Iqbal Qazi, Younus Mir M, Ahmed Asif, Ahmad Ikhlas, Iqbal Javed, Charoo Bashir A, Ali S Wajid
Department of Neonatology and Pediatrics, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Indian J Crit Care Med. 2015 Sep;19(9):523-7. doi: 10.4103/0972-5229.164800.
Decreasing mortality in sick and ventilated neonates is an endeavor of all neonatologists. To reduce the high mortality in this group of neonates, identification of risk factors is important. This study was undertaken to find out the indications of ventilation and complications in ventilated neonates and also study possible predictors of outcome.
Age <1-month; mechanically ventilated; not having suspected metabolic disorders or congenital anomalies; excluding postoperative patients.
Neonates consecutively put on mechanical ventilation during the study period (October 2011 to November 2013) enrolled. Primary disease of the neonates along with complications present listed. Clinical and laboratory parameters analyzed to find the predictors of mortality.
Total 300 neonates were ventilated. 52% were male. Mean age, weight, and gestational age were 21 ± 62 h, 2320 ± 846.2 g, and 35.2 ± 4.9 weeks, respectively. 130 (43%) neonates died. Respiratory distress syndrome (RDS) (31.1%), sepsis (22.7%), and birth asphyxia (18%) were the most common indications for ventilation. Mortality in ventilated patients with sepsis, pneumonia, RDS or birth asphyxia was 64.7%, 60%, 44.6%, and 33.3%, respectively. Weight <2500 g, gestation <34 weeks, initial pH <7.1, presence of sepsis, apnea, shock, pulmonary hemorrhage, hypoglycemia, neutropenia, and thrombocytopenia were significantly associated with mortality (P < 0.05). Resuscitation at birth, seizures, intra ventricular hemorrhage, pneumothorax, ventilator-associated pneumonia, PO2, or PCO2 did not have a significant association with mortality. On logistic regression, gestation <34 weeks, initial pH <7.1, pulmonary hemorrhage, or shock were independently significant predictors of mortality.
Weight <2500 g, gestation <34 weeks, initial arterial pH <7.1, shock, pulmonary hemorrhage, apnea, hypoglycemia, neutropenia, and thrombocytopenia were significant predictors of mortality in ventilated neonates.
降低患病及接受机械通气的新生儿死亡率是所有新生儿科医生的努力方向。为降低这组新生儿的高死亡率，识别风险因素至关重要。本研究旨在找出接受机械通气新生儿的通气指征及并发症，并研究可能的预后预测因素。
年龄<1个月；接受机械通气；无疑似代谢紊乱或先天性异常；排除术后患者。
纳入研究期间（2011年10月至2013年11月）连续接受机械通气的新生儿。列出新生儿的原发疾病及出现的并发症。分析临床和实验室参数以找出死亡率的预测因素。
共有300例新生儿接受通气。52%为男性。平均年龄、体重和胎龄分别为21±62小时、2320±846.2克和35.2±4.9周。130例（43%）新生儿死亡。呼吸窘迫综合征（RDS）（31.1%）、败血症（22.7%）和出生窒息（18%）是最常见的通气指征。患有败血症、肺炎、RDS或出生窒息的通气患者死亡率分别为64.7%、60%、44.6%和33.3%。体重<2500克、孕周<34周、初始pH<7.1、存在败血症、呼吸暂停、休克、肺出血、低血糖、中性粒细胞减少和血小板减少与死亡率显著相关（P<0.05）。出生时复苏、惊厥、脑室内出血、气胸、呼吸机相关性肺炎、PO2或PCO2与死亡率无显著相关性。逻辑回归分析显示，孕周<34周、初始pH<7.1、肺出血或休克是死亡率的独立显著预测因素。
体重<2500克、孕周<34周、初始动脉pH<7.1、休克、肺出血、呼吸暂停、低血糖、中性粒细胞减少和血小板减少是接受机械通气新生儿死亡率的显著预测因素。
