Supplementary Material for: Neonatal Respiratory Support Utilization in Low- and Middle-income Countries: a Registry-based Observational Study

Background
Newborns with hypoxemia often require life-saving respiratory support. In low-resource settings, it is unknown if respiratory support is delivered more frequently to term infants or preterm infants. We hypothesized that in a registry-based birth cohort in 105 geographic areas in seven low-and middle-income countries, more term newborns received respiratory support than preterm newborns.

Methods
This is a hypothesis-driven observational study based on prospectively collected data from the Maternal and Newborn Health Registry of the NICHD Global Network for Women’s and Children’s Health Research. Eligible infants enrolled in the registry were live-born between 22 and 44 weeks gestation with a birth weight ≥400 grams and born from January 1, 2015 to December 31, 2018. Frequency data were obtained to report the number of term and preterm infants who received treatment with oxygen only, CPAP, or mechanical ventilation (MV). Test for trends over time were conducted using robust Poisson regression.

Results
177,728 (86.3%) infants included in this study were term and 28,249 (13.7%) were preterm. A larger number of term infants (n=5,108) received respiratory support compared to preterm infants (n=3,287). Receipt of each mode of respiratory support was more frequent in term infants. The proportion of preterm infants who received respiratory support (11.6%) was higher than the proportion of term infants receiving respiratory support (2.9%, p < 0.001). The rate of provision of respiratory support varied between sites.

Conclusions
Respiratory support was more frequently used in term infants expected to be at low risk for respiratory disorders compared to preterm infants.