Resuscitation of preterm infants in the Philippines: a national survey of resources and practice

Arch Dis Child Fetal Neonatal Ed. 2020 Mar;105(2):209-214. doi: 10.1136/archdischild-2019-316951. Epub 2019 Jun 14.

Abstract

Objective: There is a high incidence of preterm birth in low-income and middle-income countries where healthcare resources are often limited and may influence decision making. We aimed to explore the interplay between resource limitations and resuscitation practices for extremely preterm infants (EPIs) in neonatal intensive care units (NICUs) across the Philippines.

Methods: We conducted a national survey of NICUs in the Philippines. Institutions were classified according to sector (private/public), region and level. Respondents were asked about unit capacity, availability of ventilators and surfactant, resuscitation practices and estimated survival rates for EPIs of different gestational ages.

Results: Respondents from 103/228 hospitals completed the survey (response rate 45%). Public hospitals reported more commonly experiencing shortages of ventilators than private hospitals (85%vs23%, p<0.001). Surfactant was more likely to be available in city hospitals than regional/district hospitals (p<0.05) and in hospitals classified as Level III/IV than I/II (p<0.05). The financial capacity of parents was a major factor influencing treatment options. Survival rates for EPIs were estimated to be higher in private than public institutions. Resuscitation practice varied; active treatment was generally considered optional for EPIs from 25 weeks' gestation and usually provided after 27-28 weeks' gestation.

Conclusion: Our survey revealed considerable disparities in NICU resource availability between different types of hospitals in the Philippines. Variation was observed between hospitals as to when resuscitation would be provided for EPIs. National guidelines may generate greater consistency of care yet would need to reflect the variable context for decisions in the Philippines.

Keywords: intensive care; neonatology; paediatric practice; resuscitation.

MeSH terms

  • Developing Countries*
  • Gestational Age
  • Health Care Rationing / standards
  • Health Care Rationing / statistics & numerical data
  • Health Expenditures
  • Hospitals, Private / standards
  • Hospitals, Private / statistics & numerical data
  • Hospitals, Public / standards
  • Hospitals, Public / statistics & numerical data
  • Humans
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal / standards*
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Philippines
  • Practice Patterns, Physicians'
  • Pulmonary Surfactants / administration & dosage
  • Respiration, Artificial / standards
  • Respiration, Artificial / statistics & numerical data
  • Resuscitation / standards
  • Resuscitation / statistics & numerical data*
  • Socioeconomic Factors
  • Survival Analysis

Substances

  • Pulmonary Surfactants