24thKarnataka Pedicon 2005
Dr. Srinath Mugali
Sneh Children's Hospital, Hubli
Introduction:
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Numbers of Neonates requiring ventilation is increasing day by day till today more of this is being done either in an Institution or corporate hospitals. Mechanically ventilated babies have high fatality. Though ventilation is one of the more expensive therapies a subsidized ventilation is being tried in my setup. This study is aimed at to present pattern of babies undergoing ventilation in private small hospital for the benefit of practicing pediatricians.
Materials & Methods :
It is a retrospective study conducted in “SNEH” Children's Hospital, Hubli.
It is a hospital with 30 Beds, a Level II NICU & PICU with a servo ventilator and blood gas analyzer where in arterial blood gas (ABG) and capillary blood gases (CBG) are done round the clock. Portable X-ray and Lab working round the clock, OT and pediatric surgeon available. Staff & sisters are trained in doing ABG & CBG. Blood gases were done regularly with every change in settings or a minimum of 3 times a day at a low cost. Subjects of study included Neonates and Children. That have been ventilated. Period of study was from 1-1-2004 to 15-9-2005 as per records.
Results :
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| Total number of Admissions |
: 1,521 Babies |
| Post Neonatal |
: 1,281 Babies |
| New Born |
: 240 Babies |
| Total number of babies ventilated |
: 44 Babies |
| Post Neonatal |
: 10 Babies |
| New Born |
: 34 Babies |
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New born comprised of 17 babies weighing more than 2500 Grams and 17 weighing less than 2500 grams.
SEX
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| Total number of Babies |
: 44 Babies |
| Male |
: 29 Babies |
| Female : |
15 Babies |
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Weight distributions of babies were
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| Neonates |
Weight |
Number of Babies |
| 1 |
<1000 Grams |
3 |
| 2 |
1000 Grams – 2500 Grams |
14 |
| 3 |
> 2500 Grams |
17 |
| Post Neonates |
Weight |
Number of Babies |
| 4 |
<5 kgs |
1 |
| 5 |
5-10 kgs |
6 |
| 6 |
> 10 kgs |
3 |
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Number of hours the babies ventilated are |
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| Hours |
<24 Hrs |
24-48 Hrs |
48 Hrs |
72-96 Hrs |
96-120 Hrs |
> 129 Hrs |
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No.of Babies |
26 |
6 |
2 |
6 |
2 |
2 |
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Clinical conditions for which the babies were ventilated and the out come
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| Conditions |
Total |
Survivors |
Non-Survivo |
Dama |
| Meconium aspiration syndrome |
12 |
8 |
4 |
0 |
| RDS |
8 |
2 |
6 |
0 |
| Birth Asphyxia |
1 |
0 |
2 |
0 |
| Status Epilepticus |
3 |
1 |
2 |
0 |
| Acute Laryngotracheobronchitis |
2 |
1 |
1 |
0 |
| Meconium Aspiration with cerebral hemorrhage |
2 |
0 |
2 |
0 |
| Septicemia |
2 |
0 |
2 |
0 |
| Bronchopneumonia |
1 |
0 |
1 |
0 |
| Cong. Heart disease with CCF with LRTI |
1 |
0 |
1 |
0 |
| Meningitis |
1 |
0 |
1 |
0 |
| Birth Asphyxia with Mec. Aspiration |
3 |
1 |
2 |
0 |
| Conjoined twins |
1 |
0 |
1 |
0 |
| Septicemia |
3 |
0 |
2 |
1 |
| Surgical Post Op. Laprotomy |
1 |
0 |
1 |
0 |
| Meningomyelocele |
1 |
1 |
0 |
0 |
| Intraventricular hemorrhage |
1 |
0 |
1 |
0 |
| Anaphylaxis (ADR) |
1 |
0 |
1 |
0 |
| Total |
44 |
15 |
28 |
1 |
Results :
| Total No. of babies ventilated |
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: 44 |
| Number of babies survivors |
: 16 Making 36.36% |
| Number of babies non-survivors |
: 27 Making 61.36% |
| Number of babies discharged againstmedical advise |
: 1 Making 2.27% |
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The day on which the baby was started on ventilation after admission and the outcome
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| - |
Conditions |
Total |
Survivors |
Non-Survivors |
Dama |
| Day 1 |
<2500 Grams
>2500 Grams
>/= 5 kgs |
12
9
9 |
1
9
2 |
11
0
7 |
0
0
0 |
| Day 2 |
<2500 Grams
>2500 Grams
>/= 5 kgs |
2
4
1 |
0
1
0 |
2
3
1 |
0
0
0 |
| Day 3 |
<2500 Grams
>2500 Grams
>/= 5 kgs |
1
6
0 |
0
0
0 |
0
6
0 |
1
0
0 |
| - |
Total |
44 |
13 |
30 |
1 |
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Discussion :
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Study conducted at Maulana Azad Medical College Delhi, Indian Ped 2005-42:645-651, Shows 39/87 in <2000 Grams survived (41.37%) and ours <2500 2/15 survived making 13.3% 44/64 in> 2000 Grams survived (68.79%) and ours> 2500 10/19 survived making 52.63%.
Study conducted by Doctor Singh, Deorari A.K.Shows 99 Neonates ventilated and 50 survived 2 (55.5%).
Results in babies weighing more than 2500 Grams were better when ventilated on Day 1, than babies ventilated on Day 2 and 3 because babies were in MODS before starting ventilation or Consent to ventilate was given late. This study suggests early referral and ventilation improves the outcome hence useful in Education of the referring Doctors. High mortality in babies with weight less than 2500 Grams and Preterm babies who were Hypothermic when referred apart from having sepsis and birth asphyxia So proper maintenance of temperature of preterm babies can be emphasized of referring doctors. The babies with MAS survived better than RDS and Birth asphyxia babies.
The limitations of study are (i) It is a retrospective study (ii) Important investigations like USG and CT Scan were not available in the premises, Indicating there is a lot of scope for improvement
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Conclusion:
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- Ventilation can be carried out in private small hospital.
- Education of referring doctors is very important for early referral and prevention of hypothermia.
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Last Updated on 01-1-2006
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| How to cite this url |
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Karnataka Pedicon 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2006 [cited 01 January 2006];3. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
ASSISTED_VENTILATION_CHILDREN.asp
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