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Three-year experience with neonatal ventilation from a tertiary care hospital in Delhi
M Singh1, A K Deorari, V K Paul
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Insights
Neonatal ventilation improved survival rates, especially with Continuous Positive Airway Pressure (CPAP) for heavier infants. However, extremely low birth weight neonates (<1kg) had poor outcomes, and infections were a significant cause of mortality.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
Background:
- Neonatal ventilation is crucial for respiratory support in critically ill newborns.
- Survival rates and outcomes vary significantly based on birth weight, ventilation mode, and underlying conditions.
Purpose of the Study:
- To analyze survival rates and outcomes of neonates requiring mechanical ventilation.
- To identify factors influencing survival, including ventilation mode, birth weight, and common indications.
Main Methods:
- Retrospective analysis of 90 neonates who received ventilation over 33 months.
- Comparison of outcomes between Invasive Positive Pressure Ventilation (IPPV) and CPAP modes.
- Assessment of survival rates based on birth weight, indications for ventilation, and complications.
Main Results:
- Overall survival rate was 55.5% (50/90 neonates).
- CPAP mode showed higher survival (100% for infants >1.5kg) compared to IPPV (57.7% for infants >1.5kg).
- Extremely low birth weight neonates (<1kg) had a low survival rate (6/22).
- HMD was the most common indication (50%), with a 53% survival rate.
- Transient tachypnea had 100% survival.
- Nosocomial infections and pulmonary air leaks were significant complications, contributing to mortality.
Conclusions:
- Neonatal ventilation can improve survival, particularly with CPAP for neonates >1.5kg.
- Ventilation for extremely low birth weight neonates (<1kg) has poor outcomes and may not be cost-effective.
- Centers should have Level II care facilities before initiating neonatal ventilation.
- Managing nosocomial infections and pulmonary air leaks is critical for improving outcomes.
Abstract:
Ninety neonates were ventilated over a period of 33 months of whom 50 (55.5%) survived. Fifty seven babies received IPPV while 33 CPAP. IPPV mode was being used more frequently recently and survival rates have steadily improved over past 3 years. Survival was cent per cent in babies above 1.5 kg on CPAP mode while 16/26 (57.7%) survived on IPPV mode. Of 22 extremely VLBW (< 1 kg) babies, six survived. HMD was the commonest indication of ventilation (50%), of which 53% (24/45) survived. The other important indications of ventilation were apnea in 13 and transient tachypnea in 11 babies. All babies requiring ventilation for transient tachypnea survived. Nosocomial infections were common in association with ventilation 34/90 (37.7%), out of which in 14 was responsible for about a third of deaths. Pulmonary air leaks developed in 12 babies of which 6 died. Two babies developed BPD and one ROP. Neonatal ventilation should be ventured in centres where basic facilities for level II care already exist. It may not be cost effective to ventilate extremely low birth weight neonates.