Outcome, Clinical Profile and Risk Factors for Mortality of Neonates Necessitating Mechanical Ventilation

2021 ◽  
Vol 15 (12) ◽  
pp. 3485-3487
Author(s):  
Amber Naseer ◽  
Riffat Farrukh ◽  
Shaheen Masood ◽  
Sarwat Sultana ◽  
Qamar Rizvi

Background: Assisted ventilation has turn out to be an essential part of the neonatal intensive care unit (NICU). It is one of the main methods of support in the ICU and undoubtedly influences the survival of sick newborns. Aims: 1. To investigate common indications for mechanical ventilation in newborns 2. To investigate factors influencing the outcome. Method: It is a descriptive study of 60 infants admitted to the Department of Pediatric Medicine in the ICU over a one-year period in the department of Paediatrics, Abbasi Shaheed Hospital. The information was gathered and analysed in a pre-designed format. Results: Of a total of 60 infants, 46 survived, 14 died, and one infant was discharged despite medical advice. 36 children were born vaginally, 20 were born via LSCS, and 4 via assisted delivery. Postnatal asphyxia was the most common ventilation indication in full-term newborns, while HMD was present in preterm infants. The best results were obtained in ventilated infants with MAS, with 100% survival, followed by apnoea in premature infants, perinatal asphyxia, and HMD. Pulmonary haemorrhage (48.3%) was the most common complication among deceased infants, followed by sepsis (28.3%) and shock (23.4%) with a significant p <0.05. There were no complications in 76.7% of the surviving infants. Conclusions: Among the many widely available variables studied in this study, maximum and mean peak inspiratory pressure (PIP or (PEEP), maximum respiratory rate, maximum mean airway pressure (MAP) and average ventilation demand was much greater among non-survivals in comparison to the survivors. Bicarbonate, PH and excess base have been found to be important determinants of mortality in ventilated newborns. Keywords: Indications, mechanical ventilation and Results

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 319-323 ◽  
Author(s):  
Forrest C. Bennett ◽  
Nancy M. Robinson ◽  
Clifford J. Sells

A prospective study of infants weighing &lt;800 g at birth and cared for in a single neonatal intensive care unit between 1977 and 1980 was conducted. Neonatal mortality was 80%; neurodevelopmental outcome was assessed in 16 of the 18 survivors. Mean birth weight for these 16 was 730 g; mean gestational age was 26 weeks. Perinatal asphyxia, respiratory distress, apnea, mechanical ventilation, and chronic pulmonary disease were commonplace. Symptomatic intracranial hemorrhage, seizures, sepsis, or meningitis did not occur in survivors. Of the 16 infants, 13 (81%), including all three with birth weight &lt;700 g, were without major CNS handicaps and were developing appropriately at 6 months to 3 years of age. Only one of the 16 had clearly subnormal mental development. None had a major visual or hearing impairment. Apgar scores at one and five minutes were significantly related to outcome; apnea, mechanical ventilation, and chronic pulmonary disease were not. These data suggest that a remarkably hopeful outcome is possible for the few survivors of extremely low birth weight.


2013 ◽  
Vol 3 (1) ◽  
pp. 19-22
Author(s):  
Afroza Haque ◽  
MA Baki ◽  
Tahmina Begum ◽  
Shahida Akhter ◽  
Suraiya Begum ◽  
...  

Objectives: Respiratory distress is one of the most common causes of admission in Neonatal intensive care unit (NICU). There are many causes of respiratory distress, among them, transient tachypnoea of newborn, respiratory distress syndrome and perinatal asphyxia are commonest causes. The aim of this study was to identify the etiology of respiratory distress in special care baby unit (SCABU) in BIRDEM General Hospital and to observe the immediate hospital outcome of these babies. Methods: A retrospective study was conducted in SCABU, BIRDEM. Data were collected from all patients files admitted in to SCABU during the period from January to December 2011. Results: A total of 562 patients were admitted, among them 192 cases were admitted due to respiratory distress (34.1%). There was male predominance (64.6%). Two third (65.6%) babies were inborn and majority (84.4%) were born by caesarian section and preterm babies were more (65.6%). The commonest causes of respiratory distress in our study were transient tachypnea of newborn (43.2%), respiratory distress syndrome (30.2%), perinatal asphyxia (25%), septicaemia (16.1%) congenital pneumonia (11.9%), congenital heart disease (10.4%). All babies required oxygen initially, subsequently mechanical ventilation and Bubble CPAP was required in 48 (25.0%) and 8(04.1%) cases respectively. Mortality was 16.7% and was highest in neonates with respiratory distress syndrome (RDS) (71.8%) followed by septicaemia (40.6%) and perinatal asphyxia (37.3%). Among neonates requiring mechanical ventilation 56.2% died. Conclusion: Transient tachypnoea of newborn (TTN), respiratory distress syndrome (RDS), perinatal asphyxia and septicaemia were the common etiology for respiratory distress. Mortality was very high in RDS and septicaemia. Birdem Med J 2013; 3(1): 19-22 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17122


2016 ◽  
Vol 35 (3) ◽  
pp. 218-223
Author(s):  
Prabina Shrestha ◽  
Srijana Basnet ◽  
Laxman Shrestha

Introduction: Many sick neonates admitted to neonatal intensive care unit (NICU) require mechanical ventilation but it is associated with various complications and the outcome of neonates is unpredictable. This study aims to identify the indications for mechanical ventilation, complications, co-morbid conditions and outcome of those neonates in terms of survival.Materials and Methods: Retrospective observational study of all neonates who underwent mechanical ventilation from 1 January 2014 to 31 December 2014 in NICU, Tribhuvan University Teaching Hospital. Medical records of the patients were retrieved from hospital record section to collect the relevant data.Results: One-third of admitted neonates in NICU required mechanical ventilation (MV). Commonest indication was severe respiratory distress (70%) followed by perinatal asphyxia (12%) and recurrent apnea (8%). Disease pattern were sepsis (37.2%), RDS of prematurity (17.6%), perinatal asphyxia (11.7%), meconium aspiration syndrome (9.8%), apnea of prematurity (7.8%) and congenital pneumonia (4%). Hospital acquired sepsis was a major complication occurring in 47% patients on mechanical ventilation. Survival rate among neonates on MV was 33%. Survival was better with increasing birth weight and gestational age. Survival was 100% in congenital pneumonia, 50% in perinatal asphyxia, 50% in recurrent apnea, 26% in sepsis, 20% in MAS and 0% in RDS of prematurity.Conclusion: Survival rate of neonates on mechanical ventilation in NICU was 33%. Sepsis was a major problem in NICU, which must be addressed to improve outcome.J Nepal Paediatr Soc 2015; 35(3): 218-223.


2020 ◽  
Vol 39 (1) ◽  
pp. 4-8
Author(s):  
Biplob Kumar Raha ◽  
Md Julfikkar Alam ◽  
Mohammad Abdul Quddus Bhuiyan

Introduction: Respiratory distress (RD) is a common problem in neonatal period. It is an important cause of neonatal mortality. There are many causes of respiratory distress, among them, transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS) and perinatal asphyxia are commonest causes. Timely and appropriate therapy is essential to prevent ongoing injury and improve outcome. The aim of this study was to determine the prevalence and to identify the causes of respiratory distress in neonatal intensive care unit (NICU) in Combined Military hospital (CMH) Sylhet and to observe the hospital outcome of these babies. Material and Methods: A descriptive type of crosssectional study was conducted in CMH Sylhet over a period of one year from April 2018 to March 2019. All live newborns delivered at CMH Sylhet during the study period were included and observed for development of respiratory distress. Results: All newborns (n=287), delivered at this hospital over the period of 12 months, were observed for respiratory distress. The overall prevalence of respiratory distress was 19.2 %. Prevalence was 10.8 % in full term, 7.3 % in preterm and 1.1% in post term. There was male predominance (54.5%) and two third (71.1%) were born by cesarean section. Transient tachypnea of newborn was found to be the commonest 47.3% cause of respiratory distress followed by respiratory distress syndrome 29.1%, perinatal asphyxia (10.9%), congenital pneumonia 3.6%, congenital heart disease 3.6%, septicaemia 3.6% and meconium aspiration syndrome (MAS) 1.9%. All babies required high flow oxygen initially, subsequently Bubble CPAP and mechanical ventilation was required in 8 (14.5%) and 1(1.8%) cases respectively. Mortality was 1.8% in neonates with respiratory distress syndrome with pneumothorax with septicaemia requiring mechanical ventilation. Conclusion: In this series, RDS in newborn majority of cases were due to TTN followed by respiratory distress syndrome and perinatal asphyxia. Mortality was mainly related to pneumothorax with septicaemia, RDS was more common in births related to caesarian section. J Bangladesh Coll Phys Surg 2021; 39(1): 4-8


Author(s):  
Hernan Tesler-Mabe

As recently as one year ago, the European Union was seemingly on a direct path toward its avowed goal of "ever closer union." In numerous publications, EU authorities asserted that they had the confidence of European peoples desirous only of further integration. In the wake of the failed referenda for a European Constitution, however, enthusiasts of European Union can no longer be certain that their enterprise will succeed. The European Union, once strong and united, seems now an entity teetering on the edge of collapse. The reasons for such a dramatic shift are, of course, wide-ranging. Yet I would suggest that a great part of the general European disillusionment with European Union has come about as a result of the actions of the Europeanists themselves. Over the last decades, European officials have exhibited a frightfully high incidence of revisionism in their literature. This practice, I argue, has caused many Europeans to question the integrity of the project of European Union. For my presentation, I intend to undertake a close study of a selection of documents published by the European Communities. In this endeavour, I will compare and contrast the messages imparted in different editions of these works and consider the semiotic significance of the textual and non-textual language appearing therein. In this manner, I hope to achieve two aims. First, I mean to add a corrective element to a literature that, guided by a teleological interpretation of integration, endows integration with”logic" to be found only in hindsight. Second, I intend to examine the many meanings that the EU has had over its history and assess how closely policy has adhered to the ideological goals of prominent Europeanists. In sum, I hope to shed light on the fundamental disconnect between advocates of Europe and the "man on the street" and help establish a dialogue which may contribute to resolving the current impasse within the European Union. Full text available: https://doi.org/10.22215/rera.v2i4.178


2021 ◽  
pp. 039139882199938
Author(s):  
Matthew L Friedman ◽  
Samer Abu-Sultaneh ◽  
James E Slaven ◽  
Christopher W Mastropietro

Background: We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality. Methods: Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality. Results: We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH2O (20,27); positive end expiratory pressure (PEEP) 10 cmH2O (8, 10); and fraction of inspired oxygen (FiO2) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FiO2 (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality. Conclusions: Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO2. Further study on the relationship between FiO2 and mortality should be pursued.


Critical Care ◽  
2014 ◽  
Vol 18 (4) ◽  
pp. R155 ◽  
Author(s):  
Guillaume Leroy ◽  
Patrick Devos ◽  
Fabien Lambiotte ◽  
Didier Thévenin ◽  
Olivier Leroy

PEDIATRICS ◽  
1976 ◽  
Vol 58 (1) ◽  
pp. 10-17
Author(s):  
Ronald L. Gutberlet ◽  
Marvin Cornblath

Between 1971 and 1973, the frequency of neonatal hypoglycemia was 4.4/1,000 total inborn live births or 15.5/1,000 low-birthweight infants. During that same time, of 257 transferred infants, 13 or 5.1% were hypoglycenic. The hypoglycemic manifestations differed between the inborn and outborn infants as well as from those previously described for transient symptomatic hypoglycemia. This required a new classification for low blood glucose values in the neonate, based on intrauterine nutrition, stress, symptoms, and underlying pathology. Four categories were defined: category I: early transitional hypoglycemia; category II: secondary hypoglycemia; category III: classical transient hypoglycemia; and category IV: recurrent, severe hypoglycemia. One outborn infant was in the latter group due to β-cell hyperplasia and was only cured after a 90% pancreatectomy. Data revealed that early treatment of perinatal asphyxia was associated with a decreased frequency of hypoglycemia. While not a prospective survey, the evidence suggested that current neonatal intensive care may decrease the frequency of transient symptomatic neonatal hypoglycemia.


PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_E1) ◽  
pp. e534-e541
Author(s):  
Joseph W. Kaempf ◽  
Betty Campbell ◽  
Ronald S. Sklar ◽  
Cindy Arduza ◽  
Robert Gallegos ◽  
...  

Objective. The purpose of this article is to describe how a neonatal intensive care unit (NICU) was able to reduce substantially the use of postnatal dexamethasone in infants born between 501 and 1250 g while at the same time implementing a group of potentially petter practices (PBPs) in an attempt to decrease the incidence and severity of chronic lung disease (CLD). Methods. This study was both a retrospective chart review and an ongoing multicenter evidence-based investigation associated with the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative (NIC/Q 2000). The NICU specifically made the reduction of CLD and dexamethasone use a priority and thus formulated a list of PBPs that could improve clinical outcomes across 3 time periods: era 1, standard NICU care that antedated the quality improvement project; era 2, gradual implementation of the PBPs; and era 3, full implementation of the PBPs. All infants who had a birth weight between 501 and 1250 g and were admitted to the NICU during the 3 study eras were included (era 1, n = 134; era 2, n = 73; era 3, n = 83). As part of the NIC/Q 2000 process, the NICU implemented 3 primary PBPs to improve clinical outcomes related to pulmonary disease: 1) gentle, low tidal volume resuscitation and ventilation, permissive hypercarbia, increased use of nasal continuous positive airway pressure; 2) decreased use of postnatal dexamethasone; and 3) vitamin A administration. The total dexamethasone use, the incidence of CLD, and the mortality rate were the primary outcomes of interest. Secondary outcomes included the severity of CLD, total ventilator and nasal continuous positive airway pressure days, grades 3 and 4 intracranial hemorrhage, periventricular leukomalacia, stages 3 and 4 retinopathy of prematurity, necrotizing enterocolitis, pneumothorax, length of stay, late-onset sepsis, and pneumonia. Results. The percentage of infants who received dexamethasone during their NICU admission decreased from 49% in era 1 to 22% in era 3. Of those who received dexamethasone, the median number of days of exposure dropped from 23.0 in era 1 to 6.5 in era 3. The median total NICU exposure to dexamethasone in infants who received at least 1 dose declined from 3.5 mg/kg in era 1 to 0.9 mg/kg in era 3. The overall amount of dexamethasone administered per total patient population decreased 85% from era 1 to era 3. CLD was seen in 22% of infants in era 1 and 28% in era 3, a nonsignificant increase. The severity of CLD did not significantly change across the 3 eras, neither did the mortality rate. We observed a significant reduction in the use of mechanical ventilation as well as a decline in the incidence of late-onset sepsis and pneumonia, with no other significant change in morbidities or length of stay. Conclusions. Postnatal dexamethasone use in premature infants born between 501 and 1250 g can be sharply curtailed without a significant worsening in a broad range of clinical outcomes. Although a modest, nonsignificant trend was observed toward a greater number of infants needing supplemental oxygen at 36 weeks’ postmenstrual age, the severity of CLD did not increase, the mortality rate did not rise, length of stay did not increase, and other benefits such as decreased use of mechanical ventilation and fewer episodes of nosocomial infection were documented.


1991 ◽  
Vol 29 (26) ◽  
pp. 104.1-104

Articles in the Bulletin have been unsigned since it began. This is because they aim to present a consensus view which incorporates contributions from many people, including specialists, general practitioners and members of the pharmaceutical industry, as well as the Bulletin’s Advisory Council. We are very grateful to them all, but although we have often been asked who they are, we cannot name the many hundreds who have helped us in any one year. However, we can at least name those not listed in our tailpiece who have taken a major share in the production of articles published in the last year, and do so now.


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