Clinical Profile and Outcome of Mechanically Ventilated Neonates in a Tertiary Level Hospital

Abstract

Introduction: Many sick neonates admitted to neonatal intensive care unit (NICU) require mechanical ventilation but it is associated with various complications and the outcome of neonates is unpredictable. This study aims to identify the indications for mechanical ventilation, complications, co-morbid conditions and outcome of those neonates in terms of survival. Materials and Methods:Retrospective observational study of all neonates who underwent mechanical ventilation from 1 January 2014 to 31 December 2014 in NICU, Tribhuvan University Teaching Hospital. Medical records of the patients were retrieved from hospital record section to collect the relevant data. Results: One-third of admitted neonates in NICU required mechanical ventilation (MV). Commonest indication was severe respiratory distress (70%) followed by perinatal asphyxia (12%) and recurrent apnea (8%). Disease pattern were sepsis (37.2%), RDS of prematurity (17.6%), perinatal asphyxia (11.7%), meconium aspiration syndrome (9.8%), apnea of prematurity (7.8%) and congenital pneumonia (4%). Hospital acquired sepsis was a major complication occurring in 47% patients on mechanical ventilation. Survival rate among neonates on MV was 33%. Survival was better with increasing birth weight and gestational age. Survival was 100% in congenital pneumonia, 50% in perinatal asphyxia, 50% in recurrent apnea, 26% in sepsis, 20% in MAS and 0% in RDS of prematurity. Conclusion: Survival rate of neonates on mechanical ventilation in NICU was 33%. Sepsis was a major problem in NICU, which must be addressed to improve outcome.

Analytical study for neonates with respiratory distress on mechanical ventilation admitted to NICU - Minia University Hospital

“…In this study, the total number of cases needed ventilation was (39.8%) and this result is in agreement with this study [7] who reported that ventilated cases were (32%). In this study, the survival rate of mechanical ventilated cases was (23%) while the mortality rate was (77%) and this result is in agreement with this study [7] who showed that survivors were (33.3%) and non survivors were (66.7%) but in contrary with these study [8],[9] , [10] , [11] who reported that the mortality rate was less than that reported in this study and reported to be between 43-67 %.This result may be explained by that the majority of the cases needed MV were preterm and they represented about two thirds of the cases died and in some of these studies MV used were more advanced with more modalities and more efficacy also in some studies reported using HFOV in cases as MAS or in air leak cases as pneumothorax. Sepsis also found to be one of the major complications in this study and one of the major indications for ventilation increasing risk for mortality unlike some of these studies who reported less incidence of sepsis than in this study.…”

“…This result is in agreement with this study [12] who found that neonates who are between (>34 -< 37) weeks gestational age had the highest survival rate followed by neonates who are between (30 -<34) weeks gestational age who had less survival rate than the previous group followed by neonates who are between (27-<30) weeks gestational age who had the least survival rate. Regarding to the duration of ventilation assistance significant difference (p=0.024) was found between survived group and group who died and this result is in agreement with this study [10] who found that (70.37%) of the cases survived needed (1-7) days of ventilation , also in agreement with this study [8] who found that (75.8%) of the cases survived required ventilation for (4)(5)(6)(7) days .This result may be explained by the fact that short period of MV will cause an inflammation cascade in the lungs as showed in this study [13] and this suggests that weaning from MV should be done as soon as possible, in order to prevent pulmonary sequelae and adverse neurodevelopmental outcomes [14]. In this study, survival rate for RDS was (48.3%)and this is in agreement with both studies [7] and [9] While the mortality rate of RDS was the highest compared to other indications of MV and this result is contrary with this study [10] and with this study [11] who reported that the mortality rate for RDS was only 15-25%.…”

Outcome of neonates requiring mechanical ventilation in a tertiary hospital

“…Overall survival in this study was 37.8%, which is comparable to a few reported from other Intensive care units (NICU) within the country where reported survival rates vary between 33.3 % to 50.8%. 1,7,11 Whereas this survival rate is poorer than those reported by different authors where it varied between 55.5 % to 86%. [14][15][16] This is probably because of larger preterm neonates who are more prone to neonatal sepsis, RDS/HMD and various complications related to different systems and unavailability of surfactant.…”

“…Premature rupture of membrane (PROM) more than 18 hours is a proven risk factor for neonatal sepsis. 6,7 Our study also reflects the fact that neonates with history of PROM more than 18 hours had a poor survival rate of only 21.2 % which was statistically significant.…”

“…[3][4][5] MAS had the best outcome in the series by Malhotra et al 4 and Riyas et al 3 with 100% and 63.6% survival, respectively. Poorest outcome of 0% survival was found in the series by Singh et al and Karthikeyeyan et al [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] We found a poor survival rate (37.5%) in babies with sepsis. Sepsis had a low survival rate in all other studies within the country.…”