Mortality Rate in Mechanically Ventilated Neonates: A Developing Country Experience

Document Type : Original Article

Authors

1 Pediatric Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

2 . Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt

Abstract

Background: Although a great improvement has been achieved in the outcome of sick neonates with the effective
widespread introduction of mechanical ventilation in neonatal intensive care units, a significant proportion of high
fatality is still detected among such patients. This study was conducted to identify the complications, outcome, and
causes of death among a sample of critically ill Egyptian neonates subjected to mechanical ventilation using pressurecontrolled
mode. 
Methods: The statistical population of this study were prospectively enrolled in the current study and consisted of 240 eligible patients fulfilling the study inclusion criteria. Those with multiple congenital malformations or post-surgical
cases were excluded from the study. The data regarding medical record, clinical examination, indication for mechanical
ventilation, complications related to mechanical ventilation, and outcome were collected, recorded, and analyzed.
Results: The incidence of complications related to mechanical ventilation was obtained at 104 (43.3%), and VAP observed
an increase (20%). Furthermore, the complications related to disease patterns were reported to be 56.7% and 22.5% for
sepsis and septic shock. It has been revealed that 124 (51.7%) of the studied neonates had favorable outcomes; however,
the remaining 116 (48.3%) of the subjects passed away with a significant increase in the incidence of VAP (P=0.013). It
was reported that smaller gestational age and lower birth weight were the most significant risk factors.
Conclusion: In Egypt; as a developing country, the mortality rate among critically ill neonates undergoing mechanical
ventilation with pressure-controlled mode was significantly high, approaching 48.3%, with VAP being the most
common cause of death.

Keywords


  1. Gurubacharya SM, Gurubacharya RL. An overview of neonatal admissions at College of Medical Sciences. J Nepal Paediatr Soc. 2007; 27(2):73-4.
  2. Jehan I, Harris H, Salat S, Zeb A. Moben N, Pasha O, et al. Neonatal mortality: risk factors and causes: a prospective population-based cohort study in Pakistan. Bull World Health Organ. 2009; 87(2):130-8.
  3. Khinchi YR, Kumar A, Yadav S. Profile of neonatal sepsis. J Coll Med Sci Nepal. 2010; 6(2):1-6.
  4. Riyas PK, Vijayakumar KM, Kulkarni ML. Neonatal mechanical ventilation. Indian J Pediatr. 2003; 70(7):537-40.
  5. Shrestha P, Basnet S, Shrestha L, Shrestha P, Kathmandu N. Clinical profile and outcome of mechanically ventilated neonates in a tertiary level hospital. J Nepal Paediatr Soc. 2016; 35(3):218-3.
  6. Keszler M. State of the art in conventional mechanical ventilation. J Perinatol. 2009; 29(4):262-75.
  7. St John EB, Carlo WA. Respiratory distress syndrome in VLBW infants: changes in management and outcomes observed by the NICHD Neonatal Research Network. Semin Perinatol. 2003; 27(4):
    288-92.
  8. Sharma R, Baheti S. Outcome of neonatal ventilation: a prospective and cross-sectional study in tertiary care centre. Int J Contemp Pediatr. 2017; 4(5):1820-6.
  9. Sankar MJ, Sankar J, Agarwal R, Paul VK, Deorari AK. Protocol for administering continuous positive airway pressure in neonates. Indian J Pediatr. 2008; 75(5):471-8.

10. Jahan N, Haque ZS, Mannan MA, Nasrin M, Afroz F, Parvez A, et al. Indication and short term outcome of Mechanical Ventilation in Neonates in a tertiary care hospital. Bangladesh J Med Sci. 2017; 16(1):24-8.

11. Bhatt S, Nayak U, Agrawal P, Patel K, Desai D. Clinical profile of mechanically ventilated newborns at tertiary care level hospital. Int J Res Med. 2015; 4(2):86-90.

12. Shrestha S, Karki U. Indicators of admission and outcome on a newly established neonatal intensive care unit in a developing country (Nepal). Nepal Med Coll J. 2012; 14(1):64-7.

13. Tayel RM, Abd El Haleem A, Hafez SF, Hammad BS. Implementation of ventilator associated pneumonia prevention bundle in the neonatal intensive care unit at Alexandria University Children’s Hospital, Egypt. Alexandria J Pediatr. 2017; 30(2):74.

14. Thatrimontrichai A, Rujeerapaiboon N, Janjindamai W, Dissaneevate S, Maneenil G, Kritsaneepaiboon S, et al. Outcomes and risk factors of ventilator-associated pneumonia in neonates. World J Pediatr. 2017; 13(4):328-34.

15. Geslain G, Guellec I, Guedj R, Guilbert J, Jean S, Valentin C, et al. Incidence and risk factors of ventilator associated pneumonia in neonatal intensive care unit: a first French study. Minerva Anestesiol. 2018; 84(7):829-35.

16. Ananthraj A, Bhat BV. Outcome of neonates requiring assisted ventilation. Turkish J Pediatr. 2011; 53(5):547-53.

17. Trivedi SS, Chudasama RK, Srivastava A. Study of early predictors of fatality in mechanically ventilated neonates in NICU. Online J Health Allied Sci South India. 2009; 8(3):1-4.

18. Fidanovski D, Milev V, Sajkovski A, Hristovski A, Sofijanova A, Kojic L, et al. Mortality risk factors in premature infants with respiratory distress syndrome treated by mechanical ventilation. Srp Arch Celok Lek. 2005; 133(1-2):29-35.

19. Trotman H. The neonatal intensive care unit at the university hospital of the west Indies- the first few years’ experience. West Indian Med J. 2006; 55(2):75-9.

20. Hossain MM, Shirin M, Mamun MA, Hasan MN, Sahidullah M. Predictors of mortality in ventilated neonates in Intensive care unit. Bangladesh J Child Health. 2009; 33(3):77-82.

21. Gurubacharya SM, Aryal DR, Misra M, Gurung R. Short-term outcome of mechanical ventilation in neonates. J Nepal Paediatr Soc. 2011; 31(1):35-8.