gms | German Medical Science

Background and aim: Respiratory disorders are the most frequent cause of admission to NICUs and are the leading cause of early neonatal morbidity and mortality. The introduction of NICUs and widespread use of mechanical ventilation revolutionized the outcome in sick neonates. This index prospective cohort study was conducted at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Bhutan, the apex institute for health care in the country. The aim of the study was to outline the clinical characteristics, indications, short term outcomes and the factors associated with the outcomes of mechanically ventilated neonates.

Methods: This prospective cohort study was conducted from 01 November 2020 to 31 October 2021 at the NICU, JDWNRH. All neonates, inborn and outborn who were admitted to the NICU and underwent mechanical ventilation were candidates for the study. Neonates with lethal congenital malformations, extreme preterm <25 weeks, weighing <500 grams, and neonates intubated for <6 hours were excluded from the study.

Results: Of the 374 admissions to the NICU over the study period, 100 neonates underwent mechanical ventilation. 95 fulfilled the inclusion criteria. The majority (60%) were preterm. Respiratory distress was the commonest indication for ventilation (57.9%). Sepsis was the most common diagnosis (31.3%) among ventilated neonates and prematurity was the leading cause of death (43.6%). The survival among ventilated neonates was (58.9%), comparable to other developing countries. Pulmonary hemorrhage predicted poor outcome and birth weight less than 1500 grams, APGAR score less than 8 at 5 minutes and SNAPPE II score ≥37 were predictors of mortality as per ROC analysis.

Table 1 [Tab. 1]

Conclusion: The judicious use of mechanical ventilation has improved outcomes in NICUs globally and in Bhutan. Birth weight, APGAR score at 5 mins and SNAPPE II score are useful indicators of mortality among ventilated neonates and pulmonary hemorrhage predicted poor outcome.