STUDY OF ASSISTED VENTILATION OF CHILDREN IN PRIVATE SMALL HOSPITAL
Dr. Srinath Mugali*
Sneh Children's Hospital, Hubli *
Introduction
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 and 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 wherein 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
Total number of Admissions       : 1521 Babies
Post Neonatal       : 1281 Babies
Newborns        : 240 Babies
Total number of babies ventilated        : 44 Babies
Post Neonatal       : 10 Babies
Newborns       : 34 Babies

Newborn comprised of 17 babies weighing more than 2500 Grams and 17 weighing less than 2500 grams.

Sex:
Total number of Babies:        44 Babies
Male:        29 Babies
Female:        15 Babies
Weight Distribution of babies were

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
Number of hours the babies ventilated are

Hours <24 Hrs 24-48 Hrs 48 Hrs 72-96 Hrs 96-120 Hrs > 129 Hrs
No.of Babies
26 6 2 6 2 2
Clinical conditions for which the babies were ventilated and the outcome

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. Laparotomy 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
: 44
Number of babies survivors : 16 Making 36.36%
Number of babies non-survivors : 27 Making 61.36%
Number of babies discharged against medical advice : 1 Making 2.27%
The day on which the baby was started on ventilation after admission and the outcome

- 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
Discussion
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
Conclusion
  1. Ventilation can be carried out in private small hospital.
  2. Education of referring doctors is very important for early referral and prevention of hypothermia.
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