Is continuous positive airway pressure a feasible treatment modality for neonates with respiratory distress syndrome in a rural district hospital?

Objectives: To assess the feasibility of using nasal continuous positive airway pressure (nCPAP) in neonates with respiratory distress syndrome at district hospital level by assessing in-hospital survival rates and the impact on transfer rates.

Methods: A prospective database was kept from 2008 to record the outcomes of neonates with mild to moderate respiratory distress treated with nCPAP at a South African rural district hospital. Transfer rates were compared for the two years before and after introduction of neonatal nCPAP using additional retrospective data from the Perinatal Problem Identification Programme (PPIP) for comparison. Outcomes for nCPAP neonates for the first 5 years after programme implementation are presented.

Results: One hundred and twenty-eight babies were treated with nCPAP over the study period. Nine of 13 extremely low birth weight (<1000 g) babies died. Eighty-four (72.4%) of the babies weighing >1000 g were successfully treated, 16 (13.8%) were transferred after trial of nCPAP and 15 (12.9%) died in hospital. Most of the transferred babies and deaths had co-morbidities. There was a significant reduction in transfer rates of low birth weight babies from 21 to 7% in the first 2 years following the introduction of nCPAP.

Conclusions: nCPAP for neonatal respiratory distress at the district hospital is feasible, safe and offers the potential for significant cost savings.