Availability and use of Continuous Positive Airway Pressure (CPAP) for neonatal care in public health facilities in India: a cross- sectional cluster survey

Dewez, Juan, Nangia, Sushma, Chellani, Harish, White, Sarah ORCID: https://orcid.org/0000-0001-5535-8075, Mathai, Matthews ORCID: https://orcid.org/0000-0002-7352-9330 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2020) 'Availability and use of Continuous Positive Airway Pressure (CPAP) for neonatal care in public health facilities in India: a cross- sectional cluster survey'. British Medical Journal (BMJ), Vol 10, Issue 2, E031128.

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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 41.4,60.9) and staff trained in the use of CPAP were present in 56.0% (45.8,65.8) of hospitals. The nurse to patient ratio was 7.3 (6.4,8.5) in MCH and 6.6 (5.5,8.3) in DH. Clinical guidelines were available in 31.0% of hospitals (22.2,41.4). Upper oxygen saturation limits of above 94% were used in 72% (59.8,81.6) of MCH and 59.3% (44.6,72.5) of DH. Respiratory circuits were reused in 53.8% (42.3,63.9) of hospitals. Case fatality rate for neonates treated with CPAP was 21.4% (16.6,26.2); complication rates were 0.7% (0.2,1.2) for pneumothorax, 7.4% (0.9,13.9) for retinopathy, and 1.4% (0.7,2.1) 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.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > WF 100 General works WY Nursing > WY 157.3 Maternal-child nursing. Neonatal nursing. Perinatal nursing
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjopen-2019-031128
Depositing User:	Tina Bowers
Date Deposited:	02 Mar 2020 15:24
Last Modified:	08 Sep 2020 09:44
URI:	https://archive.lstmed.ac.uk/id/eprint/13874

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