Implementation of Bubble CPAP in a Rural Ugandan Neonatal ICU

Respiratory distress is a leading cause of neonatal death in low-income and middle-income countries. CPAP is a simple and effective respiratory support modality used to support neonates with respiratory failure and can be used in low-income and middle-income countries. The goal of this study was to...

Full description

Saved in:

Bibliographic Details
Published in:	Respiratory care Vol. 60; no. 3; pp. 437 - 445
Main Authors:	McAdams, Ryan M, Hedstrom, Anna B, DiBlasi, Robert M, Mant, Jill E, Nyonyintono, James, Otai, Christine D, Lester, Debbie A, Batra, Maneesh
Format:	Journal Article
Language:	English
Published:	United States Daedalus Enterprises, Inc 01-03-2015
Subjects:	Care and treatment Continuous positive airway pressure Continuous Positive Airway Pressure - instrumentation Equipment Design Female Humans Infant, Newborn Intensive Care Units, Neonatal - supply & distribution Male Methods Neonatal intensive care Respiratory distress syndrome Respiratory Distress Syndrome, Newborn - therapy Retrospective Studies Socioeconomic Factors Uganda Uganda respiratory severity score neonate low-income and middle-income countries respiratory distress
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Respiratory distress is a leading cause of neonatal death in low-income and middle-income countries. CPAP is a simple and effective respiratory support modality used to support neonates with respiratory failure and can be used in low-income and middle-income countries. The goal of this study was to describe implementation of the Silverman-Andersen respiratory severity score (RSS) and bubble CPAP in a rural Ugandan neonatal NICU. We sought to determine whether physicians and nurses in a low-income/middle-income setting would assign similar RSS in neonates after an initial training period and over time. We describe the process of training NICU staff to use the RSS to assist in decision making regarding initiation, titration, and termination of bubble CPAP for neonates with respiratory distress. Characteristics of all neonates with respiratory failure treated with bubble CPAP in a rural Ugandan NICU from January to June 2012 are provided. Nineteen NICU staff members (4 doctors and 15 nurses) received RSS training. After this, the Spearman correlation coefficient for respiratory severity scoring between doctor and nurse was 0.73. Twenty-one infants, all < 3 d of age, were treated with CPAP, with 17 infants starting on the day of birth. The majority of infants (16/21, 76%) were preterm, 10 (48%) were <1,500 g (birthweight), and 13 (62%) were outborn. The most common diagnoses were respiratory distress syndrome (16/21, 76%) and birth asphyxia (5/21, 24%). The average RSS was 7.4 ± 1.3 before starting CPAP, 5.2 ± 2.3 after 2-4 h of CPAP, 4.9 ± 2.7 after 12-24 h of CPAP, and 3.5 ± 1.9 before CPAP was discontinued. Duration of treatment with CPAP averaged 79 ± 43 h. Approximately half (11/21, 52%) of infants treated with CPAP survived to discharge. Implementing bubble CPAP in a low-income/middle-income setting is feasible. The RSS may be a simple and useful tool for monitoring a neonate's respiratory status and for guiding CPAP management.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0020-1324 1943-3654
DOI:	10.4187/respcare.03438