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Introduction: Mechanical ventilation is an important factor contributing to the reduced neonatal mortality in NICU. However, many ventilated babies are left with detrimental sequelae. This study was undertaken to know the prognostic predictors and survival outcome in the ventilated neonates. We assessed the clinical profile, outcome of mechanical ventilation and analysed the risk factors for mortality and complications resulting from mechanical ventilation. Methods: A prospective study was conducted at the NICU of a tertiary care hospital in India. The study period was from May 2015 to April 2016. Neonates who underwent mechanical ventilation and met the inclusion criteria were enrolled in the study. Their demographic profile, outcomes and risk factors were documented and analysed using appropriate statistical methods. Results: 285 neonates required mechanical ventilation during the study period. Among them, 190 were included in the study. Overall mortality was 99 out of the 190 enrolled (52%). The most common indications for mechanical ventilation were Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome (MAS) and apnea. Risk factors contributing significantly to higher mortality of ventilated neonates were very low birth weight (VLBW), gestation of less than 32 weeks, shock, ventilatorassociated complications like pneumothorax and pulmonary haemorrhage. In multiple regression analysis, very low birth weight, circulatory disturbances, pneumothorax, pulmonary haemorrhage, and higher initial FiO2 requirement were found to be independent risk factors of mortality. Conclusions: The commonest indications for mechanical ventilation were RDS and MAS. Significantly higher mortality was seen amongst VLBW, preterm neonates. Co-morbidities like circulatory disturbance, and complications like pneumothorax and pulmonary haemorrhage contributed to adverse outcomes. Keywords: mechanical ventilation; neonates; outcome Correspondence: Khushboo Kamal Taneja Department of Paediatrics, Medical College, Vadodara, Gujarat, India Email: khushbooktaneja@gmail.com DOI: 10.3126/jnps.v41i1.30630 Submitted on: 2020-08-13 Accepted on: 2021-02-14 Acknowledgements: None Funding: Nil Conflict of Interest: None declared Permission from IRB: Yes To cite this article: Thakkar PA, Pansuriya HG, Bharani S, Taneja KK. Clinical Profile, Outcome And Risk Factors For Mortality Of Neonates Requiring Mechanical Ventilation At Tertiary Care Centre Of Central Gujarat, India J Nepal Paediatr Soc. 2021;41(1): 29-34. This work is licensed under creative common attribution 3.0 license ! ! Original Article Mortality of Neonates Requiring Mechanical Ventilation; Thakkar PK et al. INTRODUCTION As per the Sample Registration System (SRS) 2017 report, the present Infant Mortality Rates (IMR) of our country and Gujarat are 37 and 30 per 1000 live births respectively,1 against targeted 27/1000 live births under Millennium Development Goals-4, which was to be achieved by 2015,2,3 despite a plethora of measures taken by the Government with focus on neonatal health. The improved access to neonatal mechanical ventilation is an important factor contributing to the reduced neonatal mortality in today’s age. However, significant number of ventilated babies who survive, do so with detrimental sequelae due to their turbulent NICU stay; due to many economic and infrastructural hurdles in a low-income country like India. Various Indian studies report a survival rate of 40% to 60%.4 Thus, this study was undertaken with the objectives of studying the clinical profile, outcome of mechanical ventilation in neonates and analysing the risk factors for mortality and complications resulting from mechanical ventilation and their effect on survival. METHODS A prospective, hospital-based study was conducted at the NICU of Kashiben Gordhandas Patel Children Hospital (KGP), Vadodara, Gujarat, India. The study period was from May 2015 to April 2016. The study was commenced following approval from the Institutional Ethical and Scientific Committee. The sample size of 232 was derived by applying formula N = 4 x pq / L2; N = sample size; p = positive factor i.e. proportion, q = 100 – p; L = 20% allowable error, precision, variability. During the study period of one year, 285 (21.9%) neonates of total 1299 admissions were mechanically ventilated, of which 232 (17.8%) neonates fulfilling the inclusion criteria were enrolled after taking a written informed consent from the parents. Forty-two babies took discharge against medical advice during the study or were ventilated prior to admission, thus they were excluded. Finally, 190 (14.6%) cases requiring ventilator support were analysed. J Nepal Paediatr Soc Vol 41 Issue 1 Jan-Apr 2021 !30 Figure 1. Study flowchart ! ! Original Article Mortality of Neonates Requiring Mechanical Ventilation; Thakkar PK et al. For all included neonates, a thorough history was taken as per a set proforma, then they were examined and gestational age was established by using the expected date of delivery and / or expanded new Ballard score. Neonates presenting with respiratory distress were assessed by Downe or Silverman Anderson score (SAS). A provisional diagnosis was made based on the clinical condition and initial blood gas report, and a decision was taken for mechanical ventilation. Treatment of ventilator related complications, and other supportive management were undertaken as per standard NICU protocols. Outcome was determined in terms of survival and days of hospi ta l i sa t ion. The col lec ted data was computerised and analysed using appropriate statistical methods like Chi-square test, t test, multivariate analysis, etc. RESULTS Of the 285 neonates needing mechanical ventilation during the study period, 190 cases were finally analysed, meeting the inclusion and exclusion criteria (Figure 1). Majority of the neonates included were born outside KGP (93.2 %). The percentage of babies who got admitted within the first 24 hours of life was 63.2%. Among the babies, 48.3% were preterm and 21.6% were very low birth weight (Table 1). Overall mortality was 99 out of the 190 enrolled (52%), of which 81 (43%) died while receiving mechanical ventilation; the rest died after weaning off from the ventilator due to some other cause (e.g. aspiration, acute renal failure, sepsis with refractory shock). Among the ventilated babies, 91 (47.9 %) were successfully weaned off from the ventilator and discharged from the NICU (Figure 1).   As shown in Table 2 below, the most common indication for mechanical ventilation was Respiratory Distress Syndrome (RDS) (35.3%), followed by Meconium Aspiration Syndrome (MAS) (18.4%) and apnea (17.4%). J Nepal Paediatr Soc Vol 41 Issue 1 Jan-Apr 2021 !31 Table 1. Demographic variables of the enrolled neonates requiring ventilation! Demographic variables Distribution Number of cases (N = 190) Percent of total Cases (%) Area Rural 109 57.4 Place of birth KGP Hospital (Inborn) 13 6.8

journal of nepal paediatric society

Clinical Profile, Outcome and Risk Factors for Mortality of Neonates Requiring Mechanical Ventilation at Tertiary Care Centre of Central Gujarat, India