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Respiratory Interventions for Preterm Infants in LMICs: A Prospective Study From Cape Town, South Africa

Ilse Lategan1, Caris Price1, Natasha Raygaan Rhoda1

  • 1Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.

Frontiers in Global Women'S Health
|April 25, 2022
PubMed

Insights

Access to respiratory support like CPAP significantly reduces preterm infant mortality in low-resource settings. Improving CPAP availability is crucial for saving newborn lives in these areas.

Area of Science:

  • Neonatal Medicine
  • Global Health
  • Public Health

Background:

  • Preterm birth complications cause 1 million infant deaths annually, primarily in low- and middle-income countries (LMICs).
  • Essential respiratory interventions like continuous positive airway pressure (CPAP) and surfactant are often unavailable in low-resource settings.
  • This study investigates respiratory support needs and outcomes for preterm infants in a resource-limited environment.

Purpose of the Study:

  • To report respiratory support utilization and outcomes for preterm infants in a low-resource setting.
  • To estimate the impact of lacking access to respiratory interventions on neonatal mortality.
  • To identify key interventions for improving preterm infant survival in LMICs.

Main Methods:

  • A six-month prospective observational study of preterm infants (<1,801 g) admitted to hospitals in Cape Town, South Africa.
  • Analysis of respiratory intervention use, including CPAP, surfactant, and mechanical ventilation.
  • Extrapolation of data to model potential outcomes without these interventions.

Main Results:

  • 552 preterm infants were studied; 54.3% received CPAP, 18.1% received surfactant, and 19% received mechanical ventilation.
  • Overall mortality was 14.1%. Hypothetically removing CPAP, surfactant, and ventilation could increase mortality to 42.5% (157 additional deaths).
  • Lack of CPAP access had the largest impact, potentially causing 109 additional deaths.

Conclusions:

  • Access to respiratory interventions significantly impacts preterm infant outcomes in LMICs.
  • Continuous positive airway pressure (CPAP) demonstrates the greatest influence on reducing neonatal mortality.
  • Expanding CPAP coverage should be prioritized to save newborn lives in resource-limited areas.
Abstract

Keywords:
continuous positive airway pressure (CPAP)interventionsinvasive mechanical ventilationlow-and-middle income countries (LMIC)preterm (birth)respiratoryrespiratory distress syndrome (RDS)surfactant

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