ABSTRACT
Objectives: To prospectively study several aspects of ventilated neonates at the neonatal intensive care unit (NICU) of Sri Jayawardenepura General Hospital (SJGH) and compare this data to retrospective data from the same unit. Method: A descriptive observational, longitudinal hospital based prospective study was conducted on ventilated babies in NICU, SJGH from1st July 2009 to 1st July 2010. Data were obtained using a pre-tested recording form. NICU records were used to gather data of infants ventilated from 1st July 2000 to 1st July 2001. Data obtained from the current study were compared to data in 2000/2001. Data were analysed using SPSS version 16 for Windows. Results: During the study period 135 babies were ventilated. Four were excluded due to severe congenital defects. Seventy two percent were male and 53% had gestational periods of 32 weeks or less. There were 46% very low birth weight (VLBW) babies. In 72% the indication for ventilation was respiratory distress syndrome (RDS). Duration of ventilation was over one week in 34%. Continuous positive airway pressure (CPAP) was the sole mode of ventilation in 33%. Surfactant was used in 53% babies, 96% for RDS. Oxygen for over 2 weeks was required in 17% and 22% received theophylline as respiratory stimulants. Midazolam infusion was used for sedation in 56%. Total parenteral nutrition was started in 56%, 29% received blood transfusions and 65% received volume support or inotropes for hypotension. Complications included seizures (16%), persistent pulmonary hypertension of the newborn (9%), patent ductus arteriosus (8%), pulmonary haemorrhage (7%), retinopathy of prematurity (6%), nosocomial sepsis (6%), ventilator-associated pneumonia (5%), bronchopulmonary dysplasia (5%), necrotising enterocolitis (3%), intraventricular haemorrhage (2%) and pneumothorax (2%). Eighty eight percent babies were followed up till 2 years of age. Mortality in 2009/2010 was 18% compared to 39% in 2000/2001 (P<0.0001). Conclusions: Babies with 32 weeks or less gestation and VLBW babies were significantly more in 2009/2010 (P<0.05). Complications such as VAP, nosocomial sepsis and pneumothorax were significantly more common in babies ventilated in 2000/2001 but ROP was significantly more common in babies ventilated in 2009/ 2010 (P<0.05). HIE caused significantly more deaths in 2000/ 2001 whilst significantly more deaths occurred in ex-utero babies and babies with pulmonary haemorrhage in 2009/2010 (P<0.05). Overall mortality, mortality in babies with 32 weeks or less gestation and mortality in VLBW babies were significantly lower in 2009/2010 (P<0.0001). In 2009/2010, the outcome in babies receiving CPAP only was significantly better than those receiving IMV only (P<0.0001). There was no morbidity at 2 years of age in significantly more babies over 32 weeks gestation in 2009/2010 compared to babies with gestation 32 weeks or less (P<0.0001).