{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:15:09Z","timestamp":1787022909277,"version":"build-2736575974"},"reference-count":40,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>Our aim in this observational study was to monitor continuous positive airway pressure (CPAP) usage and outcomes in newborn wards at 26 government hospitals in Malawi after the introduction of CPAP as part of a quality-improvement initiative. CPAP was implemented in 3 phases from 2013 through 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Survival to discharge was analyzed for neonates treated with nasal oxygen and\/or CPAP with admission weights of 1 to 2.49 kg at 24 government hospitals with transfer rates &amp;lt;15%. This analysis includes neonates admitted with respiratory illness for 5.5 months before (621 neonates) and 15 months immediately after CPAP implementation (1836 neonates). A follow-up data analysis was completed for neonates treated with CPAP at all hospitals during an additional 11 months (194 neonates).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>On implementation of CPAP, survival to discharge improved for all neonates admitted with respiratory distress (48.6% vs 54.5%; P = .012) and for those diagnosed with respiratory distress syndrome (39.8% vs 48.3%; P = .042). There were no significant differences in outcomes for neonates treated with CPAP during the implementation and follow-up periods. Hypothermia on admission was pervasive and associated with poor outcomes. Neonates with normal mean temperatures during CPAP treatment experienced the highest survival rates (65.7% for all neonates treated with CPAP and 60.0% for those diagnosed with respiratory distress syndrome).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>A nurse-led CPAP service can improve outcomes for neonates in respiratory distress in low-resource settings. However, the results show that real-world improvements in survival may be limited without access to comprehensive newborn care, especially for small and sick infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2019-0668","type":"journal-article","created":{"date-parts":[[2019,9,20]],"date-time":"2019-09-20T08:24:05Z","timestamp":1568967845000},"source":"Crossref","is-referenced-by-count":34,"title":["Neonatal CPAP for Respiratory Distress Across Malawi and Mortality"],"prefix":"10.1542","volume":"144","author":[{"given":"Jennifer","family":"Carns","sequence":"first","affiliation":[{"name":"aRice 360 Institute for Global Health Technology, Houston, Texas;"},{"name":"bDepartment of Bioengineering, Rice University, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kondwani","family":"Kawaza","sequence":"additional","affiliation":[{"name":"cDepartment of Pediatrics and Child Health, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Liaghati-Mobarhan","sequence":"additional","affiliation":[{"name":"aRice 360 Institute for Global Health Technology, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aba","family":"Asibon","sequence":"additional","affiliation":[{"name":"aRice 360 Institute for Global Health Technology, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K.","family":"Quinn","sequence":"additional","affiliation":[{"name":"aRice 360 Institute for Global Health Technology, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Chalira","sequence":"additional","affiliation":[{"name":"dDepartment of Clinical Services, Ministry of Health, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"Lufesi","sequence":"additional","affiliation":[{"name":"dDepartment of Clinical Services, Ministry of Health, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Molyneux","sequence":"additional","affiliation":[{"name":"cDepartment of Pediatrics and Child Health, College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Oden","sequence":"additional","affiliation":[{"name":"aRice 360 Institute for Global Health Technology, Houston, Texas;"},{"name":"bDepartment of Bioengineering, Rice University, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Richards-Kortum","sequence":"additional","affiliation":[{"name":"aRice 360 Institute for Global Health Technology, Houston, Texas;"},{"name":"bDepartment of Bioengineering, Rice University, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,10,1]]},"reference":[{"issue":"9938","key":"2025062311040276500_B1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(14)60496-7","article-title":"Every Newborn: progress, priorities, and potential beyond survival","volume":"384","author":"Lawn","year":"2014","journal-title":"Lancet"},{"issue":"10063","key":"2025062311040276500_B2","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.1016\/S0140-6736(16)31593-8","article-title":"Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016","journal-title":"Lancet"},{"issue":"8","key":"2025062311040276500_B3","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1055\/s-0028-1085066","article-title":"The probability of neonatal respiratory distress syndrome as a function of gestational age and lecithin\/sphingomyelin ratio","volume":"25","author":"St Clair","year":"2008","journal-title":"Am J Perinatol"},{"key":"2025062311040276500_B4","doi-asserted-by":"crossref","first-page":"i122","DOI":"10.1093\/ije\/dyq029","article-title":"Antenatal steroids in preterm labour for the prevention of neonatal deaths due to complications of preterm birth","volume":"39","author":"Mwansa-Kambafwile","year":"2010","journal-title":"Int J Epidemiol"},{"key":"2025062311040276500_B5","unstructured":"WHO\n          . 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