Neonatal Mechanical Ventilation: Predictors of Mortality and Outcomes

Abstract

Introduction: A large number of neonates in neonatal intensive care require mechanical ventilation and they have high fatality rate. Early identification of complications and factors influencing the outcome is important to improve the survival of ventilated neonates. Aims: To determine the predictors of fatality in ventilated neonates. Settings and Design: This prospective cohort study was conducted among the ventilated neonates in the department of Neonatal Intensive Care Unit (NICU), BSMMU. To identify factors affecting fatality clinical, biochemical and ventilator parameters were followed. The final outcome was recorded as “survivor” and “non-survivor” at discharged or death. Quantitative variables were compared by unpaired t-test; categorical variables were compared by chi-square test. To determine predictors of fatality, multivariate logistic regression analysis was performed. Results: A total 74 neonates were included, among them 23(31.1%) were survivors and 51(68.9%) were non-survivors. Mean gestational age (30.90 ± 5.20 weeks Vs 33.91 ± 2.52 weeks, p=0.010) and mean birth wt (1501 ± 623.38 g Vs 1873.04 ± 481.76 g, p=0.013) were significantly lower in non-survivor group. Shock (84.3% Vs 34.8%; p<0.001), Pulmonary hemorrhage (15.7% Vs 0.00%; p=0.044), Acute kidney injury (58.8% Vs 30.4%; p=0.024), hyperglycemia (56.9% Vs 21.7%; p=0.005), hyponatremia (41.2% Vs 17.4%; p=0.045) were significantly higher in non-survivor group. Mean initial arterial pH (7.20 ± 0.117 Vs 7.31 ± 0.065; p<0.001), highest PIP (16.51 ± 1.91 Vs 14.96 ± 1.33; p=0.001), highest FiO2 (0.93 ± 0.07 Vs 0.58 ± 0.083; p<0.001), mean age of initiation of ventilation (8.53 ± 6.49 Vs 5.70 ± 4.15; p=027) were also significantly higher in non-survivor group then survivor group. Multivariate logistic regression analysis indicated the predictors of mortality were mean low birth weight (OR-0.997,95%CI0.995-1.00, p=0.00), AKI (OR-0.393,95% CI1.090-10.563, p=0.035), shock (OR-.507,95% CI 1.717-52.639,p=0.010), hyponatremia (OR-4.202, 95% CI 1.071-16.495, P=0.040), high FiO2 (OR-1.545, 95% CI 2.927-8.158, p=0.045) and high PIP (OR-2.122, 95% CI 1.273-3.537, p =0.004). Conclusion: The frequency of mortality in ventilated neonates was 68.9%. Low birth weight, shock, acute kidney injury, requirement of high PIP, high FiO2 and hyponatremia were associated with increased mortality.