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Availability and use of continuous positive airway pressure (CPAP) for neonatal care in public health facilities in India: a cross-sectional cluster survey
- Source :
- BMJ open, BMJ Open, BMJ Open, Vol 10, Iss 2 (2020)
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- ObjectivesTo 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.SettingCross-sectional cluster survey of a nationally representative sample of government hospitals from across India.Primary outcomesAvailability of CPAP in neonatal units.Secondary outcomesProportion of hospitals where infrastructure and processes to provide CPAP are available. Case fatality rates and complication rates of neonates treated with CPAP.ResultsAmong 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% to 60.9%) and staff trained in the use of CPAP were present in 56.0% (45.8% to 65.8%) of hospitals. The nurse to patient ratio was 7.3 (6.4 to 8.5) in MCH and 6.6 (5.5 to 8.3) in DH. Clinical guidelines were available in 31.0% of hospitals (22.2% to 41.4%). Upper oxygen saturation limits of above 94% were used in 72% (59.8% to 81.6%) of MCH and 59.3% (44.6% to 72.5%) of DH. Respiratory circuits were reused in 53.8% (42.3% to 63.9%) of hospitals. Case fatality rate for neonates treated with CPAP was 21.4% (16.6% to 26.2%); complication rates were 0.7% (0.2% to 1.2%) for pneumothorax, 7.4% (0.9% to 13.9%) for retinopathy and 1.4% (0.7% to 2.1%) for bronchopulmonary dysplasia.ConclusionsCPAP 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.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
India
Global Health
Disease cluster
neonatology
quality in health care
Intensive Care Units, Neonatal
Case fatality rate
medicine
Humans
Hospital Mortality
Neonatology
Continuous positive airway pressure
Perinatal Mortality
Bronchopulmonary Dysplasia
Oxygen saturation (medicine)
Continuous Positive Airway Pressure
business.industry
Public health
Infant, Newborn
Infant
General Medicine
medicine.disease
Oxygen
Cross-Sectional Studies
Bronchopulmonary dysplasia
Emergency medicine
Medicine
neonatal intensive and critical care
business
Complication
Subjects
Details
- ISSN :
- 20446055
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- BMJ Open
- Accession number :
- edsair.doi.dedup.....806398053fb8f15c55d947bb3d19b77f