Volume guarantee ventilation in premature neonates with respiratory distress: a comparative study

Background: Respiratory distress syndrome (RDS) occurs in about 50% of preterm infants born at less than 30 weeks of gestational age. Surfactant therapy and mechanical ventilation have been the standard of care in the management of RDS. Objective of this study to compare the time required to achieve successful extubation criteria in Volume guarantee mode of ventilation to that with Time cycled pressure-limited mode of ventilation and the duration of mechanical ventilation between them in preterm neonates ventilated for respiratory distress syndrome.Method: The study was done at Neonatal intensive care unit, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala over a period of 2 years. Total of 37 inborn preterm neonates between 26 weeks to 32weeks with RDS requiring mechanical ventilation were included in 2-year study period with 18 babies in 1st year study period ventilated with SIPPV mode and 19 babies in 2nd year study period on SIPPV'VG mode of ventilation. Analysis was done using SPSS v. 16 software.Results: In the present study the neonates receiving SIPPV-VG ventilation had stable and equivalent gas exchange at significantly lower MAP and PIP compared to neonates receiving SIPPV -TCPL. Also, neonates receiving SIPPV-VG had achieved significantly faster extubation criteria than SIPPV-TCPL and hence lesser duration of ventilation.Conclusion: Our study concludes that Volume Guarantee ventilation achieves near stable tidal volume delivery by auto-weaning peak inspiratory pressures thereby promoting early extubation and hence reducing volutrauma and barotrauma in contrast to TCPL mode.

Factors responsible for the prolonged stay of surgical neonates in intensive care units

The length of hospital stay [HS] for patients is a major concern due to its social, economic and administrative implications; this is particularly important for neonates admitted to intensive care units [ICUs]. This study aimed to determine the factors responsible for prolonged HS in surgical neonates. This retrospective study was conducted at Sultan Qaboos University Hospital, in Muscat, Oman. The medical records of 95 neonates admitted to the neonatal ICU who underwent general surgical procedures between July 2009 and June 2013 were reviewed. Mann-Whitney U and Pearson's Chi-squared tests were used for non-parametric numerical and categorical variables, respectively. A multiple regression analysis was performed to find a relationship between the variables and to detect the most important factor responsible for prolonged HS. A P value of <0.05 was considered statistically significant. Gestational age, birth weight, number of days on a ventilator and postoperative morbidity were associated with prolonged HS. Furthermore, the age of neonates at first full enteral feed was associated with increased HS using both independent and multiple regression analyses. Prolonged HS can occur as a result of many factors. In this study, a number of factors were identified, including low gestational age, low birth weight, increased number of days on a ventilator and postoperative morbidity. Additionally, neonate age at first full enteral feeds also correlated with increased HS. Further research on this topic is suggested to explore this correlation in more detail and to inform future practices

Changing survival rate of infants born before 26 gestational weeks: single-centre study

This study aimed to evaluate the changing survival rate and morbidities among infants born before 26 gestational weeks at the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman. This retrospective study assessed the mortality and morbidities of all premature infants born alive at 23-26 gestational weeks at SQUH between June 2006 and May 2013. Infants referred to SQUH within 72 hours of birth during this period were also included. Electronic records were reviewed for gestational age, gender, birth weight, maternal age, mode and place of delivery, antenatal steroid administration, morbidity and outcome. The survival rate was calculated and findings were then compared with those of a previous study conducted in the same hospital from 1991 to 1998. Rates of major morbidities were also calculated. A total of 81 infants between 23-26 gestational weeks were admitted to the neonatal unit during the study period. Of these, 58.0% were male and 42.0% were female. Median gestational age was 25 weeks and mean birth weight was 770 +/- 150 g. Of the 81 infants, 49 survived. The overall survival rate was 60.5% compared to 41% reported in the previous study. Respiratory distress syndrome [100.0%], retinopathy of prematurity [51.9%], bronchopulmonary dysplasia [34.6%], intraventricular haemorrhage [30.9%] and patent ductus arteriosus [28.4%] were the most common morbidities. The overall survival rate of infants between 23-26 gestational weeks during the study period had significantly improved in comparison to that found at the same hospital from 1991 to 1998. There is a need for the long-term neurodevelopmental follow-up of premature infants