Newborn

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  3 (2024)
Volume  2 (2023)
Volume  1 (2022)
Related articles

VOLUME 3 , ISSUE 1 ( January-March, 2024 ) > List of Articles

ORIGINAL RESEARCH

Timely Respiratory Support Can Improve Clinical Outcomes of Premature Infants in a Country with Limited Medical Resources due to Chronic Conflicts

Numan N Hameed, Musaab M Khaleel, Ola D Saugstad

Keywords : Baby, Infant, INSURE, Mechanical ventilation, Minimal invasive surfactant therapy, Neonatology, Neonate, Neonatal intensive care unit, Newborn, Preterm infants, Respiratory distress syndrome

Citation Information : Hameed NN, Khaleel MM, Saugstad OD. Timely Respiratory Support Can Improve Clinical Outcomes of Premature Infants in a Country with Limited Medical Resources due to Chronic Conflicts. 2024; 3 (1):13-18.

DOI: 10.5005/jp-journals-11002-0088

License: CC BY-NC 4.0

Published Online: 26-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: The children of Iraq have suffered greatly from military conflicts and economic sanctions since 1991. Recent years have shown some improvement in neonatal and infant mortality but more efforts are needed; prematurity and associated respiratory distress syndrome (RDS) remain the two leading causes. In this study, we investigated the efficiency of timely institution of nasal continuous positive airway pressure (nCPAP) in stabilizing these infants. These data are needed for the optimum allocation of financial resources to improve the healthcare outcomes of infants. Patients and methods: This prospective cross-sectional study was carried out over 6 months from April 1st to September 30th, 2022. Inborn preterm infants born between 26 and 32+0 weeks’ gestation who required respiratory support after delivery or immediately after admission were included. The data for the initial course of respiratory support and outcomes were assessed. Results: In our cohort of 123 infants, nCPAP significantly increased the likelihood of clinical stabilization in infants with a gestational age (GA) >28 weeks (p = 0.022), birth weight (BW) ≥1500 gm (p = 0.016), use of antenatal steroids (p = 0.002), Apgar score at 5 minutes of life (p = 0.022), mild radiographic findings (p = 0.007), and sepsis without prolonged rupture of membranes (p = 0.027). Nasal continuous positive airway pressure also reduced the need for surfactant (p = 0.001) and mortality (p = 0.0001). Conclusion: Early institution of nCPAP improved the respiratory status of premature infants who were born at a gestational age from >28 to ≤32 weeks, had birth weight ≥1500 gm, had received antenatal steroids, had a 5-minute Apgar score >7, and had sepsis but no PROM. The success of early nCPAP reduced the need for surfactant and mechanical ventilation, and the risk of pulmonary hemorrhage and mortality.

PDF Share
  1. Ascherio A, Chase R, Cote T, et al. Effect of the Gulf War on infant and child mortality in Iraq. N Engl J Med 1992;327(13):931–936. DOI: 10.1056/NEJM199209243271306.
  2. Akunjee M, Ali A. Healthcare under sanctions in Iraq: An elective experience. Med Confl Surviv 2002;18(3):249–257. DOI: 10.1080/13623690208409633.
  3. Nerlander MP, Leidman E, Hassan A, et al. Fatalities from firearm-related injuries in selected Governorates of Iraq, 2010–2013. Prehosp Disaster Med 2017;32(5):548–555. DOI: 10.1017/S1049023X17006495.
  4. Awqati NA, Ali MM, Al-Ward NJ, et al. Causes and differentials of childhood mortality in Iraq. BMC Pediatr 2009;9:40. DOI: 10.1186/1471-2431-9-40.
  5. Ali MM, Shah IH. Sanctions and childhood mortality in Iraq. Lancet 2000;355(9218):1851–1857. DOI: 10.1016/S0140-6736(00)02289-3.
  6. Al-Nouri L, Al-Rahim Q. The effect of sanctions on children of Iraq. Arch Dis Child 2003;88(1):92. DOI: 10.1136/adc.88.1.92.
  7. UNICEF. Monitoring the situation of children and women: Iraq. 2024. Available from: https://data.unicef.org/countdown-2030/country/Iraq/1/.
  8. The World Bank, UNICEF. Mortality rate, neonatal (per 1,000 live births). Available from: https://data.worldbank.org/indicator/SH.DYN.NMRT.
  9. Nasheit NA. Perinatal and neonatal mortality and morbidity in Iraq. J Matern Fetal Neonatal Med 2003;13(1):64–67. DOI: 10.1080/jmf.13.1.64.67.
  10. Siziya S, Muula AS, Rudatsikira E. Socio-economic factors associated with delivery assisted by traditional birth attendants in Iraq, 2000. BMC Int Health Hum Rights 2009;9:7. DOI: 10.1186/1472-698X-9-7.
  11. Sweet DG, Carnielli VP, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2022 Update. Neonatology 2023;120(1):3–23. DOI: 10.1159/000528914.
  12. Roberts D, Brown J, Medley N, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017;3(3):CD004454. DOI: 10.1002/14651858.CD004454.pub3.
  13. Norman M, Jonsson B, Wallstrom L, et al. Respiratory support of infants born at 22–24 weeks of gestational age. Semin Fetal Neonatal Med 2022;27(2):101328. DOI: 10.1016/j.siny.2022.101328.
  14. Stevens TP, Harrington EW, Blennow M, et al. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 2007;2007(4):CD003063. DOI: 10.1002/14651858.CD003063.pub3.
  15. Klingenberg C, Wheeler KI, McCallion N, et al. Volume-targeted versus pressure-limited ventilation in neonates. Cochrane Database Syst Rev 2017;10(10):CD003666. DOI: 10.1002/14651858.CD003666.pub4.
  16. Abdel-Latif ME, Davis PG, Wheeler KI, et al. Surfactant therapy via thin catheter in preterm infants with or at risk of respiratory distress syndrome. Cochrane Database Syst Rev 2021;5(5):CD011672. DOI: 10.1002/14651858.CD011672.pub2.
  17. Hameed NN, Abdul Jaleel RK, Saugstad OD. The use of continuous positive airway pressure in preterm babies with respiratory distress syndrome: A report from Baghdad, Iraq. J Matern Fetal Neonatal Med 2014;27(6):629–632. DOI: 10.3109/14767058.2013.825595.
  18. Elgin TG, Berger JN, Thomas BA, et al. Ventilator management in extremely preterm infants. Neoreviews 2022;23(10):e661–e676. DOI: 10.1542/neo.23-10-e661.
  19. Celik M, Bulbul A, Uslu S, et al. A comparison of the effects of invasive mechanic ventilation/surfactant therapy and non-invasive nasal-continuous positive airway pressure in preterm newborns. J Matern Fetal Neonatal Med 2018;31(24):3225–3231. DOI: 10.1080/14767058.2017.1367380.
  20. Ainsworth SB. Pathophysiology of neonatal respiratory distress syndrome: Implications for early treatment strategies. Treat Respir Med 2005;4(6):423–437. DOI: 10.2165/00151829-200504060-00006.
  21. Keszler M, Suresh G. Goldsmith's Assisted Ventilation of the Neonate. 7th edition. Keszler M, Suresh G, Goldsmith JP (Eds). Elsevier Health Sciences, Philadelphia; 2022. pp. 224, 235–237.
  22. Celentano DD, Szklo M. Gordis Epidemiology. 6th edition. Elsevier, Barcellona; 2020, pp. 179–215.
  23. Daniel WW, Cross CL. Biostatistics: A Foundation for Analysis in the Health Sciences 10th edition: John Wiley & Sons, Inc.; USA; 2013. pp. 600–670.
  24. Moore DS, McCabe G. Introduction to the Practice of Statistics. 9th ed New York: WH Freeman and Company; 2009. pp. 900–1004.
  25. Dawson B, Trapp RG. Basic & Clinical Biostatistics: Lange Medical Books; McGrawHill, USA; 2004. pp. 24–162.
  26. Dargaville PA, Gerber A, Johansson S, et al. Incidence and outcome of CPAP failure in preterm infants. Pediatrics 2016;138(1):e20153985. DOI: 10.1542/peds.2015-3985.
  27. Rehman A, Quddusi AI, Nadeem A, et al. Early nasal continuous positive airway pressure in preterm neonates with Respiratory Distress Syndrome. Professional Med J 2021;28(7):957–962. DOI: 10.29309/TPMJ/2021.28.07.5707.
  28. Pillai MS, Sankar MJ, Mani K, et al. Clinical prediction score for nasal CPAP failure in pre-term VLBW neonates with early onset respiratory distress. J Trop Pediatr 2011;57(4):274–279. DOI: 10.1093/tropej/fmq047.
  29. Tavares PN, Flor-de-Lima F, Soares H, et al. Early nCPAP versus intubation in very low birth weight infants. J Pediatr Neonat Individual Med 2013;2(2):1–6. DOI: 10.7363/64.
  30. Arora V, Gediya SG, Jain R. Outcome of premature babies with RDS using bubble CPAP. Int J Contemp Pediatr 2017;4(3):939–942. DOI: 10.18203/2349-3291.ijcp20171702.
  31. Vieira B, Souza TR, Paschoal LN, et al. Early CPAP protocol in preterm infants with gestational age between 28 and 32 weeks: Experience of a public hospital. Braz J Phys Ther 2021;25(4):421–427. DOI: 10.1016/j.bjpt.2020.09.001.
  32. Boix H, Fernandez C, Serrano Martin MDM, et al. Failure of early non-invasive ventilation in preterm infants with respiratory distress syndrome in current care practice in Spanish level-III neonatal intensive care units-A prospective observational study. Front Pediatr 2023;11:1098971. DOI: 10.3389/fped.2023.1098971.
  33. Koti J, Murki S, Gaddam P, et al. Bubble CPAP for respiratory distress syndrome in preterm infants. Indian Pediatr 2010;47(2):139–143. DOI: 10.1007/s13312-010-0021-6.
  34. Hameed NN, Na’ Ma AM, Vilms R, et al. Severe neonatal hyperbilirubinemia and adverse short-term consequences in Baghdad, Iraq. Neonatology 2011;100(1):57–63. DOI: 10.1159/000321990.
  35. Saugstad OD, Modi N, Moretti C, et al. Newborns and children in war and terror. Neonatology 2023:1–4. DOI: 10.1159/000535401.
  36. Hameed NN, Hussein MA. BIND score: A system to triage infants readmitted for extreme hyperbilirubinemia. Semin Perinatol 2021;45(1):151354. DOI: 10.1016/j.semperi.2020.151354.
  37. Lawn JE, Bhutta ZA, Ezeaka C, et al. Ending preventable neonatal deaths: Multicountry evidence to inform accelerated progress to the sustainable development goal by 2030. Neonatology 2023;120(4):491–499. DOI: 10.1159/000530496.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.