Impact of hypothermia on implementation of CPAP for neonatal respiratory distress syndrome in a low-resource setting

Jennifer Carns, Kondwani Kawaza, M K Quinn, Yinsen Miao, Rudy Guerra, Elizabeth Molyneux, Maria Oden, Rebecca Richards-Kortum, Jennifer Carns, Kondwani Kawaza, M K Quinn, Yinsen Miao, Rudy Guerra, Elizabeth Molyneux, Maria Oden, Rebecca Richards-Kortum

Abstract

Background: Neonatal hypothermia is widely associated with increased risks of morbidity and mortality, but remains a pervasive global problem. No studies have examined the impact of hypothermia on outcomes for preterm infants treated with CPAP for respiratory distress syndrome (RDS).

Methods: This retrospective analysis assessed the impact of hypothermia on outcomes of 65 neonates diagnosed with RDS and treated with either nasal oxygen (N = 17) or CPAP (N = 48) in a low-resource setting. A classification tree approach was used to develop a model predicting survival for subjects diagnosed with RDS.

Findings: Survival to discharge was accurately predicted based on three variables: mean temperature, treatment modality, and mean respiratory rate. None of the 23 neonates with a mean temperature during treatment below 35.8°C survived to discharge, regardless of treatment modality. Among neonates with a mean temperature exceeding 35.8°C, the survival rate was 100% for the 31 neonates treated with CPAP and 36.4% for the 11 neonates treated with nasal oxygen (p<0.001). For neonates treated with CPAP, outcomes were poor if more than 50% of measured temperatures indicated hypothermia (5.6% survival). In contrast, all 30 neonates treated with CPAP and with more than 50% of temperature measurements above 35.8°C survived to discharge, regardless of initial temperature.

Conclusion: The results of our study suggest that successful implementation of CPAP to treat RDS in low-resource settings will require aggressive action to prevent persistent hypothermia. However, our results show that even babies who are initially cold can do well on CPAP with proper management of hypothermia.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
(A) Fitted decision tree predicting survival on the basis of clinical features for neonates diagnosed with RDS. The first node represents the mean temperature; no neonates with a mean temperature

Fig 2

(A) The mean temperature for…

Fig 2

(A) The mean temperature for neonates diagnosed with RDS and treated with bCPAP…

Fig 2
(A) The mean temperature for neonates diagnosed with RDS and treated with bCPAP (circles) or nasal oxygen (squares); filled symbols correspond to neonates who survived to discharge and open symbols correspond to neonates who died. Neonates initially treated with nasal oxygen, but later transitioned to bCPAP when a machine became available are designated with a red diamond. (B) Percent of neonates surviving stratified by treatment group for neonates diagnosed with RDS, and for neonates with a mean temperature above and below 35.8° C.

Fig 3. Initial temperature vs. the fraction…

Fig 3. Initial temperature vs. the fraction of temperature measurements above 35.8° C for all…

Fig 3. Initial temperature vs. the fraction of temperature measurements above 35.8° C for all neonates treated with bCPAP (N = 48).
Filled symbols correspond to neonates who survived to discharge while open symbols indicate neonates who died. Neonates with a co-morbidity of sepsis are highlighted with a red square. Neonates who were admitted warm and became cold, or were admitted cold and remained cold (quadrants I and II) had poor survival rates, while neonates who were admitted warm and remained warm, or were admitted cold and became warm (quadrants III and IV) had high survival rates.
Fig 2
Fig 2
(A) The mean temperature for neonates diagnosed with RDS and treated with bCPAP (circles) or nasal oxygen (squares); filled symbols correspond to neonates who survived to discharge and open symbols correspond to neonates who died. Neonates initially treated with nasal oxygen, but later transitioned to bCPAP when a machine became available are designated with a red diamond. (B) Percent of neonates surviving stratified by treatment group for neonates diagnosed with RDS, and for neonates with a mean temperature above and below 35.8° C.
Fig 3. Initial temperature vs. the fraction…
Fig 3. Initial temperature vs. the fraction of temperature measurements above 35.8° C for all neonates treated with bCPAP (N = 48).
Filled symbols correspond to neonates who survived to discharge while open symbols indicate neonates who died. Neonates with a co-morbidity of sepsis are highlighted with a red square. Neonates who were admitted warm and became cold, or were admitted cold and remained cold (quadrants I and II) had poor survival rates, while neonates who were admitted warm and remained warm, or were admitted cold and became warm (quadrants III and IV) had high survival rates.

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