Neonatal Respiratory Support Utilization in Low- and Middle-Income Countries: A Registry-Based Observational Study

Nora Switchenko, Vivek Shukla, Musaku Mwenechanya, Elwyn Chomba, Archana Patel, Patricia L. Hibberd, Namasivayam Ambalavanan, Lester Figueroa, Manolo Mazariegos, Nancy F. Krebs, Shivaprasad S. Goudar, Richard Derman, Fabian Esamai, Edward A. Liechty, Sheri Bucher, Sarah Saleem, Robert L. Goldenberg, Adrien Lokangaka, Antoinette Tshefu, Carl L. BoseMarion Koso-Thomas, Sylvia Tan, Tracy Nolen, Elizabeth M. McClure, Waldemar A. Carlo

Research output: Contribution to journalArticlepeer-review


Background: Newborns with hypoxemia often require lifesaving respiratory support. In low-resource settings, it is unknown if respiratory support is delivered more frequently to term infants or preterm infants. We hypothesized that in a registry-based birth cohort in 105 geographic areas in seven low- and middle-income countries, more term newborns received respiratory support than preterm newborns. Methods: This is a hypothesis-driven observational study based on prospectively collected data from the Maternal and Newborn Health Registry of the NICHD Global Network for Women’s and Children’s Health Research. Eligible infants enrolled in the registry were live-born between 22 and 44 weeks gestation with a birth weight ≥400 g and born from January 1, 2015, to December 31, 2018. Frequency data were obtained to report the number of term and preterm infants who received treatment with oxygen only, CPAP, or mechanical ventilation. Test for trends over time were conducted using robust Poisson regression. Results: 177,728 (86.3%) infants included in this study were term, and 28,249 (13.7%) were preterm. A larger number of term infants (n = 5,108) received respiratory support compared to preterm infants (n = 3,287). Receipt of each mode of respiratory support was more frequent in term infants. The proportion of preterm infants who received respiratory support (11.6%) was higher than the proportion of term infants receiving respiratory support (2.9%, p < 0.001). The rate of provision of respiratory support varied between sites. Conclusions: Respiratory support was more frequently used in term infants expected to be at low risk for respiratory disorders compared to preterm infants.

Original languageEnglish
Pages (from-to)116-124
Number of pages9
Issue number1
Publication statusPublished - 1 Feb 2024


  • Infants
  • Low birth weight
  • Low- and middle-income countries
  • Low-resource setting
  • Preterm infants
  • Respiratory distress


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