Outcome of neonates ventilated in NICU of a tertiary care hospital and factors associated with poor outcome

Objective: To ascertain the outcome of neonates who are ventilated for various reasons in our Neonatal Intensive Care Unit [NICU] and determine the risk factors associated with increased incidence of adverse outcome. Study Design: Retrospective study. Place and Duration of Study: Neonatal Intensive Care Unit of Combined Military Hospital Rawalpindi from Jul 2016 to Dec 2016

Material and Methods: All neonates who received mechanical ventilation during the study period were included in the study

Results: Total sixty seven [35.8% females and 64.15% males] neonates were ventilated during the study period for various reasons. Of these 67 neonates who were ventilated, 35 [52.23%] died and 32 [47.76%] survived to be discharged home. 10 babies were born less than 28+ 0weeks gestation and all [100%] expired. Of 7 babies born between 28+1-31+6 weeks gestation, only 01 [14.28%] survived. Of 50 newborns between 32+0-36+6 weeks, 20 [40%] died and 30 [60%] survived to be discharged home. In our cohort of ventilated babies, 7 weighed less than 1000 gm of which 6 [85.71%] died and only 01 [14.28%] survived. Of 18 babies born 1000-1499 gm, 14 [77.77%] died and 4 [22.22%] survived. Of 14 babies born between 1500-2499 gm, 6 [42.85%] died and 8 [57.14%] survived. Of all ventilated babies, 28 weighed more than 2500 gm, of which 10 [35.71%] died and 18 [64.28%] survived. Out of our cohort of 67 babies, 14 were diagnosed with hypoxic ischemic encephalopathy grade 3, of which 11 [78.57%] died and 3 [21.42%] were discharged. Twenty three had RDS, of which 11 [47.82%] died and 12 [52.17%] survived. Ten babies were ventilated due to sepsis, of which 6 [60%] died and 4 [40%] survived

Conclusion: We conclude that gestational age less than 32+0 weeks, birth weight less than 1500 gm, Hypoxic Ischemic Encephalopathy grade 3 and sepsis are associated with a poor outcome in babies who are mechanically ventilated

Umbilical cord blood gas and lactate levels as a marker of birth asphyxia in neonates with particular reference to resource limited countries

Birth asphyxia remains an important cause of neonatal mortality and morbidity in the developing world. Babies who suffer birth asphyxia may develop cerebral palsy, learning difficulties and epilepsy. Early diagnosis and prompt placement of rehabilitative measures would help to reduce the burden of complications arising as a result of birth asphyxia. Time and again effort has been made to develop markers that would help in predicting outcome of neonates who have had an asphyxial insult. One such parameter that is now routinely being used in the developed world is the measurement of umbilical cord blood lactate level measured from blood gases. This review highlights the importance of early diagnosis of birth asphyxia and the role of umbilical cord blood lactate level in identifying babies who have had birth asphyxia in resource limited countries with a particular reference to Pakistan

Comparison of serum bilirubin estimation with transcutaneous bilirubinometry in neonates

To assess usefulness of Minolta Airshield transcutaneous bilirubinometer by comparing bilirubin values obtained by transcutaneous jaundice meter with serum bilirubin estimation. Design: Analytical crosssectional study. Place and duration: NICU Military Hospital Rawalpindi Pakistan Jun 2002 to May 2005. Subjects and One hundred and fifty neonates admitted to NICU because of visible jaundice were included in the study. Serum was sent to laboratory for total bilirubin estimation. At the same time bilirubin was also checked by a Jaundice Meter. Data was tabulated and t-test applied to compare the two values. One hundred and fifty paired estimations were performed. The transcutaneous bilirubin values ranged from 8.0 mg/dl to 20.4 mg/dl. While serum bilirubin by jaundice meter values ranged between 5.3 mg/dl and 26.0 mg/dl. A Scatter diagram was plotted. It showed a correlation coefficient of 0.78. Bilirubin values obtained by transcutaneous bilirubin meter were not significantly different from laboratory values thus proving the fact that transcutaneous bilirubinometer is a useful device to measure bilirubin

Diagnostic value of C-reactive protein and haematological parameters in neonatal sepsis

To analyse various parameters of sepsis screen singly and in combination to formulate a guideline for the diagnosis of neonatal sepsis. Design: A cross-sectional analytical study. Place and Duration of Study: The neonatal intensive care unit at the Paediatric Department, Military Hospital, Rawalpindi, over a period of seven months from 1st June to 31st December 2003. Subjects and One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations. C-reactive protein [CRP], erythrocyte sedimentation rate, total leukocyte count, absolute neutrophil count [ANC], immature neutrophils to total neutrophil count ratio [I/T ratio], thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology [GAC] for polymorphs were used for diagnosis of neonatal sepsis. CRP was positive in 24/28 [85.7%] of group-A [proven sepsis] and 58/72 [80.5%] of group-B [probable sepsis] and had a specificity of 95%. ANC was the second most sensitive test having sensitivity of 71.4% for group- A and 63.9% for group-B and 88% specificity. For group-A, sensitivity of GAC for polymorphs and platelet count was 71.4% and 64.3% respectively. The sensitivity, specificity and predictive values [PV] of the individual tests and different tests combination was also calculated for group-A and B. A set of investigations including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs are highly sensitive in detection of culture negative cases of neonatal sepsis. Moreover, a combination of three tests enhances the sensitivity of these tests