Short Term Outcomes and Predictors of Mortality of Preterms Who Had Continuous Positive Airway Pressure Initiated at Delivery at in Urban Sub Saharan African Setting: A Retrospective Cohort Study

Abstract Background Continuous Positive Airway Pressure (CPAP) is a low-cost treatment modality for respiratory distress syndrome that has been shown to improve survival of preterm infants. However, its application at delivery is not routinely practiced in Uganda and Africa despite evidence from high income countries. Short term outcomes and predictors of mortality of preterm infants initiated on CPAP at Delivery at the St Francis hospital, Nsambya was reviewed in this study.Methods A retrospective cohort study was conducted at St Francis Hospital, Nsambya Neonatal Unit. Maternal and Neonatal records of Preterm infants that had CPAP initiated at delivery from January 2018 to December 2021 were reviewed. The proportion of preterm infants that survived to discharge were determined, those that required mechanical ventilation and surfactant replacement therapy. The predictors of mortality were determined using Cox proportionate hazard model. Kaplan Meier survival curve was used to determine survival probability.Results A total of 198 patient’s records were reviewed, the mean age of mother was 29 years and139 (70.2%) were delivered by cesarean section. 109 (55.1%) of the preterm infants were female, 146 (73.7%) survived to discharge.31 (15.7%) required mechanical ventilation and 38 (19.2%) received surfactant replacement therapy. The mean survival time was 42 days and predictors of mortality were gestation age less than 31 weeks, apnea of prematurity, pulmonary hemorrhage and APGAR score of less than 6 at 5 minutes.Conclusions The survival of preterm infants with respiratory distress was high when CPAP was initiated at delivery and small proportion required surfactant and mechanical ventilation. However, preterm infants delivered less than 31 weeks of gestation, having apnea of prematurity, pulmonary hemorrhage and an APGAR score less than 6 at 5 minutes had an increased the risk of mortality. Thus mortality of preterm infants that receive CPAP early can be reduced by intervening on the above predictors