Oxygen management among infants in neonatal units in sub-Saharan Africa: a cross-sectional survey

Herrod, Scott K; Stevenson, Alexander; Vaucher, Yvonne E.; Lambert, Scott R.; Isenberg, Sherwin J.; Yap, Vivien; Ezeaka, Chinyere; Carlo, Waldemar A.

doi:10.1038/s41372-021-01040-7

Cited by 14 publications

(11 citation statements)

References 24 publications

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“…However, should they survive until they are more mature, they may become eligible to receive CPAP or MV later. Unlike many units in LMICs, continuous saturation monitoring and oxygen blenders are available for each infant as well as access to retinopathy of prematurity (ROP) screening, all of which help to reduce the incidence of ROP ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

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

Lategan

Price

Rhoda

et al. 2022

Front. Glob. Womens Health

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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.

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Section: Methodsmentioning

confidence: 99%

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

Lategan

Price

Rhoda

et al. 2022

Front. Glob. Womens Health

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“…In these regions, the acquisition of blenders for being used in health units comes up against financial issues, given the high price of equipment, which is usually important in developed countries that have the domain of technologies [ 66 ]. An example is presented by [ 70 ], which shows that only 1% of health facilities in Sub-Saharan African countries have air–oxygen blenders, so it is common to administer oxygen without precise control, being monitored only intermittently and limitedly.…”

Section: Main Technologies In Air–oxygen Blendersmentioning

confidence: 99%

Air–Oxygen Blenders for Mechanical Ventilators: A Literature Review

Soares

Almeida

Menezes

et al. 2022

Sensors

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Respiratory diseases are one of the most common causes of death in the world and this recent COVID-19 pandemic is a key example. Problems such as infections, in general, affect many people and depending on the form of transmission they can spread throughout the world and weaken thousands of people. Two examples are severe acute respiratory syndrome and the recent coronavirus disease. These diseases have mild and severe forms, in which patients gravely affected need ventilatory support. The equipment that serves as a basis for operation of the mechanical ventilator is the air–oxygen blender, responsible for carrying out the air–oxygen mixture in the proper proportions ensuring constant supply. New blender models are described in the literature together with applications of control techniques, such as Proportional, Integrative and Derivative (PID); Fuzzy; and Adaptive. The results obtained from the literature show a significant improvement in patient care when using automatic controls instead of manual adjustment, increasing the safety and accuracy of the treatment. This study presents a deep review of the state of the art in air–oxygen benders, identifies the most relevant characteristics, performs a comparison study considering the most relevant available solutions, and identifies open research directions in the topic.

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“…The neonatal death rate in low-and middle-income countries, particularly in sub-Saharan Africa and South Asia, is more than nine times that of high income countries, with perinatal asphyxia and premature birth being the major contributors [42,43]. For the preterm infant born in a low-resource setting, respiratory distress syndrome and its complications remain a major threat to life, with high patient-to-nurse ratios as well as shortages of compressed air and oxygen sources, gas blenders, and pulse oximetry equipment contributing to the risk [44].…”

Section: Application Of Automated Oxygen Control In Low Resource Sett...mentioning

confidence: 99%

Automation of oxygen titration in preterm infants: Current evidence and future challenges

Dargaville

Marshall

McLeod

et al. 2021

Early Human Development

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Oxygen management among infants in neonatal units in sub-Saharan Africa: a cross-sectional survey

Cited by 14 publications

References 24 publications

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

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

Air–Oxygen Blenders for Mechanical Ventilators: A Literature Review

Automation of oxygen titration in preterm infants: Current evidence and future challenges

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