Neonatal CPAP for Respiratory Distress Across Malawi and Mortality
Abstract
OBJECTIVES: Our aim in this observational study was to monitor continuous positive airway pressure (CPAP) usage and outcomes in newborn wards at 26 government hospitals in Malawi after the introduction of CPAP as part of a quality-improvement initiative. CPAP was implemented in 3 phases from 2013 through 2015. METHODS: Survival to discharge was analyzed for neonates treated with nasal oxygen and/or CPAP with admission weights of 1 to 2.49 kg at 24 government hospitals with transfer rates <15%. This analysis includes neonates admitted with respiratory illness for 5.5 months before (621 neonates) and 15 months immediately after CPAP implementation (1836 neonates). A follow-up data analysis was completed for neonates treated with CPAP at all hospitals during an additional 11 months (194 neonates). RESULTS: On implementation of CPAP, survival to discharge improved for all neonates admitted with respiratory distress (48.6% vs 54.5%; P = .012) and for those diagnosed with respiratory distress syndrome (39.8% vs 48.3%; P = .042). There were no significant differences in outcomes for neonates treated with CPAP during the implementation and follow-up periods. Hypothermia on admission was pervasive and associated with poor outcomes. Neonates with normal mean temperatures during CPAP treatment experienced the highest survival rates (65.7% for all neonates treated with CPAP and 60.0% for those diagnosed with respiratory distress syndrome). CONCLUSIONS: A nurse-led CPAP service can improve outcomes for neonates in respiratory distress in low-resource settings. However, the results show that real-world improvements in survival may be limited without access to comprehensive newborn care, especially for small and sick infants.
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Pumani was initially trialed at QECH in Malawi in 2012 and scaled from 2012 to 2017 to all 28 central and district hospitals and eight mission hospitals.
“The Pumani was initially trialed at Queen Elizabeth Central Hospital (QECH) in Malawi in 2012 [5] and from 2012 to 2017, scaled to all 28 central and district hospitals across the country, followed by eight mission hospitals.”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [13]
Limited healthcare infrastructure, including lack of equipment and skilled personnel, may compromise effective use of bubble CPAP in neonatal nurseries.
“Limited healthcare infrastructure, including lack of equipment and skilled personnel, may compromise effective use of bubble CPAP in neonatal nurseries [6,12,13,15].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [13]
Bubble CPAP is a simple and relatively inexpensive form of CPAP that may be safe and cost-effective for delivering CPAP and reducing neonatal mortality in LMICs.
“Bubble CPAP is a simple and relatively inexpensive form of CPAP [8,11].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [13]
Along with device installation, there is training and mentorship of nurses, clinicians and technicians, regular supply of consumables, and quarterly supportive supervisory visits led by Ministry of Health officials.
“Along with the installation of the devices, there is training and mentorship of nurses, clinicians and technicians, a regular supply of consumable items needed for its use and quarterly supportive supervisory visits led by Ministry of Health officials [13].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [13]
Previous work in sub-Saharan Africa largely examined barriers and enablers as issues that emerged from efficacy and safety studies.
“Previous work in sub-Saharan Africa largely examined barriers and enablers as issues that emerged from efficacy and safety studies [5,13,21,22].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [13]
A guided mentorship by experienced clinical staff has been introduced in Malawi district hospitals to help with identifying and treating eligible newborns.
“Currently, a guided mentorship by experienced clinical staff has been introduced in Malawi district hospitals in order to help with identifying and treating eligible newborns [13,26].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [13]
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References 34 · Cited by 39
- Authors
- Carns, J., Kawaza, K., Liaghati-Mobarhan, S., Asibon, A., Quinn, M. K., Chalira, A., Lufesi, N., Molyneux, E., Oden, M., & Richards-Kortum, R.
- Affiliations
- Rice University (US)
- Queen Elizabeth Central Hospital (MW)
- Ministry of Health (MW)
- aRice 360 Institute for Global Health Technology, Houston, Texas;
- Corresponding author
- Richards-Kortum, Rebecca
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2019-10-01
- Volume
- 144
- Issue
- 4
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2973354216
- Cited by
- 39
- References
- 34
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 11 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 6 · 2019: 1
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Rice Research Repository (Rice University) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- continuous positive airway pressure, neonatal respiratory distress, neonatal survival, hypothermia, quality improvement, resource-limited settings, respiratory distress syndrome, neonatal mortality, Malawi
- MeSH terms
- Body Temperature, Hospitals, Public, Humans, Hypothermia, Infant, Newborn, Infant, Premature, Malawi, Oxygen Inhalation Therapy, Respiratory Distress Syndrome, Newborn, Survival Rate, Treatment Outcome, Continuous Positive Airway Pressure, Kaplan-Meier Estimate, Quality Improvement
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