The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

REPORT ON IMPACT OF INTRODUCTION of MECANICAL VENTILATION on NEONATAL SURVIVIAL in a PUBLIC HOSPITIAL in BELIZE

Katie Sabato MS RRT, Egbert Grinage MD , Neroli Williams RN, A. Nijssen, J Asselin MS RRT, L Fifer RRT , (EG, NW and AN, Belize City, Belize; KS and JA, Children's Hospital and Research Center at Oakland, Oakland, CA: and LF UCSF Med Center, San Francisco, CA.)

BACKGROUND: There have been many advances in the field of neonatal intensive care over the past 20 years that have improved both the morbidity and mortality of severely ill infants. One of these advances is the ability to provide assisted mechanical ventilation. Though these advances are widespread in industrialized nations, their use is limited in many developing countries. We report here one account of a country in their transition to being able to offer mechanical ventilation to their pediatric and neonatal patients.

METHODS:
Two respiratory care practitioners' (RCPS) from California responded to a Belizian's request for assistance in introducing mechanical ventilation to his country of Belize in November 2000. They brought respiratory equipment and provided hours of educational inservices to the physicians and nurses in the neonatal intensive care (Special Care Baby Unit SCBU) at Karl Heusner Memorial Hospital (KHMH) in Belize City, Belize. During this visit, the 2 RCPs repaired an old donated ventilator and Belize's first neonatal patient was ventilated and survived. In 2002, one RCP returned with three infant ventilators (VIP BIRD) and a medical team including a physician. Neonatal and Pediatric Life Support classes were taught to hospital staff. The RCP also held numerous classes on mechanical ventilation and ventilator maintenance along with a biomedical engineer. The biomedical engineer provided critical inservices in machine maintenance and interfacing them with existing hospital equipment. In 2001, the use of hyperalimentation was initiated. In 2003, surfactant became available to a subset of infants whose parents could afford it. Two RCPs again returned to Belize in March of 2005 delivering two additional VIP BIRDS, donated surfactant, suction catheters, oximetry supplies and continuing educational support.

DATA COLLECTION:
We collected demographic and outcome data prior to and after the educational programs provided on mechanical ventilation. Admission logs developed for the SCBU were reviewed and data extracted.

RESULTS:
Between December 1, 2000 and Dec 31, 2004, a total of 1697 infants were admitted to the SCBU at KHMH. Of these, 116 were ventilated with an overall survival of 40%. While early survival rates of ventilated infants are less than desired, in 2004 survival of ventilated infants was 58%, and we expect the trend to continue.

CONCLUSIONS: Mechanical ventilation and the use of surfactant and hyperalimentation has improved survival of infants in Belize. Improving this survival trend will depend on the ability for infants to receive surfactant and hyperalimentation, the availability for continued assistance with education on ventilatory techniques and equipment maintenance and provide other support specialists.
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