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Assessment of the use of Continuous Positive Airway Pressure in Newborn Care Units in India

Severe respiratory distress is a serious complication which is common to these three causes of neonatal death. The case fatality rate of this condition in LMICs can be as high as 20%. 

Respiratory support to manage severe respiratory distress is provided by Continuous Positive Airway Pressure (CPAP) or mechanical ventilation in high income countries. The development of relatively inexpensive CPAP devices has led to a growing interest in using them to reduce neonatal mortality in LMICs.

However, the use of CPAP is not free of adverse events. Studies have reported harmful events caused by the use of CPAP such as pneumothorax, nasal trauma and sepsis. CPAP should be implemented only in health facilities with skilled personnel in sufficient numbers, the capacity to monitor patients, and the availability of supportive care to manage complications.

Objectives:
India has seen an increase in the implementation of CPAP in Special Newborns Care Units (SNCU) and Neonatal Intensive Care Units (NICUs). Thousands of health care providers have been trained in the use of CPAP over recent years. 

We aim to assess the extent of CPAP use in India and to examine if the use of this intervention is compliant with national and international standards. This study will be part of a broader research project aiming to assess the use of CPAP in various middle income countries.

Research questions:

  • Determine the proportion of health facilities from the public sector equipped with newborn care units using CPAP to treat respiratory distress 
  • Describe current practice in the use of CPAP in these facilities
  • Determine the number of newborns admitted to these heath facilities with severe respiratory distress and benefiting from CPAP
  • Explore the views of healthcare professionals on barriers and enablers to the use of CPAP
  • Formulate standards for the use of CPAP adapted to the local context