Uptake of Continuous Positive Airway Pressure and outcomes among newborns admitted in three county hospitals in Nairobi, Kenya

Background Neonatal mortality accounts for 47% of under-five deaths globally, with neonates comprising two-thirds of pediatric admissions in Kenya. Respiratory Distress(RD) is a leading cause of neonatal admissions, with Continuous Positive Airway Pressure (CPAP) recommended as an effective intervention in low- and middle-income countries (LMICs). We assessed CPAP uptake, short-term outcomes, and barriers to its utilization in three county hospitals in Nairobi, Kenya. Methods A mixed-methods study conducted at three county Hospitals in Nairobi, Kenya, included an analytical cross-sectional design conducted from 13^th September to 10^th October 2023 that quantitatively assessed CPAP uptake and short-term outcomes among 178 neonates (hospital stay, oxygen duration, mortality, referral for ventilatory support and adverse events) within a 28-day period. Qualitative data was collected between 13^th to 27^th September 2023 using researcher developed and piloted (Key Informant Interviews (KIIs) guide and structured in-depth interviews) from 22 healthcare workers highlighting insights on barriers to CPAP use, like limited equipment, infrastructure challenges, and inadequate staff capacity. Results Among the 178 neonates enrolled, CPAP uptake was 57.3%, with respiratory distress syndrome (RDS) being the most common diagnosis. CPAP cohort had shorter hospital stay(≤7 days), supplemental oxygen duration (median 2 days), and lower mortality (12.75% vs. 35.53%, p =<0.001). Multivariate analysis adjusted for potential confounding factors. This study did not correlate the severity of RD with outcome of mortality. CPAP cohort discharge proportion was at 78.43%, (p=0.0242). CPAP adverse events included nasal trauma (2.81%) and pneumothorax (0.56%). Barriers to optimal CPAP use and delay included limited equipment, poor infrastructure, ineffective Family Centred Care (FCC), and workforce gaps. Conclusions CPAP improves neonatal outcomes, but its impact across illness severities needs further study. Addressing barriers like limited equipment, poor infrastructure, lack of family involvement, and workforce shortages is crucial for expanding CPAP use and reducing neonatal mortality in LMICs.