Initial respiratory support outcomes and associated factors among preterm neonates with respiratory distress syndrome admitted at Moi Teaching and Referral hospital Eldoret, Kenya

Background Respiratory distress syndrome (RDS) is the single most important cause of morbidity and mortality in preterm neonates. Early management of RDS is crucial in determining short- and long-term outcomes and studies have established initial respiratory support (IRS) among other factors as an important determinant. Despite preexisting guidelines and advancements in the management of RDS, IRS failure with noninvasive ventilation is common and is associated with unfavorable outcomes. Objective This study evaluated the non-invasive initial respiratory support outcomes and associated factors among preterm neonates with respiratory distress syndrome admitted in the newborn unit (NBU) at Moi Teaching and Referral Hospital Eldoret (MTRH), Kenya Methods Using a prospective observational hospital-based study, preterm neonates ≤ 35weeks admitted at the newborn unit with clinical RDS were followed up for 28 days. The primary outcome was IRS success or failure characterized by not stepping up or stepping up the respiratory support respectively within 72 hours of life and associated maternal and neonatal factors. Descriptive statistics was described using mean ± (SD) for continuous variables and frequencies and percentages for categorical variables. Simple and multinomial regression analysis was performed to evaluate relationship between different IRS methods with outcome variables and a p-value of < 0.05 was considered significant. Results We enrolled 320 neonates, 172(53.8%) were male with a mean (SD) gestation age of 30.9 (2.95) weeks. The mothers mean age was 27 years, ranging ([15][1]–43). 70(22.4%) 95%CI:17.95,27.47] had IRS failure and 243(77.6%) had IRS success. On multivariate analysis IRS success was associated with primiparity (AOR=2.81;95%CI: 1.42, 7.99), birthweight > 1300g (AOR= 5.04;95%CI 1.81, 14.6), low modified Downes score (AOR=26.395%CI 3.37, 230) and normal admission temperatures (AOR=0.32;95%CI 0.12, 0.72) (p= <0.001). Conclusion Noninvasive ventilation had a high initial respiratory support success. Primiparity, birthweight >1300g, normal admission temperatures and low Downes score were associated with IRS success. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Moi Teaching and Referral Hospital (MTRH) and Moi University School of medicine Institutional research and ethics committee (IREC) approval number IREC FAN/0004043 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files. [1]: #ref-15