosch and Tygerberg Children's Hospital Tygerberg 7505, Republic of South Africa.
J Trop Pediatr. 2014 Oct;60(5):348-51. doi: 10.1093/tropej/fmu025. Epub 2014 May 29.
To assess the feasibility of using nasal continuous positive airway pressure (nCPAP) in neonates with respiratory distress syndrome at district hospital level by assessing in-hospital survival rates and the impact on transfer rates.
A prospective database was kept from 2008 to record the outcomes of neonates with mild to moderate respiratory distress treated with nCPAP at a South African rural district hospital. Transfer rates were compared for the two years before and after introduction of neonatal nCPAP using additional retrospective data from the Perinatal Problem Identification Programme (PPIP) for comparison. Outcomes for nCPAP neonates for the first 5 years after programme implementation are presented.
One hundred and twenty-eight babies were treated with nCPAP over the study period. Nine of 13 extremely low birth weight (<1000 g) babies died. Eighty-four (72.4%) of the babies weighing >1000 g were successfully treated, 16 (13.8%) were transferred after trial of nCPAP and 15 (12.9%) died in hospital. Most of the transferred babies and deaths had co-morbidities. There was a significant reduction in transfer rates of low birth weight babies from 21 to 7% in the first 2 years following the introduction of nCPAP.
nCPAP for neonatal respiratory distress at the district hospital is feasible, safe and offers the potential for significant cost savings.
通过评估院内生存率及对转运率的影响，评估在地区医院对患有呼吸窘迫综合征的新生儿使用鼻持续气道正压通气（nCPAP）的可行性。
建立一个前瞻性数据库，记录2008年以来在南非一家农村地区医院接受nCPAP治疗的轻至中度呼吸窘迫新生儿的治疗结果。利用围产期问题识别计划（PPIP）的额外回顾性数据，比较引入新生儿nCPAP前后两年的转运率。列出了项目实施后头5年nCPAP治疗新生儿的结果。
在研究期间，128名婴儿接受了nCPAP治疗。13名极低出生体重（<1000克）的婴儿中有9名死亡。1000克以上的婴儿中有84名（72.4%）成功接受治疗，16名（13.8%）在试用nCPAP后被转运，15名（12.9%）在医院死亡。大多数被转运的婴儿和死亡婴儿都有合并症。引入nCPAP后的头两年，低出生体重婴儿的转运率从21%显著降至7%。
在地区医院使用nCPAP治疗新生儿呼吸窘迫是可行、安全的，并且有可能大幅节省成本。
