Prognosis of Mechanical Ventilation in Very Low Birth Weight Neonates: A Single-Center Study in Tehran.
School of Medicine Students' Journal,
Vol. 2 No. 4 (2020),
1 October 2020
Background and Aims: Approximately 4–7 percent of all live births are led to a very low birth weight (VLBW) situation where the morbidity and mortality rate are very high. A large number of VLBW newborns in intensive care unit (ICU) require mechanical ventilation due to various conditions. To reduce mortality in this group, identification of risk factors is important. This study aimed to determine the prognosis of mechanical ventilation in VLBW neonates at Mahdiye hospital in Tehran.
Materials and Methods: This study is a prospective cohort study. VLBW neonates who consecutively were put on mechanical ventilation during the study period were enrolled. Then, the enrolled neonates were divided into two groups: neonates who died after implementing the ventilator were in group-I and neonates who survived after receiving mechanical ventilation were in group-II. Demographic, clinical and paraclinical variables were gathered to find out the predictors of mortality of ventilated neonates. The data were analyzed by SPSS software version 21.
Results: During the study period, a total of 177 neonates were ventilated due to different causes. 56% were male with a male to female ratio 1.27:1. Mean birth weight and gestational age were 1024.8 ± 247.5 grams and 27.9±2.2 weeks respectively. Out of 177 mechanically ventilated VLBW neonates enrolled for this study, 53% died. Significant factors determining mortality rate were mean weight, mean gestational age, pulmonary hemorrhage, advance resuscitation and duration of hospital stay (p<0.05). APGAR score, gender, Pneumothorax, IVH>II, Sepsis and Maternal Disease were not significantly associated with mortality in VLBW neonates requiring mechanical ventilation (P>0.05).
Conclusion: This study showed that among the analyzed factors weight <1000gm, gestation <28weeks, pulmonary hemorrhage and complications during ventilation were the most significant predictors of mortality in ventilated VLBW neonates in the intensive care unit.
- Artificial Respiration
- Mechanical Ventilations
- Very-Low-Birth-Weight Infant
- Intensive Care Units, Neonatal
- Newborn Intensive Care Unit
- Neonatal ICU
- Infant Mortality
- Postneonatal Mortality
- Cohort Study
- Historical Cohort Studies
- Infantile Respiratory Distress Syndrome
- Neonatal Respiratory Distress Syndrome
- Preterm Infants
- CPAP Ventilation
- BiPAP Biphasic Positive Airway Pressure
- Bilevel Continuous Positive Airway Pressure
How to Cite
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. Lancet 2012;379(9832):2162–72.
WHO. Born too soon: the global action report on preterm birth. Neuro endocrinology letters 2012. 133-6.
Khoshnood Shariati, Karimi Z, Rezaienejad M, Basiri A, Torkestani NECF. Perinatal complications associated with preterm deliveries at 24 to 33 weeks and 6 days gestation (2011- 2012): A hospital-based retrospective study. Society 2005;31:219–24.
Miller RJ, Sullivan MC, Hawes K, Marks AK. The effects of perinatal morbidity and environmental factors on health status of preterm children at age 12. J Pediatr Nurs2009;24(2):101–14.
Pramanik AK, Rangaswamy N, Gates T. Neonatal Respiratory Distress. Pediatr Clin North Am 2015;62(2):453–69.
KumarA, Bhat BV. Epidemiology of respiratory distress of newborns. Indian J Pediatr 1996;63(1):93–8.
Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician 2007;76:987–94.
Patton CD, Schulman ES. Surfactant: clinical applications. Am Fam Physician 1992 Jul;46(1):233–6.
Been JV, Zimmermann LJI. What’s new in surfactant? A clinical view on recent developments in neonatology and paediatrics. Eur J Pediatr 2007;166(9):889–99.
Zhou B. Usefulness of DuoPAP in the treatment of very low birth weight preterm infants 2015;573–7.
Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update. Neonatology 2010;97(4):402–17.
RMC. Concepts of neonatal care of the infant of the diabetic mother. Ital J Pediatr 2004;30(1):25–31.
Wax JR, Herson V, Carignan E, Mather J, Ingardia CJ. Contribution of elective delivery to severe respiratory distress at term. Am J Perinatol 2002;19(2):81–6.
Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: influence of timing of elective caesarean section. Br J Obstet Gynaecol1995;102(February):101–6.
Van den Berg A, van Elburg RM, Van Geijn HP, Fetter WP. Neonatal respiratory morbidity following elective caesarean section in term infants. Eur J Obstet Gynecol Reprod Biol 2001;98(1):9–13.
Cohen M, Carson BS. Respiratory morbidity benefit of awaiting onset of labor after elective cesarean section. Obstet Gynecol 1985; 65(6):818–24.
Krantz ME, Wennergren M, Bengtson LG, Hjalmarson O, Karlsson K, Sellgren U. Epidemiological analysis of the increased risk of disturbed neonatal respiratory adaptation after caesarean section. Acta Paediatr Scand 1986;75(5):832–9.
Hales KA, Morgan MA, Thurnau GR. Influence of labor and route of delivery on the frequency of respiratory morbidity in term neonates. Int J Gynaecol Obstet. 1993;43(1):35–40.
Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane database Syst Rev 2006;(3):CD004454.
Finer NN, Carlo W a, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010;362(21):1970–9.
Cherif A, Hachani C, Khrouf N. Risk Factors of the Failure of Surfactant Treatment by Transient Intubation during Nasal Continuous Positive Airway Pressure in Preterm Infants. Am J Perinatol 2008;25(10):647–52.
Henderson-Smart David J, Wilkinson Andrew R, Raynes-Greenow Camille H. Mechanical ventilation for newborn infants with respiratory failure due to pulmonary disease. Cochrane Database of Systematic Reviews. 2002.
Dani C, Corsini I, Bertini G, Fontanelli G, Pratesi S, Rubaltelli FF. The INSURE method in preterm infants of less than 30 weeks’ gestation. J Matern Neonatal Med 2010;23(9):1024–9.
St John EB, Carlo WA. Respiratory distress syndrome in VLBW infants: changes in management and outcomes observed by the NICHD Neonatal Research Network. Semin Perinatol 2003;27(4):288–92.
Lista G, Fontana P, Castoldi F, Cavigioli F, Bianchi S, Bastrenta P. ELBW infants: to intubate or not to intubate in the delivery room? J Matern Fetal Neonatal Med 2012 Oct;25 Suppl 4:63–5.
Walsh MC, Morris BH, Wrage L a., Vohr BR, Poole WK, Tyson JE, et al. Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. J Pediatr 2005;146(6):798–804.
Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008;358(7):700–8.
Mortola JP, Fisher JT, Smith JB, Fox GS, Weeks S, Willis D. Onset of respiration in infants delivered by cesarean section. J Appl Physiol 1982;52(3):716–24.
Keszler M, Sant’Anna G. Mechanical Ventilation and Bronchopulmonary Dysplasia. Clin Perinatol 2015;42(4):781–96.
Lindner W, Vossbeck S, Hummler H, Pohlandt F. Delivery room management of extremely low birth weight infants: spontaneous breathing or intubation? Pediatrics 1999 May;103(5 Pt 1):961–7.
Aly H, Massaro AN, Patel K, El-Mohandes AA. Is it safer to intubate premature infants in the delivery room? Pediatrics 2005;115(6):1660–5.
Vanpée M, Walfridsson-Schultz U, Katz-Salamon M, Zupancic J a F, Pursley D, Jónsson B. Resuscitation and ventilation strategies for extremely preterm infants: a comparison study between two neonatal centers in Boston and Stockholm. Acta Paediatr2007;96(1):10–6.
Ramanathan R. Optimal ventilatory strategies and surfactant to protect the preterm lungs. Neonatology 2008;93(4):302–8.
Miller NE. Techniques of early respiratory management of very low and extremely low birth weight infants. Neonatal Netw 2010;29:153–60ذ.
Dargaville P a, Aiyappan A, De Paoli AG, Dalton RGB, Kuschel Ca, Kamlin CO, et al. Continuous positive airway pressure failure in preterm infants: Incidence, predictors and consequences. Neonatology 2013;104(1):8–14.
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