Remote Mentorship to Improve Continuous Positive Airway Pressure Use in the Ethiopian Neonatal Network

BACKGROUND Continuous positive airway pressure (CPAP) is an evidence-based therapy for respiratory distress syndrome (RDS), the leading cause of death for preterm infants globally. Ethiopian Neonatal Network (ENN) teams identified a quality gap in CPAP use for preterm infants with RDS. We sought to use remote education and mentorship without additional resources to improve CPAP use in this population. METHODS Nineteen public ENN hospitals participated in this quality improvement (QI) collaborative (September 2021 to September 2022). The primary intervention was implementation of a telementoring program. Five Ethiopian nurse-physician mentor pairs each supported 4 mentee hospitals through a remote CPAP optimization training package. Quarterly ENN collaborative meetings reviewed progress and challenges. Hospitals submitted patient-level data for all neonatal unit admissions and monthly audits. Run chart rules were used to assess for nonrandom evidence of change related to CPAP use. Preterm mortality in preintervention and postintervention periods was evaluated by a χ2 test. RESULTS The launch of the QI collaborative with remote education and mentoring coincided with an increase in the documentation of Downes score on admission (57.8% to 95.6%) and number of preterm infants (<37 weeks’ gestation) receiving CPAP (129 to 138 per month). Preterm mortality decreased significantly from preintervention (28%) to postintervention periods (21.6%) (P < .0001). CONCLUSION Ethiopian nurse-physician mentorship pairs supporting mentee hospitals in standardizing assessments of respiratory distress and optimizing the use of CPAP increased the number of preterm infants treated with CPAP. Significant reduction in preterm mortality postintervention is encouraging as CPAP use continues to scale up globally.