Outcome of Neonates with Meconium Aspiration Syndrome on High Frequency Oscillatory Ventilation in NICU of Tertiary Care Centre

Background: Meconium Aspiration Syndrome (MAS) is a complex respiratory disease of the term and near-term neonate. Inhalation of meconium causes airway obstruction, atelectasis, epithelial injury, surfactant inhibition and pulmonary hypertension, the chief clinical manifestations of which are hypoxemia and poor lung compliance. Supplemental oxygen is the mainstay of therapy of MAS, with around one-third of infants requiring mechanical ventilation. For those ventilated, high ventilator pressures, as well as relatively long inspiratory time and slow ventilatory rate, may be necessary to achieve adequate oxygenation. High frequency ventilation may offer a benefit in infants with refractory hypoxemia and/or gas trapping. High-frequency oscillatory ventilation (HFOV) is a lung-protective strategy that can be utilized in the full spectrum of patient populations ranging from neonatal to adults with acute lung injury. HFOV uses low tidal volumes and constant mean airway pressures in conjunction with high respiratory rates to provide beneficial effects on oxygenation and ventilation, while eliminating the traumatic “inflate–deflate” cycle imposed by CV. Few studies have shown that, HFOV can effectively improve lung ventilation and oxygenation function, shorten ventilator treatment time and reduce the incidence of air leakage for neonatal MAS, making it a safe and effective treatment method. Objective:To study the Outcome of Neonates with Meconium Aspiration Syndrome on High Frequency Oscillatory Ventilation (HFVO).Material & Methods:It is a Prospective Observational Study of 10 neonates >34 weeks of gestation and birth weight >1500gm with meconium-stained liquor with respiratory distress requiring mechanical ventilation. Study was conducted over a period of 10months from August 2021 to May 2022. These neonates requiring mechanical ventilation were electively first hand put on SensorMedics 3100A High Frequency Oscillatory Ventilator after taking informed written consent from parents and given appropriate Intensive care. Data was analyzed at the end of the study duration and looked for outcome in the form of successful weaning from mechanical ventilation and discharge from NICU, and Death.Results:8 out of 10 (80%) neonates with MAS that were ventilated via HFOV were successfully weaned from mechanical ventilation and discharged, while death was reported in 2 out of 10 (20%) of the neonates included in the study.Conclusion:80% of neonates with MAS that were provided mechanical ventilation in the form of HFOV were effectively weaned off from mechanical ventilation, whereas 20% neonates died. This shows clinical effectiveness of HFOV in MAS making it a safe and effective treatment modality in neonates with MAS.

Outcome of Early Versus Late Surfactant Therapy in Preterm Neonates with Respiratory Distress Syndrome at a Tertiary Care Centre

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD), has been recognized as the most common co-morbidity of prematurity. Prematurity and RDS largely contribute to early neonatal morbidity and mortality. With adequate antenatal steroid and early continuous positive airway pressure, early surfactant therapy improve survival outcome.Material & Methods:Prospective interventional study included newborns with prematurity 28-36 weeks(GA) with clinical Respiratory distress syndrome and birth weight(BW)>650 gm. All subjects were preferably provided early surfactant therapy (within 2hours after birth). Surfactant (survanta) was delivered by INSURE technique (Intubate- Surfactant administration- Extubate) and only those who required further respiratory support were ventilated. Records on birth weight, gestational age, timing of therapy (early/late), sepsis, complications, and survival/death outcome were collected and data was analyzed using SSPS version 20 software.Results:Out of 76 neonates (42 male, 34 female), 46 received early surfactant therapy and 30 obtained it late; Although mortality was observed with both early(36.66%) and late therapy(63.33%), there was significantly higher survival with early therapy. higher mortality occurred in lower Birth weight(LBW) /Gestational age (GA) subgroups. Culture positive sepsis was found in 52.6% with higher association with late therapy . Hypotension was most common complication with late intervention , whereas there was no difference for pulmonary haemorrhage or apnea.Conclusion:Early surfactant administration improved survival with minimal complications in RDS except for extremely premature/LBW babies.

Study of Clinical Presentation and Associated Complications of Tetanus in Pediatric Patients- A Prospective Study

Background:Tetanus is caused by a potent toxin produced by anaerobic bacilli clostritiumtetani. Though it’s a completely vaccine preventable disease its incidence is still high in developing countries including in India. Tetanus is a disease of poor and developing countries of the world. Its incidence chiefly depends on economic, demographic and environmental factors. Since it carries a high morbidity and mortality despite advanced medical care the emphasis should be on complete immunization of children. We conducted this prospective study to analyze clinical features and complication in children with tetanus. Aims and Objectives: To study clinical presentation and complications of tetanus in children.Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 12 pediatric patients diagnosed with tetanus. The study was a prospective cohort study conducted in the department of pediatrics of a tertiary care hospital situated in a metropolitan area. Patients were included in this study on the basis of predefined inclusion criteria. Patients having any exclusion criteria were excluded from the study. The data was tabulated and analyzed using SPSS 16.0 version software.Results:The study comprised of 12 pediatric patients admitted with tetanus. Out of these 12 patients there were 6 males and 6 females with a M: F ratio of 1:1. 6 patients belonged to age group of 0-5 years and 6 patients were more than 5 years of age. Majority of the patients belonged to urban area (66.66%) while 4 patients (33.33%) belonged to rural area. The analysis of probable mechanism of infection showed that most of the patients acquired infection through injuries (41.66%) followed by ear infections (25%), wounds (16.66%) and burns (16.66%). Trismus (33.33%), hypertonicity in legs (25%), dysphagia (16.66%), stiffness (16.66%) and fever (8.33%) were the common presenting complaints in the studied cases. Clinical signs seen in the studied cases included tachycardia (66.66%), tachypnea (33.33%) and autonomic disturbances (8.33%). The study of immunity status showed that 6 children (50%) were partially immunized while 5 (41.66%) and 1 (8.33%) children were completely unimmunized and completely immunized. Complications were seen in 10 (83.33 %) children and were more common in the age group of 0-5 years in which all patients developed complications. Common complications seen in treated children included Pneumonia (33.33%), ARDS (16.66%), congestive cardiac failure (16.66%), Renal Failure (16.66%), DIC (8.33%), sepsis (8.33%) and bedsores (8.33%). Mortality was found to be 41.66%.Conclusion: Though being a vaccine preventable disease incidence of tetanus is still high in developing countries.Unimmunized children are susceptible to this dreadful disease after trauma, ear infections and burns. Since it carries a high morbidity and mortality the emphasis should be given in immunization of all children.