Current Pediatric Research

Background: A substantial proportion of neonates admitted to the Neonatal Intensive Care Unit (NICU) necessitate mechanical ventilation, and despite the implementation of advanced mechanical ventilation techniques, the mortality rate among critically ill neonates remains alarmingly high. Therefore, identifying adverse prognostic factors and devising appropriate interventions is imperative to enhance survival rates in this vulnerable population. Objectives: To examine the clinical profile and immediate outcomes of neonates requiring mechanical ventilation. Methods: This prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) of Indira Gandhi Government Medical College and Mayo Hospital, Nagpur, Maharashtra, Central India, from May 2022 to April 2024. The study population comprised ventilated neonates admitted to the NICU, who were subsequently enrolled. Risk factors were meticulously documented. All data were recorded in an Excel spreadsheet, and results were presented in terms of frequency and percentage. The study received approval from the institutional ethical committee. Results: A total of 85 mechanically ventilated neonates, who met both inclusion and exclusion criteria, were enrolled following the acquisition of written informed consent from the guardians. Among the 85 neonates, 45 (53%) were male and 40 (47%) were female. Regarding the mode of delivery, 36 (42.3%) were delivered vaginally, while 49 (57.7%) underwent caesarean section. The highest incidence of neonates requiring mechanical ventilation, 27 (31.7%), fell within the gestational age range of 28 to 32 weeks. Notably, the majority of neonates, 50 (58.8%), who required mechanical ventilation, had a birth weight between 1500 and 2499 grams. Of the 85 mechanically ventilated neonates, respiratory distress was the predominant clinical presentation, observed in 46 (54.1%), followed by jaundice in 11 (13%), poor feeding in 9 (10.6%), lethargy in 7 (8.2%), and convulsions in 7 (8.2%). Additionally, abdominal distension, vomiting, and bleeding were documented in 1 (1.2%), 3 (3.5%), and 1 (1.2%) neonates, respectively. Perinatal asphyxia emerged as the most prevalent indication for mechanical ventilation in 28 (33%) cases, succeeded by neonatal sepsis in 27 (31.8%), respiratory distress syndrome (RDS) in 14 (16.4%), and meconium aspiration syndrome (MAS) in 10 (11.8%). Furthermore, apnoea of prematurity and persistent pulmonary hypertension of the newborn (PPHN) were noted in 4 (4.7%) and 2 (2.3%) neonates, respectively. Among the 85 mechanically ventilated neonates, 25 (29.4%) developed complications attributable to mechanical ventilation, with the most common being septicemia in 11 (12.9%), pneumothorax in 5 (5.9%), pulmonary hemorrhage in 5 (5.9%), and ventilator-associated pneumonia (VAP) in 4 (4.7%). Out of the 85 neonates, 52 (61.2%) survived and were subsequently discharged, while 33 succumbed, resulting in a mortality rate of 38.8%. Conclusion: In the present study, we observed that respiratory distress constituted the most prevalent clinical presentation, underscoring the critical necessity for respiratory support in these neonates. Perinatal asphyxia and neonatal sepsis were identified as the primary indications for mechanical ventilation, highlighting their substantial contribution to the demand for respiratory intervention among neonates. Septicaemia emerged as the most frequent complication during ventilation, exerting diverse effects on patient outcomes. The overall discharge rate surpassed the mortality rate, indicating a favourable prognosis. Survival rates appeared to improve with shorter durations of ventilation and more effective management of complications.

Author(s):

Dipak Madavi, Nilima Kursunge, Lakshmikant A.Rohadkar*, Swati Kshirsagar, Sakshi Keshattiwar, Renoy Jose CL

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