Malawi: National CPAP program is a boon for more than half of newborns with respiratory illness

Malawi has the world's highest preterm birth rate, with almost 1 in 5 babies born prematurely , but the Continuous Positive Airway Pressure (CPAP) programme introduced by the health ministry as part of a quality-improvement initiative increased survival rates of respiratory illness for newborns finds a new study.

With use of CPAP devices, the survival rates increased from 49% to 55% for newborns admitted with breathing problems. The national neonatal CPAP technology as a part of routine hospital care, adopted by Malawi Ministry of Health, resulted in sustained improvements in the survival of babies with respiratory illness, according to a new study in the journal Pediatrics. The study was conducted by researchers from the Malawi Ministry of Health, Malawi's leading medical school and its teaching hospital and Rice 360° Institute for Global Health. The objective of this study was the introduction of Continuous Positive Airway Pressure (CPAP) technology as part of a quality-improvement initiative. The CPAP machines use mild air pressure to keep the airways open, and are typically used by patients who have breathing problems during sleep. With one in five babies born prematurely in Malawi, this African nation has the world's highest preterm birth rate. This three-year study conducted at 26 Malawi government hospitals had adopted Continuous Positive Airway Pressure (CPAP) devices as a part of routine hospital care between 2013 and 2016.

Pumani CPAP machine used in the study was developed by Rice 360° Institute for Global Health based in Houston at Texas. The study found that with the use of this device the survival rates went up from 49% to 55% for newborns admitted with breathing problems. For newborns with severe breathing problems, survival improved from 40% to 48%. "For babies that had respiratory distress syndrome -- these are the tiniest babies that have some of the biggest challenges with breathing -- we saw a nearly a 10% improvement in survival after CPAP was available," said Rice University engineering professor Rebecca Richards-Kortum, the study's corresponding author and co-director of the Rice 360° Institute for Global Health.

According to this study, babies did not get the full benefit of CPAP if they were too cold. During CPAP treatment, newborns with normal mean temperatures experienced the highest survival rates. The normal body temperature of a baby lies between 36 to 37 degrees Celsius. "For infants with normal body temperatures, survival rates were 66% -- more than 25% higher than those who were too cold," said lead author Jennifer Carns, a Rice 360° bioengineer and research scientist at Rice's Brown School of Engineering. The success of the study in Malawi demonstrates that a low-income can scale-up CPAP nationally and see improvements in newborn respiratory illness. It needs to be introduced as part of a quality program that focuses on improving essential newborn care says Richards-Kortum , Professor at Rice’s Brown School of Engineering