Outcome of very low birth weight infants over 3 years report from an Iranian center

Very low birth weight [VLBW] infants are at high risk for morbidity and mortality. This article determines the frequency of disease, rate od survival, complications and risk factors for morbidity and mortality in VLBW neonates admitted to a level III neonatal intensive care unit [NICU]at Mahdieh Hospital in Tehran. This cross-sectional retrospective study was performed from April 2007 to March 2010 on all hospitalized VLBW neonates. Relevant pre- and peri-natal data up to the time of discharge from the hospital or death, including complications during the course of hospitalization, were collected from the case notes, documented on a pre-designed questionnaire and analyzed. Out of 13197 neonates, 564 [4.3%] were VLBW with 51.4% males. Mean gestational age was 29.6 +/- 2.5 weeks; mean birth weight 1179 +/- 257 grams. Mean birth weight, gestational age and Apgar scores were significantly higher in babies who survived than in those who died, [1275 +/- 189 vs. 944 +/- 253 grams; 30.5 +/- 2.2 vs. 27.5 +/- 2 weeks and 6.9 +/- 1.7 vs. 5 +/- 2.1 respectively, P<0.001 in all instances]. Overall survival was 70.9%; in extremely low birth weight [ELBW] newborns this figure was 33.3% rising to 84.1% in infants weighing between 1001-1500 grams. Respiratory failure resulting from RDS in ELBW babies was the major factor leading to death. Need for mechanical ventilation, pulmonary hemorrhage and gastro-intestinal bleeding were also significant predictive factors for mortality. Birth weight and mechanical ventilation are the major factors predicting VLBW survival

Surveillance of ventilator-associated pneumonia in a neonatal intensive care unit: characteristics, risk factors, and outcome

This study determined the incidence, characteristics, risk factors, and outcomes of ventilator-associated pneumonia [VAP] in newborns hospitalized in a Neonatal Intensive Care Unit [NICU] in Tehran, Iran. A prospective cohort study was carried out in the NICU of Mandieh Hospital over a period of one year, from December 2008 to November 2009, on all neonates mechanically ventilated for more than 48 hours. VAP was diagnosed in accordance with the CDC definition of nosocomial pneumonias for patients younger than 12 months. Risk factors relevant to the development of VAP were studied. Multiple logistic and Cox regression analysis were performed to determine independent predictors for VAP and survival rate, respectively. There were 81 neonates enrolled. VAP occurred in 14[17.3%], at rate of 11.6/1000 days on the ventilator. Gram negative bacteria were the predominant etiologic agents. The most common bacterial isolates from the endotracheal aspirate were E.coli [21.4%]. KIebsiella [21.4%], and Pseudomonas [14.1%]. The only VAP predictor was sputum [odds ratio [OR]=5.11, P=0.02]. Mortality rate for VAP was 2/14[14.3%]. Duration of mechanical ventilation [hazard ratio [HR] 0.96, P0.01], birth weight [HR=0.81, P < 0.001], and purulent tracheal aspirate [HR=0.25, P < 0.006] were independent predictors of overall survival. VAP occurs at a significant rate in mechanically ventilated newborns. Additional studies are needed to accurately determine the incidence and risk factors in order to develop effective preventive and therapeutic protocols

[Survey of one year neonatal resuscitation in the delivery room of Mahdieh Hospital, Tehran]

Timely identification and prompt resuscitation of newborns in the delivery room may cause a decline in neonatal asphyxia. The aim of this study was to identify risk factors that result in the resuscitation of newborns at birth in Mahdieh Hospital. This cross sectional study was done during one year and risk factors for neonatal resuscitation, level of resuscitation and short outcomes [survival or death], wre extracted from charts and were analyzed. During the study period, 4692 neonates were delivered; 97.7% did not require respiratory assistance. 2.3% needed resuscitation with bag and mask in the delivery unit; of these, 1.6% responded to bag and mask ventilation while 0.65% needed endotracheal intubation and 0.3% were given chest compressions. Epinephrine/volume expander was administered to 0.2%. In multiple regression analysis, low birth weight, meconium stained liquor and chorioamnionitis were revealed as independent risk factors for advance resuscitation. Neonatal mortality was 10 in 1000 live birth; asphyxia with 23.4% was one of major causes of neonatal mortality. Incidence of asphyxia was 0.3%, 24.7% and 50% in neonates without resuscitation, basic resuscitation and advance resuscitation, respectively. It seems that low birth weight, meconium stain amniotic fluid and chorioamnionitis are major risk factors for neonatal resuscitation in delivery room.