Predictors of Immediate Outcome in Neonates on Invasive Mechanical Ventilation

Document Type : Original Article

Authors

1 Department of Pediatrics and Neonatology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India

2 Department of Anesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India

Abstract

Background: Neonatal mechanical ventilation has contributed to a significant decline in neonatal mortality but is associated with various complications. It is necessary to identify the prognostic factors and their management to reduce the complications in mechanically ventilated neonates. Therefore, this study was designed to investigate the common indications, complications, and predictive factors associated to immediate outcomes in neonates from rural North India who received invasive mechanical ventilation.
Methods: This study includes all neonates admitted to the neonatal intensive care unit requiring invasive mechanical ventilation for at least 12 hours. All enrolled neonates were categorized into two groups: those who were successfully extubated were labeled as survivors, while those who did not survive during ventilation were classified as non-survivors. Clinical and ventilator parameters, as well as the occurrence of complications were analyzed to identify factors associated with outcomes in ventilated neonates.
Results: A total of 150 neonates who met the inclusion criteria were enrolled. The most frequent reason for ventilation was perinatal asphyxia. Among ventilated neonates, the mortality rate was 38.7%. When comparing survivor and non-survivor groups, a significant difference was observed in birth weight, gestational age, indication for ventilation, duration of ventilation, and blood acidosis (with a p-value < 0.05). Additionally, non-survivors experienced a higher prevalence of complications, including sepsis, shock, air leak syndrome, and pulmonary hemorrhage. Multivariate analysis revealed that gestational age less than 34 weeks, initial blood pH of 7.1 or lower, ventilation duration exceeding 72 hours, and the presence of sepsis, shock, or disseminated intravascular coagulation were significant independent predictors of mortality in ventilated neonates.
Conclusion: The mortality among ventilated neonates is still high in developing countries. Hospital acquired sepsis with shock is still the major complication among ventilated neonates. Early identification of risk factors for mortality and timely intervention may decrease the mortality.

Keywords

References

  1. Sankar MJ, Neogi SB, Sharma J, Chauhan M, Srivastava R, Prabhakar PK, Khera A, Kumar R, Zodpey S, Paul VK. State of newborn health in India. J Perinatol. 2016;36(s3):S3-S8.
  2. Mokhtar WA, Sherief LM, Kamal NM, Kamel SE. Mortality Rate in Mechanically Ventilated Neonates: A Developing Country Experience. Iran J Neonatol. 2021;12(2):1-7.
  3. 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):218-223.
  4. Iqbal Q, Younus MM, Ahmed A, Ahmad I, Iqbal J, Charoo BA, et al. Neonatal Mechanical Ventilation: Indications and Outcome. Indian J Crit Care Med. 2015;19(9):523-527.
  5. Anantharaj A, Bhat BV. Outcome of Neonates Requiring Assisted Ventilation. Turk J Pediatr. 2011;53(5):547-553.
  6. Trotman H, Barton M, Mitchell V. Outcome of Neonates Ventilated in the Main Intensive Care Unit at The University Hospital of the West Indies: A 15-year Experience. Trop Doct. 2007;37(4):249-250.
  7. Riyas PK, Vijayakumar KM, Kulkarni ML. Neonatal Mechanical Ventilation. Indian J Pediatr. 2003;70:537-540.
  8. Chakkarapani AA, Adappa R, Mohammad Ali SK, Gupta S, Soni NB, Chicoine L, et al. "Current Concepts of Mechanical Ventilation in Neonates" - Part 1: Basics. Int J Pediatr Adolesc Med. 2020 Mar;7(1):13-18. 
  9. Sultana SN, Khan MM, Islam MT, Sharmin A, Ismat J, Dey SK, et al. Clinical Profile and Outcome of Neonates Requiring Mechanical Ventilation. Birth. 2019;37(11):20-28.
  10. Thakur R, Mishra A. Mean Duration of Mechanical Ventilation among Newborns Admitted to the Neonatal Intensive Care Unit in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2023;61(262):546-548.
  11. Rai R, Singh DK. An Experience with Neonatal Ventilation in Eastern U.P. Indian J Pediatr. 2009;76(11):1177.
  12. Thakkar PA, Pansuriya HG, Bharani S, Taneja KK. Clinical Profile, Outcome and Risk Factors for Mortality of Neonates Requiring Mechanical Ventilation at Tertiary Care Centre of Central Gujarat, India. Journal of Nepal Paediatric Society. 2021;41(1):29-34.
  13. Mathur NB, Garg P, Mishra TK. Predictors of fatality in neonates requiring mechanical ventilation. Indian Pediatr. 2005;42:645-651.
  14. Othman AA, Oshaib ZF, Abd El Moneim ME. Mechanical Ventilation Outcomes at the NICU at EL-Zahraa University Hospital. Open J Pediatr. 2020;10(4):732-743.
  15. Monsef AR, Eghbalian F, Sabzehei MK, Khanlarzadeh E. Evaluating the Short-Term Outcome of Mechanically Ventilated Neonates Admitted to the Neonatal Intensive Care Unit of Besat Hospital, Hamadan, Iran. Int J Pediatr 2019;7(9):10029-10034.
  16. Hossain MM, Shirin M, Mamun M. Predictors of Mortality in Ventilated Neonates in Intensive Care Unit. Bangladesh J Child Health. 2009;33(3):77-82.
  17. Yadav M, Chauhan G, Bhardwaj AK, Sharma PD. Clinicoetiological Pattern and Outcome of Neonates Requiring Mechanical Ventilation: Study in a Tertiary Care Centre. Indian J Crit Care Med. 2018;22(5):361-363.
  18. Regmi S, Pathak S, Awasti PR, Bhattarai S, Poudel R. Outcome of neonates requiring mechanical ventilation in a tertiary hospital. J Chitwan Med Coll. 2018;8(3):24-30.
  19. Petdachai W. Ventilator-Associated Pneumonia in a Newborn Intensive Care Unit. Southeast Asian J Trop Med Public Health. 2004;35(3):724-729.
  20. Torres-Castro C, Valle-Leal J, Martínez-Limón AJ, Lastra-Jiménez Z, Delgado-Bojórquez LC. Pulmonary Complications Associated with Mechanical Ventilation in Neonates. Bol Med Hosp Infant Mex. 2016;73(5):318-324. Spanish.
Iranian Journal of Neonatology
Volume 15, Issue 4
October 2024
Pages 29-34

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