Outcome of neonatal ventilation: a prospective and cross-sectional study in tertiary care centre

Abstract

Background: Neonatal mortality accounts for nearly two thirds of infant mortality and half of under 5 mortalities in India. It is possible to increase neonatal survival and improve the quality of life only through prompt and adequate management of critically ill newborn. Mechanical ventilation has become a must to enhance neonatal survival and is an essential component of neonatal intensive care.Methods: Hospital based prospective, cross-sectional study from 1st July 2012 to 30th June 2013. All NICU admitted neonate requiring mechanical ventilation were included. It was a descriptive, cross-sectional study of a prospective data.Results: Indication of mechanical ventilation: Out of 72 neonates studied, majority of preterm were ventilated for RDS - 34 (89.5%) and majority of Full term were ventilated for MAS - 16 (100%) followed by HIE - 8 (88.89%). Out of 38 RDS cases, 30 (79%) were ventilated till 4-7 days duration and 3 (7.9%) required ventilation for >10 days. Out of 16 MAS cases, 10 (62.5%) were ventilated for 4-7 days duration and none required prolonged ventilation. Duration of ventilation is not statistically associated with indication of mechanical ventilation with p=0.301.Conclusions: Mechanical and Pulmonary complications of mechanical ventilation are not statistically significant for outcome of mechanical ventilation but it increases length of NICU stay. Hypotension on ventilator, requirement of more than 3 ionotropes were associated with high mortality.

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

“…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%.…”

“…Regarding to sepsis as the third most common complication in our study with high mortality rate, this result is in agreement with this study [10] that showed that sepsis was the third most common complication in their study (8.6%) with disease specific mortality rate (40%). VAP and pneumothorax incidence in our study was (4.8%) and (3.2%) respectively and this result is in agreement with this study [18] and with this study [19] but in contrary with this study [10] who observed that pneumonia was more common complication (12.06%) with mortality rate (14.28%) and pneumothorax incidence was (10.34%) with disease specific mortality (50%). No cases with IVH reported in our study and this result is contrary with this study [20] with incidence (2.35%) and in contrary with this study [21] who found that number of IVH cases were 3 with 100% mortality rate.…”

“…In our study pulmonary hemorrhage (27.8%) and shock (25.8%) had significant association with mortality and this result is in agreement with this study [11] and this study [17] who found a very poor outcome in neonates following pulmonary hemorrhage and shock. In this study [18] who described pulmonary hemorrhage as predictive of mortality and a terminal event. Shock represents an advanced stage of a disease process of varied etiologies and its relationship with mortality is understandable.…”

Outcome of neonates requiring mechanical ventilation in a tertiary hospital

“…[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.…”

“…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.…”