Clinical Profile and Outcome of Neonates Requiring Mechanical Ventilation

ABSTRACT

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 ratio2.31.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.