Factors Influencing Continuous Positive Airway Pressure Outcome in Neonates with Respiratory Distress in Resource-Constrained Settings: Experience from Mosul, Iraq

Ahmed Khalil Ibrahim; Noor Sameer Yahya; Rikan Sulaiman Jumaah

doi:10.54133/ajms.v9i2.2488

Authors

Ahmed Khalil Ibrahim Department of Pediatrics, College of Medicine, Ninevah University, Mosul, Iraq https://orcid.org/0000-0001-7729-1852
Noor Sameer Yahya Department of Pediatrics, College of Medicine, University of Mosul, Mosul, Iraq
Rikan Sulaiman Jumaah Department of Pediatrics, College of Medicine, University Mosul, Mosul, Iraq

DOI:

https://doi.org/10.54133/ajms.v9i2.2488

Keywords:

CPAP outcome, LMICs, Neonatal respiratory distress, Neonatal mortality

Abstract

Background: Neonatal respiratory distress (RD) remains a leading cause of morbidity and mortality, particularly in low- and middle-income countries (LMICs) with limited resources. Continuous Positive Airway Pressure (CPAP) is a cornerstone of management, but its efficacy and factors influencing outcomes in such settings require further investigation. Objective: To identify predictors of CPAP success or failure and subsequent survival in neonates with RD in a neonatal critical care institution in a post-conflict area like Mosul (a healthcare-constrained system). Methods: This prospective observational study included 119 neonates initiated on CPAP. Data on demographics, clinical characteristics, CPAP outcomes (success/failure), and final patient outcomes (discharge/death) were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Results: Overall, 79(66.4%) neonates achieved CPAP success, while 40(33.6%) experienced failure. Birth weight ≤1500 g and a 5-minute APGAR score <7 were independent predictors of CPAP failure. Mortality occurred in 29.4% of cases, with 87.5% of deaths occurring among those who failed CPAP (p<0.001). In multivariate analysis, low birth weight remained the sole independent predictor of death. Kaplan-Meier survival analysis showed significantly reduced survival in neonates weighing 1500 g or less. Conclusions: Low birth weight and low APGAR are strong predictors of CPAP failure, increasing the risk of death. In resource-constrained settings, improving antenatal care, ensuring the availability of surfactants, and expanding access to mechanical ventilation may help improve outcomes for high-risk neonates requiring CPAP.

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