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Neonatal CPAP for Respiratory Distress Across Malawi and Mortality

Jennifer Carns^1,2, Kondwani Kawaza³, Sara Liaghati-Mobarhan¹

¹Rice 360 Institute for Global Health Technology, Houston, Texas.

|September 22, 2019

Insights

Continuous positive airway pressure (CPAP) improved survival for neonates with respiratory distress in Malawi. However, comprehensive newborn care is crucial for optimal outcomes, especially for vulnerable infants.

Area of Science:

Neonatal Medicine
Public Health
Quality Improvement Initiatives

Background:

Continuous positive airway pressure (CPAP) is a vital intervention for neonatal respiratory distress.
Implementing CPAP in low-resource settings presents unique challenges and opportunities for improving infant survival rates.

Purpose of the Study:

To evaluate the impact of a nurse-led continuous positive airway pressure (CPAP) program on neonatal outcomes in Malawian government hospitals.
To assess CPAP usage and survival rates among neonates with respiratory illness following its introduction as a quality improvement initiative.

Main Methods:

Observational study analyzing survival to discharge for neonates (1-2.49 kg) treated with CPAP across 24 government hospitals in Malawi.
Data collected over 5.5 months pre-CPAP implementation and 15 months post-implementation, with an additional 11-month follow-up.

Main Results:

CPAP implementation significantly improved survival to discharge for neonates with respiratory distress (48.6% to 54.5%) and respiratory distress syndrome (39.8% to 48.3%).
Hypothermia on admission was linked to poorer outcomes; neonates with normal temperatures during CPAP treatment had the highest survival rates (up to 65.7%).

Conclusions:

A nurse-led CPAP service can enhance survival for neonates with respiratory distress in resource-limited environments.
Sustained improvements in survival necessitate integrated newborn care, particularly for small and critically ill infants.

Read full analysis

Abstract

Objectives:

Our aim in this observational study was to monitor continuous positive airway pressure (CPAP) usage and outcomes in newborn wards at 26 government hospitals in Malawi after the introduction of CPAP as part of a quality-improvement initiative. CPAP was implemented in 3 phases from 2013 through 2015.

Methods:

Survival to discharge was analyzed for neonates treated with nasal oxygen and/or CPAP with admission weights of 1 to 2.49 kg at 24 government hospitals with transfer rates <15%. This analysis includes neonates admitted with respiratory illness for 5.5 months before (621 neonates) and 15 months immediately after CPAP implementation (1836 neonates). A follow-up data analysis was completed for neonates treated with CPAP at all hospitals during an additional 11 months (194 neonates).

Results:

On implementation of CPAP, survival to discharge improved for all neonates admitted with respiratory distress (48.6% vs 54.5%; P = .012) and for those diagnosed with respiratory distress syndrome (39.8% vs 48.3%; P = .042). There were no significant differences in outcomes for neonates treated with CPAP during the implementation and follow-up periods. Hypothermia on admission was pervasive and associated with poor outcomes. Neonates with normal mean temperatures during CPAP treatment experienced the highest survival rates (65.7% for all neonates treated with CPAP and 60.0% for those diagnosed with respiratory distress syndrome).

Conclusions:

A nurse-led CPAP service can improve outcomes for neonates in respiratory distress in low-resource settings. However, the results show that real-world improvements in survival may be limited without access to comprehensive newborn care, especially for small and sick infants.

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