Mechanical Ventilation in Neonates: Experience at a Tertiary Care Center in Eastern Nepal.

Aims: To study the diagnoses and survival of neonates receiving mechanical ventilation. Study Design: Prospective observational study. Place and Duration of Study: Department of Pediatrics and Adolescent Medicine; B. P. Koirala Institute of Health Sciences, Dharan, Nepal, from February 2012 to January 2013. Methodology: All the neonates who received mechanical ventilation in neonatal intensive care unit (NICU) during the study period were included. We excluded the neonates with surgical malformations. Data were entered in a pre-designed pro forma and statistical analysis was done using SPSS version 17 for Windows Results: A total of 88 neonates were ventilated during the study period of which 65 met the inclusion criteria. Birth asphyxia (34%), neonatal sepsis (31%), meconium aspiration syndrome (MAS) (20%), congenital pneumonia (11%) and hyaline membrane disease (HMD) (5%) were the diagnoses of babies who received mechanical ventilation at our center. Overall survival rate was 50.8%, as 33 patients survived. The highest survival rate was seen in babies admitted with birth asphyxia (68.2%) and the lowest survival rate was seen in neonates with an admission diagnosis of sepsis (30%). Mean Downes score for respiratory distress at intubation in non-survivors was significantly higher compared to Downes score in non-survivors (P value = .003). Mean oxygen saturation before intubation in non-survivors was significantly lower than the oxygen saturation in survivors (P value = .001). Conclusion: Birth asphyxia, sepsis and meconium aspiration syndrome were the common diagnoses of neonates who received mechanical ventilation. Neonates with lower Downes score and higher oxygen saturation at the time of admission were associated with decreased mortality rate.

Unusual presentations of visceral leishmaniasis.

We report 3 cases of Visceral leishmaniasis, who presented with unusual clinical manifestations. One child was diagnosed as hemophagocytic syndrome; another masqueraded with features of leukemoid changes alongwith hemophagocytosis and trilineage myelodysplasia; the third case presented with pyothorax. All the three patients showed amastigote forms of Leishmania donovani and positive serology (rk39 antigen). They showed complete clinical, hematological and parasitological resolution with Amphotericin B therapy.