Management of Newborn Respiratory Distress Using CPAP: Capacity and Readiness of Public Health Facilities in High-Focus Aspirational Districts of India

Abstract

Background and Objective: Adequate respiratory support is crucial for managing respiratory distress in hypoxic newborns. Continuous positive airway pressure (CPAP) devices are widely recommended for this purpose, but their availability and functionality in district-level healthcare facilities in India are unclear. This study aims to assess the capacity and readiness of public health facilities in high-focus Aspirational Districts of India to manage respiratory distress using CPAP and oxygen support. Methods: A cross-sectional descriptive study was conducted in 15 functional Special Newborn Care Units (SNCUs) across 14 Aspirational Districts in five Indian states. Data were collected using a semi-structured tool developed in collaboration with state health authorities, aligned to national and global newborn care guidelines. The study focused on assessing the status of infrastructure, human resources, oxygen supply, CPAP utilization, and staff practices. Results: Pulse oximeters were available in all SNCUs, with most units using monitor-based devices. Oxygen supply was available at 89% of SNCU beds. Different sources of oxygen supply at SNCUs included oxygen concentrators (93%), manifold rooms (33%), and oxygen plants (13%). CPAP devices were available in only 20% of SNCUs. Oxygen concentrators emerged as the predominant method for oxygen therapy (66.7%), followed by central oxygen supply via manifold room or oxygen plant (26.7%). Monitoring of the oxygenation status of newborns on respiratory support was done at a frequency of at least every 3 hours in 66.7% of units. Conclusion and Global Health Implications: The study identified significant gaps in the use of CPAP devices for managing hypoxic newborns in special newborn care units (SNCUs) of Aspirational Districts, reflecting broader healthcare challenges. There is an urgent need to improve oxygen delivery systems and increase CPAP availability in secondary health facilities. These findings call for targeted interventions, capacity building, and strategic resource allocation to enhance neonatal health outcomes in resource-limited settings.