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
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.
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.
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