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.

[ INSURE method in VLBW preterm infant with RDS]

Respiratory distress syndrome [RDS] is one of the most common causes of morbidity and mortality in preterm neonates, and is caused by surfactant deficiency. Among different strategies for treatment of RDS, the INSURE method [Intubation, Surfactant, Extubation to NCPAP] has some advantages over the mechanical ventilation with surfactants administration. This study was conducted to determine the efficacy of INSURE method in NICU of Mahdieh Hospital, during 2007-8. In this study, 66 preterm infant with gestational age of 25 to 32 weeks and birth weight of 600 to 1500 gram who had clinical sign of moderate to server RDS were included. These infants received surfactant by INSURE method [surfactants administration via endotracheal tube during 2-3 min and then extubation to NPCPAP]. INSURE success rate was 60.6% and proved to be gestational age [p=0.019] and birth weight [p<0.001] dependent. In the INSURE success group, the need for second dose of surfactant [p<0.001], mean duration of hospital stay [p=0.035], complication of disease [p<0.001] and death [p<0.001] were less than the INSURE failure group. However no significant difference in gender, method of delivery, parity and age of surfactants administration were seen among the groups. The INSURE method reduces the use of mechanical ventilation, complications, duration of hospital stay and death in neonates with RDS