Clinical Profile and Outcome of Neonates Requiring Mechanical Ventilation

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.

Correlation of Transcutaneous Bilirubin with Serum Bilirubin in Term and Preterm Neonates with Jaundice

Background: Jaundice is a very common neonatal problemand contributes a lot to the admission into neonatal care unitsand hospitals. Early estimation of TcB may help identifyingneonates with significant jaundice requiring serum bilirubinestimation. This may help avoiding unnecessary estimation ofserum bilirubin by invasive method in preterm and termneonates. TcB has been practised mostly in the whitepopulation and studies in the nonwhite population is relativelyscarce. In Bangladesh, estimation of TcB is a very newapproach and not in practice in most of the centres; andinvolves only term and near-term neonates sparing pretermones.Objective: To evaluate the correlation of transcutaneousbilirubin with serum bilirubin in term and preterm neonates withjaundice.Methods: This cross sectional study was conducted in thedepartment of Neonatology, Bangabandhu Sheikh MujibMedical University (BSMMU) from September 2015 to August2016. Jaundiced neonates ranging from 28 to 42 weeks ofgestation were studied. JM-103 device and DichlorophenylDiazonium method were used to measure TcB and TSBrespectively. TcB measurements were obtained over thesternum 30 minutes prior or after blood sampling for TSB.Pearson’s correlation coefficient and linear regression analysiswere used to determine the correlation between TcB and TSB.Bland-Altman plot was used to analyse the agreement betweenTcB and TSB. ROC curve was constructed both for term andpreterm infants to determine the best cut-off values with theirsensitivity and specificity.Results: A total of 148 paired TcB-TSB readings for 102jaundiced term and preterm infants were obtained. Correlationcoefficient in total population, term and preterm neonates were0.83, 0.92 and 0.69 respectively. Bland-Altman plot showedreasonable agreement in term newborns but not in pretermbabies. Overall best sensitivity and specificity of TcB in termneonates was 90% and 73%, and in preterm neonates 65%and 60% respectively. Area under the curve for TcB was 86%in term neonates, whereas it was 63% in preterm neonates.