Bronchopulmonary dysplasia in ventilated neonates :incidence and risk factors

Bronchopulmonary dysplasia occurs in neonates who need supplemental oxygen at 36 weeks gestational age and those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Mechanical ventilation is an invasive life support procedure that may cause lung injury through a combination of oxygen toxicity, barotrauma, and volutrauma. Alveolar development is interrupted and parenchyma destroyed leading to emphysematous changes, decreased lung compliance, and impaired gas exchange. There is a positive correlation between ventilator settings, duration of assisted ventilation and development of BPD. The aim of the study was evaluation of the incidence of bronchopulmonary dysplasia among ventilated neonates and determination of associated risk factors. A retrospective study conducted in the Neonatal Intensive Care Unit Cairo University over the period from January 2007 to December 2008. It included 633 ventilated neonates out of 3321 total admissions [19.06%]. All data were collected from patient's records. Patients were diagnosed to have bronchopulmonary dysplasia if they needed supplemental oxygen at 36 weeks gestational age or those born at >/= 32 weeks gestation who need additional oxygen after 28 postnatal days. Patients were classified to 2 groups: BPD group and non BPD group. Bronchopulmonary dysplasia [BPD] developed in 221633 ventilated neonates [3.48%]. Twenty of them had gestational age between [28 - 32] weeks [90.90%],14/22 were males [63.63%], 13/22 were delivered by CS [59.09%], BPD developed in 18/290 [6.2%] neonates ventilated by SIMV from start, 3/178 ventilated by NCPAP followed by SIMV [1.7%], 1/165 ventilated by NCPAP only [0.61%], with P-value 0.002 [significant]. Eleven neonates out of 22 BPD cases [50%] were discharged. Twenty one out of 285 neonates diagnosed as respiratory distress syndrome [7.4%] developed BPD. In BPD group, Mean Fraction of inspired oxygen was 60.68 +/- 16.90, compared to 33.24 +/- 21.57 in non BPD group P value < 0.001 Highly Significant [HS]. Mean PIP in BPD group was 21.94 +/- 4.22 and 21.32 +/- 5.26 non BPD group, P Value 0.63. Mean PEEP was3.94 +/- 0.24 in BPD group and3.79 +/- 0.45 in non BPD group, P value 0.17. Mean Rate was 39.29 +/- 8.27 in BPD group compared to 36.23 +/- 12.10 in non BPD group, P value 0.32. Mean Flow was 7.83 +/- 0.71 in BPD group and 7.66 +/- 0.57 in non BPD group, P Value 0.25. Mean I/E Ratio was 0.40 +/- 0.02 in BPD group and 0.38 +/- 0.03 in non BPD group, P value 0.04 [significant]. Mean birth weight in BPD group was 1.22 +/- 0.21 compared to 2.27 +/- 0.80 in non BPD group, P value <0.001 [H.S.]. Mean duration of ventilation was 35.77 +/- 4.07 days in BPD group compared to 6.36 +/- 4.07days in non BPD group, P value<0.001 [H.S]. Mean length of hospital stay was 39.36 +/- 4.58 days in BPD group compared to 8.12 +/- 5.68 days in non BPD group, P value <0.001. In conclusion; The use of NCPAP is associated with a lower incidence of BPD compared to SIMV. The least required oxygen should be delivered to minimize oxygen toxicity and reduce the incidence of chronic lung disease

Pneumothorax in mechanically ventilated neonates Cairo university: two years study

Pneumothorax is a severe complication of pulmonary disease in newborn infants. It is often related to therapeutic procedures such as resuscitation and mechanical ventilation. Aim of this study was to detect the incidence of pneumothorax in mechanically ventilated neonates in the Neonatal Intensive Care Unit [NICU] -Cairo University and determine their associated risk factors. A retrospective study conducted in the NICU Children's Hospital-Cairo University during the period from January 2007 to December 2008. Files of 633/3321[19.06%] neonates receiving assisted ventilation were studied for presence of a radiological evidence of air leaks. Accordingly, they were classified into 2 groups: Group I including neonates with evidence of pneumothorax, and Group II including those with no evidence of pneumothorax. Results detected pneumothorax in 26/633[4.10%] of ventilated neonates. There were statistical significant differences between both groups in: Mean birth weight which was1.47 +/- 0.58 kg in group I versus 2.48 +/- 0.77 kg in group II with P value<0.001 highly significant [HS], mean duration of Ventilation which was 13.15 +/- 8.61 days in group I versus 7.13 +/- 6.56 days in group II with P value<0. 001 [HS], days in group II with P value<0.001[HS], and outcome as 20/26[76.92%] neonates of group I died and 319/607[52.90%] of group II died with P value<0.001[HS]. Twenty one out of twenty six [80.76%] neonates were diagnosed as respiratory distress syndrome [RDS], while 5126 [19.23%] were meconium aspiration syndrome. The highest percentage of pneumothorax was observed in neonates receiving SIMV from the start of ventilation 15126 [57.69%], followed by those receiving NCPAP then SIMV 10126 [38.46%], and only in 1 neonate receiving NCPAP only[3.84%] with P value 0.032[Significant]. FIO2 was higher in group I compared to group II: 51.54 +/- 23.14 versus 35.09 +/- 19.10; P value<0.001[HS]. PIP was higher in group I than group II: 25.16 +/- 5.79 cm H20 versus20.82 +/- 4.57 cm H20; P value 0.01 [S]. Respiratory rate was higher in group I versus group II: 41.40 +/- 10.93 versus 34.55 +/- 11.65 ; P value 0.01 [S]