Uptake of Continuous Positive Airway Pressure and Outcomes among Newborns Admitted with Respiratory Distress in Three County Hospitals in Nairobi, Kenya

Abstract

Respiratory distress (RD) is a leading cause of neonatal mortality, with bubble continuous positive airway pressure (bCPAP) being a low-cost, effective therapy. Despite its benefits, the adoption of bCPAP in neonatal units remains a challenge. This study aimed to assess the utilization and outcomes of CPAP therapy among neonates with RD and identify barriers to its implementation in three hospitals in Nairobi, Kenya: Mama Lucy Kibaki Hospital, Pumwani Maternity Hospital, and Mbagathi Hospital. This mixed-methods study employed both quantitative and qualitative approaches. A total of 178 neonates with RD requiring CPAP were recruited. The quantitative aspect of this study employed a prospective cohort design to examine the short-term outcomes of newborns within a defined 28-day period. The study examined key outcomes, including length of hospital stay, supplemental oxygen use, need for ventilatory support, referral, and mortality, for each neonate, comparing those initiated on CPAP with those who missed out on CPAP therapy. Data were analyzed using SPSS 27 software. A total of 22 healthcare providers participated in the qualitative component, comprising 22 structured in-depth interviews, of whom 5 also participated in Key Informant Interviews (KIIs), to identify barriers to effective CPAP implementation. Qualitative data were manually coded and thematically analyzed. Of the 178 neonates enrolled, 58% were male, with most neonates (30.3%) being born between 28 and 32 weeks of gestation. CPAP was initiated for 57.3% of the neonates, while the remaining neonates received oxygen therapy via nasal prongs (NP) or a non-rebreather mask (NRM). Neonates in the CPAP group had better outcomes, with a higher proportion discharged (78.43% vs. 61.84%, p = 0.0242) and a lower mortality proportion (12.75% vs. 35.53%, p < 0.001). The proportions of referral (2.94% vs. 2.63%, p = 1.000), trauma to the nares (2.94% vs. 0%, p = 0.3580), and air leak syndromes (0.98% vs. 0%, p = 1.000). The average length of hospital stay for all neonates was 15.6 days, with neonates initiated on CPAP experiencing shorter stays, exhibited through discharge within 7 days (43.14% vs. 27.6%, Crude OR = 2.0, 95% CI: 1.1–3.8), while those who missed out on CPAP had longer stays beyond 28 days (46.1% vs. 17.64%, Crude OR = 0.3, 95% CI: 0.1–0.5). The study identified several barriers to CPAP implementation, including inadequate human resources, poor infrastructure, limited equipment, and communication gaps among healthcare staff. Though most healthcare workers had basic CPAP knowledge, many had not undergone refresher training or continuing medical education. In conclusion, CPAP therapy demonstrated improved outcomes for newborns with RD, but its successful implementation is hindered by systemic challenges such as staff shortages, inadequate infrastructure, and equipment limitations. Addressing these barriers could improve neonatal survival and healthcare delivery in resource-limited settings.