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

Abstract

BackgroundPreterm birth is a global public health issue and complications of preterm birth result in the death of approximately 1 million infants each year, 99% of which are in low-and-middle income countries (LMIC). Although respiratory interventions such as continuous positive airway pressure (CPAP) and surfactant have been shown to improve the outcomes of preterm infants with respiratory distress, they are not readily available in low-resourced areas. The aim of this study was to report the respiratory support needs and outcomes of preterm infants in a low-resourced setting, and to estimate the impact of a lack of access to these interventions on neonatal mortality.MethodsWe conducted a six-month prospective observational study on preterm infants <1,801 g admitted at Groote Schuur Hospital and Mowbray Maternity Hospital neonatal units in Cape Town, South Africa. We extrapolated results from the study to model the potential outcomes of these infants in the absence of these interventions.ResultsFive hundred and fifty-two infants (552) <1,801 g were admitted. Three hundred (54.3%) infants received CPAP, and this was the initial respiratory intervention for most cases of respiratory distress syndrome. Surfactant was given to 100 (18.1%) infants and a less invasive method was the most common method of administration. Invasive mechanical ventilation was offered to 105 (19%) infants, of which only 57 (54.2%) survived until discharge from hospital. The overall mortality of the cohort was 14.1% and the hypothetical removal of invasive mechanical ventilation, surfactant and CPAP would result in an additional 157 deaths and increase the overall mortality to 42.5%. A lack of CPAP availability would have the largest impact on mortality and result in the largest number of additional deaths (109).ConclusionThis study highlights the effect that access to key respiratory interventions has on preterm outcomes in LMICs. CPAP has the largest impact on neonatal mortality and improving its coverage should be the primary goal for low-resourced areas to save newborn lives.

Factors influencing survival and short-term outcomes of very low birth weight infants in a tertiary hospital in Johannesburg

“…When it comes to antenatal steroids, the coverage in this study had improved slightly (from 39.1 to 48%) compared to 2013 (12). However, this remains poor compared to other South African studies (15,16,22). Despite this improvement the goal should be even higher since antenatal steroids have an effect on RDS (hence the amount of respiratory support required for patients), as well as the rates of NEC and IVH (23).…”

“…Despite this improvement the goal should be even higher since antenatal steroids have an effect on RDS (hence the amount of respiratory support required for patients), as well as the rates of NEC and IVH (23). Lategan et al found that exposure to any antenatal steroids was associated with a nearly three-quarter reduction in mortality in their cohort of preterm infants ≤1,800 (15). Concerted efforts need to be made to further improve the coverage of antenatal steroids.…”

Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations

“… 84 They are therefore currently unavailable in many resource-limited settings, which is estimated to have a significant impact on neonatal mortality in these populations. 85 …”

Outcomes of Premature Neonates Less Than 35 Weeks in Low Income Countries, Case of Democratic Republic of Congo

“…The main causes of early death during the neonatal age are serious complications associated with prematurity [1]. In almost every African country, mortality is higher in newborns under 32 weeks [1,4,5]. Democratic Republic of Congo (D.R.C.)…”

“…Taking into account the recommendations of the World Health Organization (WHO) [1], interventions such as antenatal corticosteroid therapy (ACS), the use of CPAP and surfactant are among the most effective means for improving the management of premature babies [1,5,9].…”