Journal of Postgraduate Medicine, Education and Research

Register      Login

VOLUME 56 , ISSUE 2 ( April-June, 2022 ) > List of Articles

Original Article

Short-term Outcome of Manually Ventilated Outborn Neonates Admitted in Pediatric Emergency of a Developing Economy

Rajendra P Anne, Suresh K Angurana, Praveen Kumar, Venkatasesan Sundaram

Keywords : Manual ventilation, Neonates, Positive pressure ventilation, Self-inflating bag

Citation Information : Anne RP, Angurana SK, Kumar P, Sundaram V. Short-term Outcome of Manually Ventilated Outborn Neonates Admitted in Pediatric Emergency of a Developing Economy. J Postgrad Med Edu Res 2022; 56 (2):75-80.

DOI: 10.5005/jp-journals-10028-1439

License: CC BY-NC 4.0

Published Online: 07-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim and objectives: In our country, managing neonates and children in need of positive pressure ventilation (PPV) with manual ventilation are not an uncommon practice due to a lack of adequate resources. But there is a lack of data on the outcome of manually ventilated neonates. This study was conducted to determine the short-term outcome of manually ventilated outborn neonates admitted in pediatric emergency of tertiary care hospital in North India. Materials and methods: This retrospective study was conducted from April to June 2018 involving 131 outborn neonates who were manually ventilated with self-inflating bags (SIBs). Details regarding demographic variables, perinatal period, treatment received, ventilation, the reason for intubation and PPV, duration of intubation, complications related to PPV, diagnosis, and final outcome were noted. Results: The mean age at admission was 5.6 days and 76% were males. The mean gestation and birth weight were 36.4 (±4.1) weeks and 2,309 (750) g, respectively. The common diagnoses were hypoxic-ischemic encephalopathy (HIE), early-onset neonatal sepsis (EONS), late-onset neonatal sepsis (LONS), and hyaline membrane disease (HMD). The survival rate was 22.1%, 45.8% of cases died, and 32.1% left against medical advice (LAMA). On univariate analysis, complications related to PPV; and presence of shock, thrombocytopenia, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), and HIE were associated with poor outcome (death + LAMA); whereas on multivariate analysis, complications related to PPV, and presence of shock and HIE were independent predictors of poor outcome (death + LAMA). Conclusion: One-fifth of manually ventilated outborn neonates survived. Complications related to PPV, and presence of shock, and HIE were an independent predictor of poor outcome (death + LAMA). Therefore, the facilities for the care of outborn neonates need to be upgraded, but in the setting where these facilities are not available, the provision of manual ventilation may save a significant number of babies.

  1. Million Death Study C, Bassani DG, Kumar R, et al. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet 2010;376(9755):1853–1860. DOI: 10.1016/S0140-6736(10)61461-4
  2. Thakur N, Saili A, Kumar A, et al. Predictors of mortality of extremely low birthweight babies in a tertiary care centre of a developing country. Postgrad Med J 2013;89(1058):679–684. DOI: 10.1136/postgradmedj-2012-131736
  3. Sankar MJ, Neogi SB, Sharma J, et al. State of newborn health in India. J Perinatol 2016;36(S3):S3–S8. DOI: 10.1038/jp.2016.183
  4. Million Death Study C. Changes in cause–specific neonatal and 1–59–month child mortality in India from 2000 to 2015: a nationally representative survey. Lancet 2017;390(10106):1972–1980. DOI: 10.1016/S0140-6736(17)32162-1
  5. Krishnamoorthy V, Vavilala MS, Mock CN. The need for ventilators in the developing world: an opportunity to improve care and save lives. J Glob Health 2014;4(1):010303. DOI: 10.7189/jogh.04.010303
  6. Riviello ED, Letchford S, Achieng L, et al. Critical care in resource-poor settings: lessons learned and future directions. Crit Care Med 2011;39(4):860–867. DOI: 10.1097/CCM.0b013e318206d6d5
  7. Trotman. The neonatal intensive care unit at the University Hospital of the West Indies: The first few years’ experience. West Indian Med J 2006;55(2):75–79. DOI: 10.1590/s0043-31442006000200002
  8. Karthikeyan G, Hossain MM. Conventional ventilation in neonates: experience from Saudi Arabia. Indian J Pediatr 2002;69(1):15–18. DOI: 10.1007/BF02723768
  9. Riyas PK, Vijayakumar KM, Kulkarni ML. Neonatal mechanical ventilation. Indian J Pediatr 2003;70(7):537–540. DOI: 10.1007/BF02723151.
  10. Singh M, Deorari AK, Paul VK, et al. Three-year experience with neonatal ventilation from a tertiary care hospital in Delhi. Indian Pediatr 1993;30:783–789.
  11. Khoury A, De Luca A, Sall FS, et al. Performance of manual ventilation: how to define its efficiency in bench studies? A review of the literature. Anaesthesia 2015;70(8):985–992. DOI: 10.1111/anae.13097
  12. Bhalla A, Suri V, Sharma N, et al. An experience with manual ventilation in respiratory paralysis due to Indian common krait (bungarus caeruleus) bite. Asia Pac J Med Toxicol 2014;3:55–58.
  13. Maurya PK, Kalita J, Paliwal VK, et al. Manual AMBU ventilation is still relevant in developing countries. QJM 2008;101(12):990–991. DOI: 10.1093/qjmed/hcn113
  14. Suri V, Sharma N, Bhalla A, et al. Ambu bag – basic life support saves the day. Emerg Med J Online 2006.
  15. Baqui AH, Darmstadt GL, Williams EK, et al. Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes. Bull World Health Organ 2006;84(9):706–713. DOI: 10.2471/BLT.05.026443
  16. Group IYIS. Age profile of neonatal deaths. Indian Pediatr 2008;45:991–994.
  17. Bang AT, Paul VK, Reddy HM, et al. Why do neonates die in rural Gadchiroli, India? (Part I): primary causes of death assigned by neonatologist based on prospectively observed records. J Perinatol 2005;25(S1):S29–S34. DOI: 10.1038/
  18. Rocha G, Soares P, Gonçalves A, et al. Respiratory care for the ventilated neonate. Can Respir J 2018;2018:7472964. DOI: 10.1155/2018/7472964
  19. Berger E. Karachi Hackathon takes on emergency medicine challenges: solutions pitched for resource-poor environments. Ann Emerg Med 2017;69(2):A17–A20. DOI: 10.1016/j.annemergmed.2016.11.015
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.