Aims To assess feasibility of introducing bubble CPAP into three neonatal units in a low-income country. We determined if, by regular training visits by UK health professionals, bubble CPAP could be established, and its short-term complications and neonatal outcome. Method A bubble CPAP system was designed using an air compressor, with additional cylinder oxygen. Gases are warmed and humidified, pass via an oxygen analyser to the baby and delivered with nasal prongs or mask. Expiratory circuit contains a water pressure manometer. Circuits are reused, after cleaning. Oxygen saturation monitors were provided for each machine. Eight CPAP machines were provided, six to the university teaching hospitals and two to a large provincial hospital. Regular intensive staff training was provided. Data on babies receiving CPAP was recorded prospectively. Results Between March 2012-September 2013 a total of 482 staff training days were provided; 63 days by 3 neonatologists (6 visits), 172 days by neonatal nurses (18 visits), 17 days by a medical technician (3 visits), 230 days by two paediatric specialist registrars. All were volunteers. 319 babies received CPAP. There were no equipment failures or malfunctions. It was commenced on the first day of birth in 71% of babies, for a median of 2 days. Although surfactant therapy is unavailable, only 16% needed >40% oxygen and none were transferred for ventilator care. No babies developed a pneumothorax, however 13% experienced significant nasal trauma. Retinopathy of prematurity screening was not available. In the university hospitals, 45 babies had a birthweight <1 kg (mortality 67%), 139 birthweight 1.0 – 2.49 kg (mortality 37%), and 21 birthweight >2.5 kg (mortality 11%). This contrasted with the provincial hospital where only 8 babies had a birthweight <1 kg (mortality 43%), 56 birthweight 1.0 – 2.49 kg (mortality 8%) and 50 birthweight >2.5 kg (mortality 10%). Conclusion Bubble CPAP was established in this low resource country. It provided adequate respiratory support for most babies currently admitted for neonatal care. However, in spite of intensive staff training, nasal trauma was problematic.
Aim Training and knowledge of specialist neonatal care is frequently limited in low resource countries. We aimed to assess if the introduction of a standardised medical record could improve documentation, assisting nurses and doctors in their approach to daily care of the sick newborn. Method We gained national approval for the implementation of a novel neonatal medical record. The booklet was divided into sections for admission history, assessment and management, daily ward rounds, growth, prescriptions, investigation results, nursing documentation and discharge information. It was introduced in October 2013, with staff training provided for three weeks. An audit of documentation completeness was performed comparing 30 notes before and one month after the booklet was introduced. Results Completeness of documentation improved for 7 sections (see Table 1). With the new booklet 57% patients had an entry for every day of admission, compared to 23% previously. Growth charts, not previously available, were completed for 50% at admission. Investigation results and discharge planning had not improved. Use by nurses was inconsistent, with many defaulting to the old note format. Abstract G223(P) Table 1Completeness of documentation by section: old notes versus new booklet Section Old notes: New booklet: Maternal history 35% 75% Birth details 44% 75% Admission assessment of baby 53% 78% Admission plan 51% 71% Ward round day 1 21% 73% Ward round subsequent days 32% 75% Parental communication 7% 10% Prescriptions 57% 82% Entries dated and signed 71% 90% Investigations 47% 41% Discharge information 24% 16% Conclusion A standardised neonatal medical record improved documentation by doctors. Nursing documentation was still lacking indicating further teaching and minor amendments to fit local agendas may be required. If improved neonatal outcomes (reduced mortality) are to be observed, full co-operation of staff is required to follow and document daily progress. This is a great quality improvement initiative for a low resource setting, and further assessment is needed after long term use of the document.
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