# Neonatal respiratory care in Vietnam: surfactant use and clinical practices in a large neonatal intensive care unit

## TL;DR

This study examines neonatal respiratory care practices in Vietnam, focusing on surfactant use and clinical outcomes in a large hospital's NICU.

## Contribution

The study provides a detailed characterization of neonatal respiratory care practices in a lower-middle-income setting in Southeast Asia.

## Key findings

- Respiratory distress syndrome was the leading cause of respiratory support, affecting 41% of infants.
- Non-invasive respiratory support methods like nCPAP and NIPPV were widely used, with NIPPV more common in larger infants.
- Surfactant therapy was administered to 37% of infants with RDS, primarily within six hours of birth.

## Abstract

Neonatal mortality remains a significant health challenge, particularly in low- and middle-income settings, where respiratory distress is a major contributor to mortality. Characterizations of respiratory care practices in the neonatal intensive care unit (NICU), in lower-middle-income contexts in south-east Asia, are notably sparse in the literature. This study aimed to describe the management practices, morbidity, and mortality of newborns requiring respiratory support at a large level III NICU in Hanoi, Vietnam.

This prospective, descriptive observational study was conducted at Phu San Hanoi Hospital with about 35 000 births in 2023. Infants born alive, requiring respiratory support, and with a birth weight ≥ 700 g were included. Data were collected from September 1 to November 30, 2023, and analysed using descriptive statistics.

During the study period 17% of infants born at the hospital were admitted to the NICU of which n=874, 52% were included in the analysis. The median gestational age was 34.6 weeks, and the median birth weight was 2,150 g. Respiratory distress syndrome (RDS) was the leading cause of respiratory support (41%), followed by transient tachypnoea of the newborn (24%) and early-onset sepsis (13%). Non-invasive respiratory support, especially nasal continuous positive airway pressure (nCPAP) (45%) and nasal intermittent positive airway pressure (NIPPV) (21%), was widely utilized, with NIPPV being more common among larger infants. Invasive mechanical ventilation was required in 23% of infants, with higher rates in lower birth weight groups. The overall mortality rate was 3%, with the highest mortality among extremely low birth weight infants (36%). Surfactant therapy was administered to 37% of infants with RDS which was also the primary indication for surfactant treatment (98%). Of all first-dose surfactant therapies, 92% were given within the first six hours after birth and 49% were administered by the INSURE (intubation-surfactant-extubation) method.

This study provides valuable insights into respiratory care practices and outcomes for infants requiring respiratory support at northern Vietnam’s largest obstetrical hospital. It highlights RDS as a significant contributor to neonatal morbidity and identifies opportunities to enhance non-invasive support and surfactant administration techniques, potentially reducing invasive mechanical ventilation and improving neonatal outcomes.