Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Hospital, New Delhi, Delhi, India.
BMJ Open. 2020 Feb 28;10(2):e031128. doi: 10.1136/bmjopen-2019-031128.
To determine the availability of continuous positive airway pressure (CPAP) and to provide an overview of its use in neonatal units in government hospitals across India.
Cross-sectional cluster survey of a nationally representative sample of government hospitals from across India.
Availability of CPAP in neonatal units.
Proportion of hospitals where infrastructure and processes to provide CPAP are available. Case fatality rates and complication rates of neonates treated with CPAP.
Among 661 of 694 government hospitals with neonatal units that provided information on availability of CPAP for neonatal care, 68.3% of medical college hospitals (MCH) and 36.6% of district hospitals (DH) used CPAP in neonates. Assessment of a representative sample of 142 hospitals (79 MCH and 63 DH) showed that air-oxygen blenders were available in 50.7% (95% CI 41.4% to 60.9%) and staff trained in the use of CPAP were present in 56.0% (45.8% to 65.8%) of hospitals. The nurse to patient ratio was 7.3 (6.4 to 8.5) in MCH and 6.6 (5.5 to 8.3) in DH. Clinical guidelines were available in 31.0% of hospitals (22.2% to 41.4%). Upper oxygen saturation limits of above 94% were used in 72% (59.8% to 81.6%) of MCH and 59.3% (44.6% to 72.5%) of DH. Respiratory circuits were reused in 53.8% (42.3% to 63.9%) of hospitals. Case fatality rate for neonates treated with CPAP was 21.4% (16.6% to 26.2%); complication rates were 0.7% (0.2% to 1.2%) for pneumothorax, 7.4% (0.9% to 13.9%) for retinopathy and 1.4% (0.7% to 2.1%) for bronchopulmonary dysplasia.
CPAP is used in neonatal units across government hospitals in India. Neonates may be overexposed to oxygen as the means to detect and treat consequences of oxygen toxicity are insufficient. Neonates may also be exposed to nosocomial infections by reuse of disposables. Case fatality rates for neonates receiving CPAP are high. Complications might be under-reported. Support to infrastructure, training, guidelines implementation and staffing are needed to improve CPAP use.
确定持续气道正压通气（CPAP）的可用性，并概述其在印度政府医院新生儿病房中的使用情况。
对印度各地政府医院进行全国代表性样本的横断面聚类调查。
新生儿病房中 CPAP 的可用性。
基础设施和提供 CPAP 的流程可用的医院比例。接受 CPAP 治疗的新生儿的病死率和并发症发生率。
在提供 CPAP 用于新生儿护理的信息的 694 家政府医院中有 661 家，其中 68.3%的医学院附属医院（MCH）和 36.6%的地区医院（DH）在新生儿中使用 CPAP。对 142 家医院（79 家 MCH 和 63 家 DH）的代表性样本进行评估，结果显示，空气-氧气混合器的可用性为 50.7%（95%CI 41.4%至 60.9%），接受 CPAP 使用培训的工作人员的存在率为 56.0%（45.8%至 65.8%）。MCH 的护士与患者比例为 7.3（6.4 至 8.5），DH 为 6.6（5.5 至 8.3）。31.0%的医院（22.2%至 41.4%）有临床指南。MCH 中有 72%（59.8%至 81.6%）和 DH 中有 59.3%（44.6%至 72.5%）的上氧饱和度上限超过 94%。53.8%（42.3%至 63.9%）的医院重复使用呼吸回路。接受 CPAP 治疗的新生儿病死率为 21.4%（16.6%至 26.2%）；并发症发生率为气胸 0.7%（0.2%至 1.2%）、视网膜病变 7.4%（0.9%至 13.9%）和支气管肺发育不良 1.4%（0.7%至 2.1%）。
印度政府医院的新生儿病房都在使用 CPAP。由于缺乏检测和治疗氧中毒后果的手段，新生儿可能会过度暴露于氧气中。新生儿也可能因重复使用一次性用品而感染医院获得性感染。接受 CPAP 的新生儿病死率较高。并发症可能报告不足。需要提供基础设施、培训、指南实施和人员配备方面的支持，以改善 CPAP 的使用。
