Optimal Ventilation and Surfactant Therapy in Very-Low-Birth-Weight Infants in Resource-Restricted Regions

Abstract

In resource-restricted regions, respiratory distress syndrome (RDS) data are often underreported, making the determination of effective interventions and their outcome difficult. The combination of oxygen, nasal continuous positive airway pressure (CPAP) and surfactant therapy has the potential to prevent 42% of RDS-related deaths in sub-Saharan Africa, despite the financial implications. This article provides a brief overview on the status of RDS management, mainly nasal CPAP and surfactant therapy in very-low-birth-weight infants, in resource-restricted regions of sub-Saharan Africa. Data from the public health sector, as compared to the private health sector, of the Western Cape province, South Africa, are used to illustrate what RDS management strategies are able to accomplish in a resource-restricted region. Upscaling of all components (antenatal care, antenatal corticosteroids, prevention of hypothermia and RDS management strategies) are required to decrease premature infant mortality rates in resource-restricted areas.

Prospective cohort study of mortality in very low birthweight infants in a single centre in the Eastern Cape province, South Africa

“…4 The data support that although South Africa is considered an upper-middle-income country by the World Bank, survival of VLBW varies greatly dependent on resources. 22 Consistent with other studies examining the causes of mortality in VLBW babies, birth weight and low gestational age were predictors of neonatal mortality in our study population. 18 23 26 35 Complications of prematurity, such as the development of HMD and the associated need for surfactant replacement therapy with ventilation was associated with a significantly increased risk of mortality, as reported in previous research.…”

“…Thus, the overall mortality rate is higher than the reported average of approximately 25% in major cities in South Africa, 24 36 37 and much higher than in the hospitals with much greater resources from the Western Cape province. 22 It is also much higher than in most hospitals in high-income countries where mortality rates for VLBW infants are as low as 9.5%-17.2%. 14 17-19 38 39 The high mortality in our setting is most likely due to the scarcity of skilled healthcare workers, limited infrastructures, as well as a patient overloaded, resource-restricted system, as described.…”

“…22 The team found a significant difference with a survival rate of 84.4% and 70.4%, respectively. 22 Kalimba and Ballot 23 studied the survival rate of extremely low birth weight (ELBW) babies (babies weighing less than 1000 g at birth) born between 2006 and 2010 in Johannesburg and found that only 25.6% of babies born with a birth weight of less than 900 g survived their hospital stay, with birth weight and gestational age being the strongest predictors for survival. A newer retrospective cross-sectional South African study found an overall survival rate in VLBW babies (500-1499 g) of 75.7%.…”

The use of data in resource limited settings to improve quality of care

“…In South Africa, better financed private neonatal units partnered with government-funded units offering expertise, financial, and administrative support which has allowed many public government units to join VON and participate in the database for the high risk neonatal intensive care unit population of very low birth weight infants as well as QI education. Some South African units have been able to utilize the database to improve outcomes and produce novel valuable research [37][38][39]. The partnership has been mutually beneficial as neonatologists in the public sector have been able to assist with both data interpretation and improvement in the private hospital groups.…”

Sharing Progress in Neonatology (SPIN): Old Favorites – Bronchopulmonary Dysplasia, Patent Ductus Arteriosus, and Necrotizing Enterocolitis plus Some Global Neonatology and the Future of Clinical Trials

“…Johan Smith and his colleagues from Cape Town continue the theme of providing neonatal care in the less developed world with their review entitled “Optimal ventilation and surfactant in very low birth weight infants in resource-limited regions” [11]. They report that data on respiratory distress syndrome (RDS) are often under-reported in resource-restricted regions making determination of the effectiveness of interventions and their outcome difficult [12].…”