Ekhaguere Osayame A, Okonkwo Ikechukwu R, Batra Maneesh, Hedstrom Anna B
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.
Department of Pediatrics, University of Benin Teaching Hospital, Benin City, Nigeria.
Front Pediatr. 2022 Jul 29;10:961509. doi: 10.3389/fped.2022.961509. eCollection 2022.
The complications of prematurity are the leading cause of neonatal mortality worldwide, with the highest burden in the low- and middle-income countries of South Asia and Sub-Saharan Africa. A major driver of this prematurity-related neonatal mortality is respiratory distress syndrome due to immature lungs and surfactant deficiency. The World Health Organization's Every Newborn Action Plan target is for 80% of districts to have resources available to care for small and sick newborns, including premature infants with respiratory distress syndrome. Evidence-based interventions for respiratory distress syndrome management exist for the peripartum, delivery and neonatal intensive care period- however, cost, resources, and infrastructure limit their availability in low- and middle-income countries. Existing research and implementation gaps include the safe use of antenatal corticosteroid in non-tertiary settings, establishing emergency transportation services from low to high level care facilities, optimized delivery room resuscitation, provision of affordable caffeine and surfactant as well as implementing non-traditional methods of surfactant administration. There is also a need to optimize affordable continuous positive airway pressure devices able to blend oxygen, provide humidity and deliver reliable pressure. If the high prematurity-related neonatal mortality experienced in low- and middle-income countries is to be mitigated, a concerted effort by researchers, implementers and policy developers is required to address these key modalities.
早产并发症是全球新生儿死亡的主要原因，在南亚和撒哈拉以南非洲的低收入和中等收入国家负担最重。这种与早产相关的新生儿死亡的一个主要驱动因素是由于肺部不成熟和表面活性剂缺乏导致的呼吸窘迫综合征。世界卫生组织的《每一名新生儿行动计划》目标是80%的地区具备照顾体弱患病新生儿的资源，包括患有呼吸窘迫综合征的早产儿。围产期、分娩期和新生儿重症监护期存在基于证据的呼吸窘迫综合征管理干预措施——然而，成本、资源和基础设施限制了这些措施在低收入和中等收入国家的可及性。现有的研究和实施差距包括在非三级医疗机构安全使用产前皮质类固醇、建立从低级到高级护理机构的紧急运输服务、优化产房复苏、提供价格可承受的咖啡因和表面活性剂以及实施非传统的表面活性剂给药方法。还需要优化价格可承受的持续气道正压通气设备，使其能够混合氧气、提供湿度并输送可靠的压力。如果要降低低收入和中等收入国家与早产相关的高新生儿死亡率，研究人员、实施者和政策制定者需要共同努力解决这些关键问题。
