Iranian Journal of Neonatology

Iranian Journal of Neonatology

Predictors of Immediate Outcome in Neonates on Invasive Mechanical Ventilation

Document Type : Original Article

Authors
Durgesh Kumar 1
Dinesh Kumar 1
Shashi Vinod 1
Indra Kumar Sharma 1
Rajesh Kumar Yadav 2
Rakesh Bahadur Singh 2
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
10.22038/ijn.2024.70616.2376
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
Mechanical ventilation
Neonates
Outcome
Sepsis
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Iranian Journal of Neonatology
Volume 15, Issue 4
Autumn 2024
Pages 29-34