ABSTRACT
Background: Mechanical ventilation is one of the importantadvancement which has contributed to the decline of neonatalmortality in the various parts of the world. Many sick neonatesadmitted to neonatal intensive care unit (NICU) requiremechanical ventilation for different clinical conditions but it isassociated with various complications and the outcome ofthese neonates is unpredictable.Objective: To find out the clinical conditions and immediateoutcome of neonates requiring mechanical ventilation.Methods: This prospective observational study was conductedin Neonatal Intensive Care Unit (NICU), Department ofNeonatology of Bangabandhu Sheikh Mujib Medical University,Dhaka during the period of August 2015 to July 2016.Neonates required to put on mechanical ventilation wereconsecutively enrolled. All babies were monitored for clinicalprofile and outcome as well as complications. The enrolledneonates were divided into two groups. Neonates whoremained successfully extubated for >48 hours and did notrequire re-intubation were grouped as survivors and who diedduring mechanical ventilation or within 48 hours of extubationwere grouped as non-survivors. Clinical, biochemical, ventilatorparameters and occurrence of complications were analyzed tofind out the factors associated with mortality of ventilatedneonates.Results: During the study period 53(8.6%) of admittedneonates in NICU received mechanical ventilation. Out ofthese 53 neonates 69.8% were male with male to female ratio2.3:1.Inborn babies were more (58.5%) than out born (41.5%).Mean age, gestational age and birth weight were3.58±5.45days 33.34±3.40 weeks and 1852.55±513.48grespectively. Commonest condition for initiating mechanicalventilation was refractory apnea (35.8%) followed by severerespiratory distress with Downe score >6 (20.8%) and SpO2<accepted level (17.0%). Disease pattern were sepsis (35.8%),RDS (20.8%), congenital pneumonia (18.9%), perinatalasphyxia (15.1%), meconium aspiration syndrome (3.8%), TTN(1.9%) and Meningitis (3.8%). The survival rate was 35.8%.Factors significantly different in non-survivors were meangestational age, mean birth weight, initial arterial pH, age atadmission and age at initiation of ventilation (p<0.05). Themean maximum PIP requirement was significantly higher innon-survivors (p<0.05). Hospital acquired sepsis (67.9%) wasthe most common complication during mechanical ventilationfollowed by tube block (52.8%) and ventilator associatedpneumonia (26.4%). Shock (64.2%) was the commonest comorbidity followed by dyselectrolytemia (52.8%), sepsis(35.8%) and DIC (28.3%). Hospital acquired sepsis, shock andDIC were associated with mortality (p<0.05). Shock was foundindependent predictor of mortality (p=0.001).Conclusion: The most common condition for initiatingmechanical ventilation was refractory apnea. Sepsis was thecommonest disease for which ventilation required. The survivalrate of ventilated neonates was 35.8% and percentage ofsurvival was more in babies with RDS. Hospital acquiredsepsis was the major complication of ventilated neonates.Presence of hospital acquired sepsis, shock and DIC wassignificantly high in non-survivors. Shock was found asindependent predictor of mortality.
ABSTRACT
Background: Fetal growth is a complex process whichdepends on nutrient and oxygen availability and transport fromthe mother to the fetus across the placenta. This involveshormones and growth factors as well as maternal and fetalgenes. The failure of the fetus to reach his or her full potentialfor growth is called intrauterine growth restriction (IUGR) andimplies risk for adverse short- and long-term outcomes.Objective: To study the frequency, risk factors and outcome ofthe clinical management of IUGR infants in the NICU of atertiary care hospital.Methods: This case control study was conducted from August2015 to July 2016 in the department of Neonatology,Bangabandhu Sheikh Mujib Medical University (BSMMU). Priorapproval from Institutional Review Board (IRB) for this researchwork was taken.After taking consent from parents/Guardians, particulars of theneonates, antenatal, natal and postnatal history were recordedin a data collection form. All Newborn in the NICU during studyperiod were the study population. Newborn who meet theinclusion criteria were divided into two groups as case group(IUGR babies) and control group (AGA babies). The riskfactors were identified by taking face to face interview ofmother regarding prenatal period whereas the outcome ofclinical management was observed by the caution and carefulNICU follow up of the baby. Data were analyzed by statisticalpackage for social sciences (SPSS) version 20. At firstfrequency of IUGR was found among all admitted newborn.Risk factors were analyzed to calculate the odds ratio. Thenrisk factors were analyzed with chi square test to find outsignificant risk factors. P values less than 0.05 (95% CI) wereconsidered statistically significant.Results: The frequency of IUGR babies in this one year studywas found 11.86%. Congenital malformation (p=0.02) wasfound as significant fetal risk factor. Congenital CMV infectionwas found in 16.3 % case of IUGR babies. Maternal weight(p=<0.001), height (p=<0.001), socioeconomic status of mother(p=0.001), Inter pregnancy Interval (p=0.04), placentalinsufficiency (p=0.001), Pregnancy Induced hypertension(p=0.001) are significant maternal risk factor. Hypoglycemia(p=0.007) and hyperbilirubinemia (p=<0.001) were foundsignificant co-morbidities. Length of hospital stay wassignificantly higher among IUGR babies (p= 0.001) thatproclaim the outcome of clinical management. In case group16.3% and in control 8.2% babies expired even after providingall available standard clinical management. Most of thepatients died due to sepsis in both the groups. But the mortalityshowed no significant differences as outcome of clinicalmanagement.Conclusion: IUGR babies in BSMMU was 11.86%. Maternalweight, height, inter pregnancy interval, socioeconomic status,Pregnancy induced hypertension, placental insufficiency, lessANC visits were maternal risk factors for IUGR babies.
ABSTRACT
A considerable progress in plant breeding for higher yield is attained mainly through selection of morpho-physiological attributes in rice. The field experiments were conducted at three different locations under sub-tropical conditions with four early maturing rice varieties viz., Binadhan-7, Binadhan-17, BRRI dhan33, and BRRI dhan39 during kharif-2 rice season (Aman; July-October) of 2016 to find out the natural variation in the morpho-physiological attributes contributing to higher grain yield in rice. Morphological parameters on plant height, root structure, tillering ontogeny, internode elongation pattern, flag leaf length, flag leaf width, flag leaf angle, number of primary & secondary rachis, branches and also physiological traits on chlorophyll content, photosynthesis rate, total dry mass, growth rate, number of vascular bundles, harvest index with yield and yield contributing characters were studied. Results indicated that plants having rapid growth and development at early growth stages showed higher chlorophyll content, photosynthesis rate, long flag leaf, number of vascular bundles in 1st internode and also exhibited the increase in the number of grains per panicle resulting higher grain yield. Among the test varieties, Binadhan-17 showed superiority in the most morpho-physiological criteria and higher number of vascular bundles manifesting in higher grain yield. This information may help breeders to identity and develop high yielding rice variety.