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Neonatal mechanical ventilation--experience at a level II care centre
1Department of Paediatrics, Kalawati Saran Children's Hospital, New Delhi.
Insights
Neonatal mechanical ventilation shows a 46.54% survival rate. Factors like birth weight, gestational age, and avoiding nosocomial infections significantly impact outcomes for ventilated newborns.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Respiratory Support
Background:
- Mechanical ventilation is a critical intervention for critically ill neonates.
- Understanding ventilation indications, complications, and outcomes is essential for improving neonatal care.
Purpose of the Study:
- To analyze indications, complications, and outcomes of mechanical ventilation in neonates.
- To evaluate survival rates based on birth weight, gestational age, and ventilation type.
- To identify common complications associated with assisted ventilation.
Main Methods:
- Retrospective analysis of 159 neonates requiring mechanical ventilation over one year.
- Categorization of ventilation modes: Invasive Positive Pressure Ventilation (IPPV) and Continuous Positive Airway Pressure (CPAP).
- Assessment of survival rates, indications, and complications including sepsis, pulmonary hemorrhage, pneumothorax, and intraventricular hemorrhage (IVH).
Main Results:
- Overall survival rate was 46.54% (74 out of 159 neonates).
- Survival rates significantly correlated with higher birth weight and gestational age (e.g., 53% survival for >2500g vs. 25% for <1000g).
- Common indications included HMD, birth asphyxia, and apnea of prematurity; sepsis was the most frequent complication (26%).
Conclusions:
- Neonatal survival on mechanical ventilation is strongly influenced by birth weight and gestational age.
- Exclusive CPAP showed 100% survival in this cohort.
- Nosocomial infections pose a significant challenge, contributing to lower success rates, particularly in very low birth weight and preterm infants.
Abstract:
One hundred and fifty nine neonates were ventilated over a period of one year of whom 74 (46.54%) survived. This study aims to analyse the indications, complications and outcome of babies requiring mechanical ventilation. The early outcome measures were (i) survival rate with respect to birth weight, gestation and indication of ventilation, and (ii) Complications of assisted ventilation. One hundred and forty seven babies received IPPV and 34 received CPAP. Twenty two out of these 34 required IPPV later. Survival was cent percent on exclusive CPAP mode. HMD was the commonest indication for ventilation followed by Birth asphyxia, Apnea of prematurity, Meconium Aspiration Syndrome and Persistent Pulmonary Hypertension of the New born. Survival rates increased with increasing birth weight and gestational age, changing from 25% for < 1000 gm and 20% for < 28 wks to 53% for > 2500 gms and 50.2% for > 37 wks. Prolonged ventilatory support was needed for HMD (mean 114 hrs) and PPHN (mean 156 hrs). Commonest complication was Sepsis (26%) followed by Pulmonary hemorrhage, Pneumothorax and IVH. Lower success rates in ventilation is due to the poor survival of babies weighing < 1000 gms and those with a gestation of < 28 wks with nosocomial infections as a major complication of assisted ventilation being an additional factor.