Availability and use of continuous positive airway pressure (CPAP) for neonatal care in public health facilities in India: a cross-sectional cluster survey

Abstract

Objectives To determine the availability of continuous positive airway pressure (CPAP) and to provide an overview of its use in neonatal units in government hospitals across India. setting Cross-sectional cluster survey of a nationally representative sample of government hospitals from across India. Primary outcomes Availability of CPAP in neonatal units. secondary outcomes Proportion of hospitals where infrastructure and processes to provide CPAP are available. Case fatality rates and complication rates of neonates treated with CPAP. results Among 661 of 694 government hospitals with neonatal units that provided information on availability of CPAP for neonatal care, 68.3% of medical college hospitals (MCH) and 36.6% of district hospitals (DH) used CPAP in neonates. Assessment of a representative sample of 142 hospitals (79 MCH and 63 DH) showed that air-oxygen blenders were available in 50.7% (95% CI 41.4% to 60.9%) and staff trained in the use of CPAP were present in 56.0% (45.8% to 65.8%) of hospitals. The nurse to patient ratio was 7.3 (6.4 to 8.5) in MCH and 6.6 (5.5 to 8.3) in DH. Clinical guidelines were available in 31.0% of hospitals (22.2% to 41.4%). Upper oxygen saturation limits of above 94% were used in 72% (59.8% to 81.6%) of MCH and 59.3% (44.6% to 72.5%) of DH. Respiratory circuits were reused in 53.8% (42.3% to 63.9%) of hospitals. Case fatality rate for neonates treated with CPAP was 21.4% (16.6% to 26.2%); complication rates were 0.7% (0.2% to 1.2%) for pneumothorax, 7.4% (0.9% to 13.9%) for retinopathy and 1.4% (0.7% to 2.1%) for bronchopulmonary dysplasia.Conclusions CPAP is used in neonatal units across government hospitals in India. Neonates may be overexposed to oxygen as the means to detect and treat consequences of oxygen toxicity are insufficient. Neonates may also be exposed to nosocomial infections by reuse of disposables. Case fatality rates for neonates receiving CPAP are high. Complications might be under-reported. Support to infrastructure, training, guidelines implementation and staffing are needed to improve CPAP use.

Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review

“…Twenty-seven studies examined CPAP-related complications and comfort. The most common reported complications were related to nasal irritation [ 36 , 37 ], nasal lesions [ 38 – 40 ] and abrasions [ 41 ] as well as nasal trauma or injuries such as nasal bleeds or hyperemia [ 40 , 42 , 43 ], and nasal septal necrosis [ 37 , 44 – 46 ]. Low patient birthweights, low gestational ages [ 46 , 47 ], and longer treatment times [ 40 , 48 , 49 ] were associated with increased nasal trauma.…”

Management of neonates with respiratory distress syndrome in resource-limited settings

“… 30 , 32 Initiating nCPAP is an easy process; however, for optimal effectiveness, it requires continuous usage for hours or days, involving a consistent supply of electricity and medical gases, along with ongoing clinical monitoring. 33 Nasal continuous positive airway pressure stands out as a promising and reliable technology for delivering respiratory support to neonates facing respiratory distress. 29 , 31 Its potential for extensive adoption, especially in addressing respiratory distress in developing nations, is emphasised by its lower initial costs.…”

Trends in the use of non-invasive respiratory support for term infants in tertiary neonatal units in Australia and New Zealand

“…Modes of non-invasive respiratory support, such as continuous positive airway pressure (CPAP) and nasal high flow, are commonly used to treat newborn infants with respiratory distress 1–4. Most evidence for non-invasive respiratory support use comes from trials performed in tertiary neonatal intensive care units (NICUs).…”