Mbale Campus, Busitema University, P.O.Box 1460, Mbale, Uganda.
Varimetrics Group Limited, P. O Box 2190, Mbale, Uganda.
BMC Pediatr. 2019 Sep 4;19(1):311. 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.
早产儿并发症是导致五岁以下儿童死亡的主要原因。这些早产儿死亡的主要原因是呼吸窘迫综合征（RDS）。在低收入国家（LICs），RDS 的治疗选择有限。由于其简单性和可负担性，低成本的气泡持续气道正压通气（bCPAP）设备已被引入 LIC 的新生儿病房，用于治疗 RDS。这项研究是来自 LIC 的第一项观察性研究，旨在比较 RDS 治疗前后极低出生体重（VLBW）新生儿的结局。
这是一项对姆巴莱地区转诊医院新生儿病房（MRRH-NNU）的 VLBW 新生儿（体重<1500g）的回顾性研究，MRRH-NNU 是乌干达东部的一家政府医院。它旨在衡量 RDS 治疗前后两个不同研究期间 VLBW 新生儿的结局：MRRH-NNU 开放至 bCPAP 引入期间的 14 个月（前 bCPAP 期）和 bCPAP 引入后的 18 个月（后 bCPAP 期）。在引入 bCPAP 后，当临床上需要且设备可用时，将其应用于患有 RDS 的早产儿。比较 bCPAP 引入前后所有<1500g 新生儿的临床特征和结局。
获得了 377 名<1500g VLBW 新生儿的入院记录。158 名在前 bCPAP 期入院，219 名在后 bCPAP 期入院。在前 bCPAP 期的死亡率为 39.2%（62/158），在后 bCPAP 期为 26.5%（58/219，P=0.012）。总体而言，死亡率降低了 44%（OR 0.56，95%CI 0.36-0.86，P=0.01）。两组之间在出生体重、性别、呼吸窘迫或呼吸暂停的体征存在方面无差异。
专门的、资源适宜的新生儿护理，适当应对 LIC 提供医疗保健的挑战，有可能降低新生儿死亡。在乌干达东部的新生儿病房中，使用低成本的 bCPAP 治疗 RDS 可显著提高 VLBW 新生儿的存活率。由于 RDS 是新生儿死亡的主要原因之一，因此这种相对简单且负担得起的干预措施可能会对全球新生儿死亡率产生巨大影响。
