Implementation of Bubble CPAP in a Rural Ugandan Neonatal ICU.
BACKGROUND
Respiratory distress is a leading cause of neonatal death in low-income and middle-income countries. CPAP is a simple and effective respiratory support modality used to support neonates with respiratory failure and can be used in low-income and middle-income countries. The goal of this study was to describe implementation of the Silverman-Andersen respiratory severity score (RSS) and bubble CPAP in a rural Ugandan neonatal NICU. We sought to determine whether physicians and nurses in a low-income/middle-income setting would assign similar RSS in neonates after an initial training period and over time.


METHODS
We describe the process of training NICU staff to use the RSS to assist in decision making regarding initiation, titration, and termination of bubble CPAP for neonates with respiratory distress. Characteristics of all neonates with respiratory failure treated with bubble CPAP in a rural Ugandan NICU from January to June 2012 are provided.


RESULTS
Nineteen NICU staff members (4 doctors and 15 nurses) received RSS training. After this, the Spearman correlation coefficient for respiratory severity scoring between doctor and nurse was 0.73. Twenty-one infants, all < 3 d of age, were treated with CPAP, with 17 infants starting on the day of birth. The majority of infants (16/21, 76%) were preterm, 10 (48%) were <1,500 g (birthweight), and 13 (62%) were outborn. The most common diagnoses were respiratory distress syndrome (16/21, 76%) and birth asphyxia (5/21, 24%). The average RSS was 7.4 ± 1.3 before starting CPAP, 5.2 ± 2.3 after 2-4 h of CPAP, 4.9 ± 2.7 after 12-24 h of CPAP, and 3.5 ± 1.9 before CPAP was discontinued. Duration of treatment with CPAP averaged 79 ± 43 h. Approximately half (11/21, 52%) of infants treated with CPAP survived to discharge.


CONCLUSIONS
Implementing bubble CPAP in a low-income/middle-income setting is feasible. The RSS may be a simple and useful tool for monitoring a neonate's respiratory status and for guiding CPAP management.
Department of Pediatrics, University of Washington, Seattle, Washington. Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington. mcadams@uw.edu.
Ryan M
RM
McAdams
Department of Pediatrics, University of Washington, Seattle, Washington. Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
Anna B
AB
Hedstrom
Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
Robert M
RM
DiBlasi
Paediatrics Department, York Hospital, York, United Kingdom.
Jill E
JE
Mant
Pediatrics, Kiwoko Hospital, Luweero, Uganda.
James
J
Nyonyintono
Pediatrics, Kiwoko Hospital, Luweero, Uganda.
Christine D
CD
Otai
The ISIS Foundation, Edmonds, Washington.
Debbie A
DA
Lester
Department of Pediatrics, University of Washington, Seattle, Washington. Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
Maneesh
M
Batra
D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000600:supply & distribution*; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014454:Uganda
low-income and middle-income countries; neonate; respiratory distress; respiratory severity score