Indications And Outcomes In Neonates Requiring Mechanical Ventilation In Level III Neonatal Intensive Care Unit, Wah Cantt, Pakistan

Abstract

Objective: This study was carried out in resource-restricted settings receiving patients predominantly from middle- or lower-income classes, to highlight the indications, outcomes, and multiple factors affecting the outcome of mechanical ventilation in neonates.Materials and Methods: A retrospective study was conducted in level 3 NICU. Neonates ventilated from January 2018 to July 2021 were included in this study. Primary disease as an indication of ventilation along with outcomes in comparison to various parameters (clinical and laboratory) was listed as predictors of mortality. Thrombocytopenia was defined as platelet count<150,000/ μl and thrombocytopenia present was recorded as positive and negative for normal platelet count. C Reactive Protein levels of > 6 mg/dl were taken as positive.Results: A total of 320 ventilated neonates were included in the study. Among them 65.6% were males and 41.3% survived. Respiratory distress syndrome (RDS ) (28.7%), Hypoxic Ischaemic Encephalopathy (HIE) (26.6%), and Neonatal sepsis (NNS) (14.1%) were the three most indications for ventilation. The disease-specific outcome shows mortality was 64.4% in NNS, 64% in RDS, and 56.4% in HIE. Out of the total enrolled babies for the study, 62.1% were received outdoors and 37.8 % were indoors 74.4% of babies with HIE were received outdoors. Low birth weight, prematurity, mode of admission, first CRP at the time of presentation, thrombocytopenia, and duration of ventilation were portending factors of mortality Conclusion: Prematurity associated with RDS, HIE and NNS were the major indications for ventilation. Outdoor babies have poor survival due to late referrals and late presentations. Thrombocytopenia and early sepsis were found to be bad prognostic factors.