Respiratory Distress Syndrome: An analysis of neonatal mortality risk factors within lower- and middle-income countries using the CHAMPS network Open Access
Huang, Ryan (Spring 2023)
Published
Abstract
Approximately 5.2 million children under the age of five die each year, and <80% of these deaths occur in sub-Saharan Africa and South Asia, indicating the significant burden of child mortality within lower- and middle-income countries (LMIC). Global childhood mortality is driven by neonatal deaths, and prematurity and preterm births are the leading causes of death despite recent advances in obstetric and neonatal care. Respiratory distress syndrome (RDS) is the most common adverse birth outcome and cause of death for neonates, but LMICs lack the health infrastructure and diagnostic resources to accurately determine cause-specific mortality. The Child Health and Mortality Prevention Surveillance (CHAMPS) network was launched to ensure quality data collection on the etiologies of child mortality in LMICs, but little is known about neonatal deaths due to RDS. This study aims to better understand the risk factors for RDS among neonatal deaths to continue reducing childhood mortality in LMICs. Using CHAMPS DeCoDe and verbal autopsy datasets, we conducted Chi-square analyses to investigate the relationship between RDS and site characteristics; Student’s t-tests and ANOVA analysis were used to examine differences in mean gestational ages between RDS diagnoses. Univariate and multivariate logistic regression analyses were performed to determine risk factors and predictors of neonatal mortality due to RDS. Among all CHAMPS cases, neonates are more likely to be diagnosed with RDS as a cause of death than non-neonates. Individual CHAMPS sites are also associated with having RDS as a cause of death, suggesting the influence of unique regional characteristics on survival. Mean gestational ages among age groups and RDS diagnosis were significantly different, indicating the variable as a crucial risk factor. Univariate regression analysis reported a high level of HIV prevalence, multiple gestation, and low gestational age at birth as significant risk factors for RDS among neonatal deaths. Multivariable regression analysis reported low gestational age and dying at another health facility as significant factors. In LMICs, neonates are more susceptible to dying from RDS, and the translation of CHAMPS data can inform local and regional policymakers to advocate for targeted interventions that will further reduce child mortality.
Table of Contents
Chapter 1: Introduction 1
1.1. Background 1
1.2. Risk Factors for Preterm Births and Prematurity 3
1.3. Respiratory Distress Syndrome 4
1.4. The Child Health and Mortality Prevention Surveillance 5
1.5. Purpose Statement 7
Chapter 2: Literature Review 8
2.1. The Foundation and Case Definition of Preterm Births and Prematurity 10
2.2. The Epidemiology of Preterm Births and Prematurity 12
2.3. Risk Factors for Preterm Births and Prematurity 15
2.3.1. Multiple Gestations 15
2.3.2. Maternal HIV Status 16
2.4. Respiratory Distress Syndrome 18
2.5. Current Respiratory Therapy and Support 22
2.5.1. Continuous Positive Airway Pressure (CPAP) 22
2.5.2. Bubble-CPAP 24
2.6. Conclusion 26
Chapter 3: Methods 27
Chapter 4: Results 35
4.1. Gestational Age at Birth 36
4.2. Respiratory Distress Syndrome 37
4.3. Risk Factors for RDS among Neonates 38
Chapter 5: Discussion 39
References 47
Tables 54
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