Neonatal mechanical ventilation: Indications and outcome

Abstract

Background and Aims:Decreasing mortality in sick and ventilated neonates is an endeavor of all neonatologists. To reduce the high mortality in this group of neonates, identification of risk factors is important. This study was undertaken to find out the indications of ventilation and complications in ventilated neonates and also study possible predictors of outcome.Subjects:Age <1-month; mechanically ventilated; not having suspected metabolic disorders or congenital anomalies; excluding postoperative patients.Methods:Neonates consecutively put on mechanical ventilation during the study period (October 2011 to November 2013) enrolled. Primary disease of the neonates along with complications present listed. Clinical and laboratory parameters analyzed to find the predictors of mortality.Results:Total 300 neonates were ventilated. 52% were male. Mean age, weight, and gestational age were 21 ± 62 h, 2320 ± 846.2 g, and 35.2 ± 4.9 weeks, respectively. 130 (43%) neonates died. Respiratory distress syndrome (RDS) (31.1%), sepsis (22.7%), and birth asphyxia (18%) were the most common indications for ventilation. Mortality in ventilated patients with sepsis, pneumonia, RDS or birth asphyxia was 64.7%, 60%, 44.6%, and 33.3%, respectively. Weight <2500 g, gestation <34 weeks, initial pH <7.1, presence of sepsis, apnea, shock, pulmonary hemorrhage, hypoglycemia, neutropenia, and thrombocytopenia were significantly associated with mortality (P < 0.05). Resuscitation at birth, seizures, intra ventricular hemorrhage, pneumothorax, ventilator-associated pneumonia, PO2, or PCO2 did not have a significant association with mortality. On logistic regression, gestation <34 weeks, initial pH <7.1, pulmonary hemorrhage, or shock were independently significant predictors of mortality.Conclusions:Weight <2500 g, gestation <34 weeks, initial arterial pH <7.1, shock, pulmonary hemorrhage, apnea, hypoglycemia, neutropenia, and thrombocytopenia were significant predictors of mortality in ventilated neonates.

Outcome of neonates requiring mechanical ventilation in a tertiary hospital

“…Neonatal sepsis (33.6%) was the commonest indication for ventilation followed by BA 24.3%, RDS 16%, apnea of prematurity 16% and MAS 10.1%. Similar pattern were reported in various other studies conducted within the country and abroad [8][9][10] . Shrestha P et al also reported that the 37.2% ventilated neonates had sepsis as the primary cause followed by respiratory distress (17.6%) Sepsis was the second most common cause for ventilation in studies conducted by Shrestha S et al, Srinivas N et al, Iqbal Qazi et al [8][9][10] Birth asphyxia was the most common cause for mechanical ventilation in neonates in BPKIHS Dharan (34%) and Paropakar Maternity and Women's Hospital (60%) Nepal.…”

“…Sepsis had a uniformly poor outcome in other studies by Iqbal Q et al (35.3%) and Ananthraj A et al (46.1%). 10,14 Neonates with RDS had a survival rate of 36.8%, which is lower than 50 % -82.6 % as reported by other authors. 7,8,[10][11][12]17 Various authors claim that better survival rates in their study was made possible by early intervention and uniform use of surfactant in all PT/MAS/BA.…”

“…[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.…”

“…7,8,[10][11][12]17 Various authors claim that better survival rates in their study was made possible by early intervention and uniform use of surfactant in all PT/MAS/BA. [10][11][12]17 Low survival in our study may be due to unavailability of surfactant to PT babies, late referral & high rate of sepsis during the study period. So easy availability of surfactant at a reasonable cost would have decreased the mortality.…”

Effects of Different Doses of Fentanyl on the Sedation of Infants Under Mechanical Ventilation; A Randomized Clinical Trial

“…3 Surfactant and mechanical ventilation are among the primary treatments to help infants with respiration. 4,5 Even after mechanical ventilation, infants show restlessness and stress because of abnormal and incomplete breathing, and this stress effectively results in altered lung function. 6 Some sedative drugs, such as benzodiazepines and opioids, are used to reduce infants' stress and restlessness under mechanical ventilation.…”