Outcome of neonates requiring mechanical ventilation in a tertiary hospital

Abstract

Mechanical ventilation is a key therapeutic modality in treatment of sick neonates. Our hospital based retro­spective study conducted at Chitwan Medical College (CMC), Nepal over the duration of 2 years, from February 2015 to January 2017, with aims to study the clinical profile, indications, complications and outcome in terms of survival in mechanically ventilated neonates. Total of 119 mechanically ventilated neonates were included in the study. Along with admission and discharge register record, all the patient’s record files were retrieved from the medical record section, necessary details were entered in a predesigned proforma and statistical analysis was done using IBM SPSS 20 software. Out of 1306 total NICU admission, total 130 were mechanically ventilat­ed, among them only 119 (9.1%) were included in the study. Majority (71.4%) were male. More than half were Preterm (51.3%) and outborn (58%). Most common indication of mechanical ventilation was sepsis followed by Birth asphyxia (BA), respiratory distress syndrome/hyaline membrane disease (RDS/HMD) and Meconium Aspiration Syndrome (MAS). Overall survival was 45(37.8%). Among the indications during the study period, the best survival observed was in birth asphyxia. Shock and Disseminated intravascular coagulation (DIC) were the two most common complications encountered during the course of ventilation. Increasing birth weight, higher gestational age and Downes Score at intubation of 6 or < 6 was associated with a better outcome. Shock, multi organ dysfunctions (MODS), and ventilator associated pneumonia (VAP) were the statistically proven individual predictors of outcome.

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

“…In the study by Ahmed SM et al It is the most common indication with 22.5% survival. The third most common indication in our study was asphyxia 18 . The 2020 NNPD lists asphyxia at birth as the most common primary cause of neonatal death, with a frequency of 28.8% of all intramural deaths 19 .…”

Neonatal palliative care: Assessing the nurses educational needs for terminally ill patients

“…This situation might be connected to how tense and stressful it is for parents and other family members when a loved one passes away. Additionally, parents claimed that their stress levels are rising as a result of watching their child suffer and worrying about the child's death, particularly because they are unable to protect their child and are unaware of the [5,8,13,15]. Parents who experience these stressors often feel very helpless, and they require empathetic assistance from caregivers; nurses are well-positioned to offer this support [5,8,13,15].…”

“…Additionally, parents claimed that their stress levels are rising as a result of watching their child suffer and worrying about the child's death, particularly because they are unable to protect their child and are unaware of the [5,8,13,15]. Parents who experience these stressors often feel very helpless, and they require empathetic assistance from caregivers; nurses are well-positioned to offer this support [5,8,13,15]. As a result, nurses must set aside time to listen when family members need to express their emotions, offer consoling words, and have an honest conversation about grieving.…”

“…Many studies revealed uncertainty, discomfort, and chaos among nurses about the prognosis of the disease, the management and treatment of symptoms, and the appropriate time to transition from curative to palliative care [11][12][13][14][15]. These studies revealed that education works as the foundation for competency development that focuses on delivering the best care possible to neonates who are dying and their families [12][13][14].…”