Letters to the Editor

Indian Pediatrics 2000;37: 1285-1286.

Mechanical Ventilation: Our Experience

Neonatal mechanical ventilation is probably the single most important factor contributing to the rapid decrease in neonatal mortality within the last two decades(1). Here we share our experience with mechanical ventilation during the last three years (1997 to 1999). Our Neonatal Intensive care unit is a level II unit catering for babies born in the hospital as well as for babies born outside. The unit uses multi-channel criti-care monitors, Infant Star and Bear Club ventilators with central supply of oxygen and suction.

This study mainly focuses only on immediate outcome of ventilated babies. All cases were carefully analyzed and a detailed antenatal, intranatal and postnatal history was obtained. Birth weight, gestational age and age of onset of respiratory distress were recorded. Standard clinical, laboratory and/or radiologic criteria were used for diagnosis of hyaline membrane disease (HMD), apnea of pre-maturity, meconium aspiration syndrome (MAS), birth asphyxia (BA), transient tachypnea of newborn, sepsis, and pneumonia. For all babies, cranial ultrasound was done as a routine investigation to detect intraventri-cular hemorrhage and bedside echocardio-graphy for diagnosing patent ductus arteriosus (PDA) on day 3.

All preterm babies received standard Inj. Betamethasone, 2 doses before delivery 12 hours apart. All babies were nursed under servo control open-care systems. Arterial blood gas analysis using radial artery puncture was done as and when necessary. Oxygen saturation was continuously monitored with pulse oximeter. Chest X-ray was done before and after extubation and whenever required. One-tenth of babies who were admitted to NICU during the study period required ventilation. The overall survival rate was 14.2% in 1997, 25% in 1998 and 50% in 1999. Similar success rate had been achieved in the West in the early 1980’s(2). HMD was the chief indication for ventilator therapy (Table I). The other indications included birth asphyxia, MAS and apnea of prematurity. The causes of apnea were hypoglycemia, sepsis and anemia. Sepsis was the commonest complication followed by air leaks, IVH and PDA.

Table I–Analysis of Ventilated Babies

MAS - Meconium aspiration syndrome
TTN - Transient tachypnea of newborn.

Age of initiation of ventilation ranged from day 1 to day 4. Babies ventilated on day 1 had HMD, severe birth asphyxia and MAS. Babies ventilated between day 3 to day 4 had sepsis and apnea of prematurity. Babies who needed ventilation early were mostly very sick thereby explaining the poor outcome. With availability of multichannel Criticare monitor and experienced personnel working as a team, survival improved from 1997 to 1999.

Pramila Hariprasad,
V. Sundararajan,
G. Srimathi,
Department of Pediatrics
G.K.N.M. Hospital,
Coimbatore 641 037, India.
E-mail: [email protected]

1. Donald I, Lord J. Augmented respiration. Studies in atelectasis neonatorum. Lancet 1953; 1: 9-17.

2. Bhakoo ON. Assisted ventilation in neonates: The Indian perspective. Indian Pediatr 1995; 32: 1261-1264.