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The Care of Preterm and Term Newborns with Respiratory Conditions: A Systematic Synthesis of Evidence from Low- and
Georgia Dominguez1, Oviya Muralidharan1, Rachel Lee Him1
1Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Bubble CPAP and prophylactic CPAP show promise in reducing treatment failure for neonatal respiratory distress syndrome (RDS). However, the efficacy of other interventions for neonatal respiratory conditions in low- and middle-income countries (LMICs) requires further investigation.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Global Health
Background:
- Neonatal respiratory conditions are primary causes of mortality and morbidity in newborns.
- This review focuses on 11 management interventions for conditions including respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), and bronchopulmonary dysplasia (BPD).
- The study specifically examines interventions within low- and middle-income countries (LMICs).
Purpose of the Study:
- To evaluate the effectiveness of 11 management interventions for common neonatal respiratory conditions.
- To assess the impact of these interventions in low- and middle-income countries (LMICs).
- To identify evidence-based practices for neonatal respiratory care in resource-limited settings.
Main Methods:
- Conducted systematic reviews by updating existing literature and re-analyzing studies from LMICs.
- Included a total of 50 studies across four review updates and seven review re-analyses.
- Methodology involved rigorous systematic review processes between October 2022 and February 2023.
Main Results:
- Bubble CPAP (RR 0.74) and prophylactic CPAP (RR 0.39) significantly reduced treatment failure for RDS compared to alternative ventilation or supportive care.
- Postnatal corticosteroids demonstrated a reduction in bronchopulmonary dysplasia (BPD) (RR 0.56) as measured by oxygen requirement at 36 weeks' postmenstrual age.
- No significant outcomes were found for other interventions across the evaluated conditions.
Conclusions:
- Prophylactic and bubble CPAP appear beneficial in reducing treatment failure for neonatal respiratory distress syndrome.
- The safety and efficacy of other management strategies for RDS, AOP, BPD, MAS, and TTN remain uncertain due to limited LMIC data.
- Future research should prioritize adequately powered trials in underrepresented LMIC regions, focusing on long-term outcomes and cost-effectiveness.
Introduction:
Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs).
Methods:
Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses.
Results:
Findings indicate that bubble CPAP (RR 0.74, 95% CI: 0.58-0.96) and prophylactic CPAP (RR 0.39, 95% CI: 0.26-0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks' postmenstrual age (RR 0.56, 95% CI: 0.41-0.77). All other outcomes were found to be non-significant across remaining interventions.
Conclusions:
Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness.
Introduction:
Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs).
Methods:
Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses.
Results:
Findings indicate that bubble CPAP (RR 0.74, 95% CI: 0.58-0.96) and prophylactic CPAP (RR 0.39, 95% CI: 0.26-0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks' postmenstrual age (RR 0.56, 95% CI: 0.41-0.77). All other outcomes were found to be non-significant across remaining interventions.
Conclusions:
Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness.
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