Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax. Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Relationship of ventilator mode, selected settings, and risk procedures prior to detection of pneumothorax was studied using matched controls. Results. Of 540 neonates receiving mechanical ventilation, 10 (1.85%) were found to have pneumothorax. Respiratory distress syndrome, meconium aspiration syndrome, and pneumonia were the underlying lung pathology. Pneumothorax mostly (80%) occurred within 48 hours of life. Among ventilated neonates, significantly higher percentage with pneumothorax received mandatory ventilation than controls (70% versus 20%; P < 0.01). Peak inspiratory pressure >20 cm H2O and overventilation were not significantly associated with pneumothorax. More cases than controls underwent care procedures in the preceding 3 hours of pneumothorax event. Mean airway pressure change (P = 0.052) and endotracheal suctioning (P = 0.05) were not significantly associated with pneumothorax. Reintubation (P = 0.003), and bagging (P = 0.015) were significantly associated with pneumothorax. Conclusion. Pneumothorax among ventilated neonates occurred at low frequency. Mandatory ventilation and selected care procedures in the preceding 3 hours had significant association.

Burkholderia cepacia is a rare cause of sepsis in newborns and its transmission involves human contact with heavily contaminated medical devices and disinfectants. The authors aimed to determine epidemiology, clinical features, antibiotic sensitivity pattern, complications and outcome of blood culture proven B. cepacia infections in 12 neonates. All neonates were outborn, 5 preterm and 7 term. B. cepacia was isolated from blood in all and concurrently from CSF in three neonates. Lethargy and respiratory distress (41.7 %) were major presenting features. Five newborns (41.7 %) required mechanical ventilation for 3-7 d. Highest bacterial susceptibility was observed for meropenem (100 %), followed by cefoperazone-sulbactam, piperacillin-tazobactam, sulfamethoxazole-trimethoprim (all 83 %), ceftazidime (75 %) and ciprofloxacin (42 %). Piperacillin-tazobactam, ciprofloxacin and cotrimoxazole either singly or in combination led to complete recovery of 11 (91.7 %) newborns; one developed hydrocephalus. Eight of nine infants who completed 6 mo follow up were normal. Prompt recognition and appropriate antibiotic therapy for B. cepacia infection results in complete recovery in majority.

Background: Increased incidence and severity of acute lower respiratory tract infection (ALRI) are variably associated with malnutrition. Objectives: We aimed to examine the prevalence of malnutrition in under-five year old hospitalized children with ALRI. Patients and Methods: Children aged from 6 to 60 months, mostly from a low socioeconomic population, admitted with ALRI, were enrolled prospectively. WHO case definition was used for ALRI. The data about the weight, length/height, mid-arm circumference (MAC) in 1-5 year old children and acute respiratory infections (ARI) episodes in the preceding 6 months were collected in addition to demographic characteristics. Nutritional status was assessed using an age independent criteria in the form of ratio of weight (in kilograms multiplied by 100) to the length or height (in centimeter) squared. Results: Among 206 children with ALRI, 21.9% had pneumonia, 55.8% had severe pneumonia and 22.3% had very severe disease. About 85% of the children were younger than 3 years old. Male to female ratio was 1.34:1. The prevalence of malnutrition was seen in 54.9% of the children. MAC was below 13.5 cm in 59.4 %. Severe malnutrition was observed in 68.7% of 3-5 years age group and 59.4% of 1-3 years age group. Severe malnutrition had shown higher percentages among children with pneumonia and severe pneumonia. Severely malnourished children had more ARI episodes in the preceding 6 months although it was not statistically significant (OR 1.22; 95% CI 0.71-2.12; P = 0.47). Conclusions: High prevalence of severe malnutrition and its significant association with increased ALRI in 1-5 year old children highlights the need for strengthened nutrition intervention programs.