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Use of continuous positive airway pressure in neonates in India

Doctor adjusting a tube in a baby's mouth

Severe respiratory distress is a serious complication which is common to the main causes of neonatal death. Respiratory support to manage severe respiratory distress is provided by CPAP, or, mechanical ventilation in high-resource settings. The development of relatively simple CPAP devices has led to a growing interest in using this method to reduce neonatal mortality in India.

CMNH has been awarded a WHO grant to assess the use of Continuous Positive Airway Pressure (CPAP) in newborn care units across India.

The results will inform policy makers and healthcare implementers on the current use of an intervention, which has the potential to reduce neonatal mortality and morbidity.

The project is divided into two phases. Phase 1, completed in December 2015, was well received and included:

  • Literature review and secondary data analysis
  • Meeting key stakeholders in India
  • Development of study protocol and assessment tool

Phase 2, data collection and analysis, will begin in February 2016.

Background

An estimated 2.9 million neonatal deaths occur each year. The majority of these happen in low- and middle-income countries (LMICs). Three main causes account for the majority of deaths: prematurity (34%), intra-partum related conditions (25%) and infections.

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 CPAP, or, mechanical ventilation in high-resource settings. The development of relatively simple CPAP devices has led to a growing interest in using this method to reduce neonatal mortality in India.

However, the use of CPAP is not free of adverse events which may include pneumothorax, nasal trauma and sepsis. In line with the WHO Guideline Development Group for Preterm Care, CMNH advocates that the context of care, including the availability of structures and processes required to safely deliver CPAP and the ability to monitor outcomes, must be considered prior to implementing CPAP.