{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:15:15Z","timestamp":1787022915714,"version":"build-2736575974"},"reference-count":17,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Continuous positive airway pressure (CPAP) is an evidence-based therapy for respiratory distress syndrome (RDS), the leading cause of death for preterm infants globally. Ethiopian Neonatal Network (ENN) teams identified a quality gap in CPAP use for preterm infants with RDS. We sought to use remote education and mentorship without additional resources to improve CPAP use in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Nineteen public ENN hospitals participated in this quality improvement (QI) collaborative (September 2021 to September 2022). The primary intervention was implementation of a telementoring program. Five Ethiopian nurse-physician mentor pairs each supported 4 mentee hospitals through a remote CPAP optimization training package. Quarterly ENN collaborative meetings reviewed progress and challenges. Hospitals submitted patient-level data for all neonatal unit admissions and monthly audits. Run chart rules were used to assess for nonrandom evidence of change related to CPAP use. Preterm mortality in preintervention and postintervention periods was evaluated by a \u03c72 test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The launch of the QI collaborative with remote education and mentoring coincided with an increase in the documentation of Downes score on admission (57.8% to 95.6%) and number of preterm infants (&amp;lt;37\u00a0weeks\u2019 gestation) receiving CPAP (129 to 138 per month). Preterm mortality decreased significantly from preintervention (28%) to postintervention periods (21.6%) (P\u2009&amp;lt;\u2009.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Ethiopian nurse-physician mentorship pairs supporting mentee hospitals in standardizing assessments of respiratory distress and optimizing the use of CPAP increased the number of preterm infants treated with CPAP. Significant reduction in preterm mortality postintervention is encouraging as CPAP use continues to scale up globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2024-067985","type":"journal-article","created":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T20:03:07Z","timestamp":1749672187000},"source":"Crossref","is-referenced-by-count":2,"title":["Remote Mentorship to Improve Continuous Positive Airway Pressure Use in the Ethiopian Neonatal Network"],"prefix":"10.1542","volume":"156","author":[{"given":"Danielle E. Y.","family":"Ehret","sequence":"first","affiliation":[{"name":"1University of Vermont Larner College of Medicine, Burlington, Vermont"},{"name":"2Vermont Oxford Network, Burlington, Vermont"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogale","family":"Worku","sequence":"additional","affiliation":[{"name":"3Ethiopian Pediatrics Society, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asrat","family":"Demtse","sequence":"additional","affiliation":[{"name":"4Addis Ababa University, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huluagerish","family":"Eshete","sequence":"additional","affiliation":[{"name":"4Addis Ababa University, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gesit","family":"Metaferia","sequence":"additional","affiliation":[{"name":"5St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aster","family":"Teketel","sequence":"additional","affiliation":[{"name":"5St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailu","family":"Berta","sequence":"additional","affiliation":[{"name":"6Zewditu Memorial Hospital, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misgana","family":"Hirpha","sequence":"additional","affiliation":[{"name":"6Zewditu Memorial Hospital, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel","family":"Arega","sequence":"additional","affiliation":[{"name":"7Hawassa University Specialized Hospital, Hawassa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Saleeye","sequence":"additional","affiliation":[{"name":"8Karamara Hospital, Jigjiga, 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Vermont"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dunn","sequence":"additional","affiliation":[{"name":"11University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahlet","family":"Abayneh","sequence":"additional","affiliation":[{"name":"5St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"2026042410571359000_r1","article-title":"Newborn mortality","author":"World Health Organization","year":"2022"},{"key":"2026042410571359000_r2","article-title":"Department of Economic and Social Affairs","author":"United Nations"},{"issue":"2","key":"2026042410571359000_r3","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S2352-4642(21)00311-4","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201319: an updated systematic analysis with implications for the Sustainable Development Goals","volume":"6","author":"Perin","year":"2022","journal-title":"Lancet Child Adolesc Health."},{"issue":"8","key":"2026042410571359000_r4","doi-asserted-by":"crossref","first-page":"e1130","DOI":"10.1016\/S2214-109X(19)30220-7","article-title":"Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study","volume":"7","author":"Muhe","year":"2019","journal-title":"Lancet Glob Health."},{"issue":"10","key":"2026042410571359000_r5","first-page":"CD002271","article-title":"Continuous positive airway pressure (CPAP) for respiratory distress in preterm infants","volume":"10","author":"Ho","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"2026042410571359000_r6","doi-asserted-by":"crossref","first-page":"961509","DOI":"10.3389\/fped.2022.961509","article-title":"Respiratory distress syndrome management in resource limited settings-Current evidence and opportunities in 2022","volume":"10","author":"Ekhaguere","year":"2022","journal-title":"Front Pediatr."},{"issue":"11","key":"2026042410571359000_r7","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1111\/apa.16957","article-title":"High inter-rater reliability between physicians and nurses utilising modified Downes\u2019 scores in preterm respiratory distress","volume":"112","author":"Ehret","year":"2023","journal-title":"Acta Paediatr."},{"key":"2026042410571359000_r8","author":"Vermont Oxford Network","year":"2023"},{"key":"2026042410571359000_r9","volume-title":"The Health Care Data Guide: Learning from Data for Improvement","author":"Provost","year":"2022","edition":"2nd ed"},{"issue":"1","key":"2026042410571359000_r10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12887-021-02544-z","article-title":"Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda","volume":"21","author":"Tuyisenge","year":"2021","journal-title":"BMC Pediatr."},{"issue":"1","key":"2026042410571359000_r11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40985-020-00124-7","article-title":"Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review","volume":"41","author":"Kinshella","year":"2020","journal-title":"Public Health Rev."},{"issue":"1","key":"2026042410571359000_r12","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s43058-020-00092-8","article-title":"Scaling up newborn care technologies from tertiary- to secondary-level hospitals in Malawi: an implementation case study of health professional perspectives on bubble CPAP","volume":"1","author":"Kinshella","year":"2020","journal-title":"Implement Sci Commun."},{"key":"2026042410571359000_r13","volume-title":"Ethiopia Mini Demographic and Heath Survey 2019: Final Report.","author":"Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF","year":"2021"},{"issue":"4","key":"2026042410571359000_r14","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1159\/000530496","article-title":"Ending preventable neonatal deaths: multicountry evidence to inform accelerated progress to the sustainable development goal by 2030","volume":"120","author":"Lawn","year":"2023","journal-title":"Neonatology."},{"issue":"4","key":"2026042410571359000_r15","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1111\/tmi.13743","article-title":"Telementoring initiative for newborn care providers in Kenya, Pakistan and Tanzania","volume":"27","author":"Merali","year":"2022","journal-title":"Trop Med Int Health."},{"issue":"10","key":"2026042410571359000_r16","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1097\/ACM.0000000000001328","article-title":"The impact of Project ECHO on participant and patient outcomes: a systematic 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Nurs."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2024-067985\/1819837\/pediatrics.2024067985.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2024-067985\/1819837\/pediatrics.2024067985.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:57:17Z","timestamp":1777042637000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/156\/1\/e2024067985\/202106\/Remote-Mentorship-to-Improve-Continuous-Positive"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,12]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,6,12]]},"published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2024-067985","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,12]]},"article-number":"e2024067985"}}