Predictors of Immediate Outcome in Neonates on Invasive Mechanical Ventilation

Background: Neonatal mechanical ventilation has contributed to a significant decline in neonatal mortality but is associated with various complications. It is necessary to identify the prognostic factors and their management to reduce the complications in mechanically ventilated neonates. Therefore, this study was designed to investigate the common indications, complications, and predictive factors associated to immediate outcomes in neonates from rural North India who received invasive mechanical ventilation. Methods: This study includes all neonates admitted to the neonatal intensive care unit requiring invasive mechanical ventilation for at least 12 hours. All enrolled neonates were categorized into two groups: those who were successfully extubated were labeled as survivors, while those who did not survive during ventilation were classified as non-survivors. Clinical and ventilator parameters, as well as the occurrence of complications were analyzed to identify factors associated with outcomes in ventilated neonates. Results: A total of 150 neonates who met the inclusion criteria were enrolled. The most frequent reason for ventilation was perinatal asphyxia. Among ventilated neonates, the mortality rate was 38.7%. When comparing survivor and non-survivor groups, a significant difference was observed in birth weight, gestational age, indication for ventilation, duration of ventilation, and blood acidosis (with a p-value < 0.05). Additionally, non-survivors experienced a higher prevalence of complications, including sepsis, shock, air leak syndrome, and pulmonary hemorrhage. Multivariate analysis revealed that gestational age less than 34 weeks, initial blood pH of 7.1 or lower, ventilation duration exceeding 72 hours, and the presence of sepsis, shock, or disseminated intravascular coagulation were significant independent predictors of mortality in ventilated neonates. Conclusion: The mortality among ventilated neonates is still high in developing countries. Hospital acquired sepsis with shock is still the major complication among ventilated neonates. Early identification of risk factors for mortality and timely intervention may decrease the mortality.