الفهرس 
INDICATIONS OF MECHANICAL VENTILATIONOnly 14 pages are availabe for public view
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Abstract
Neonatal morbidity and mortality are important public health problems in developing countries. The neonatal period is considered highly vulnerable time for an infant, who is completing many of the physiologic adjustment required for extra uterine existence.
The late fetal and early neonatal period is the time of the life exhibiting the highest mortality rate of any age interval.
A retrospective study was conducted over a period of one year (January – December 2006), in the neonatal intensive care unit of ELmounira Children’s Hospital Cairo University. The aim was to review the outcome of mechanically ventilated neonates in the NICU and to correlate such outcome with the percentage of infection, type of organism, treatment and outcome.
The total number of cases was 61 infants. Thirty six of them were males (59%) and 25(41%) were females. Their gestational age ranged from 26 weeks to 40 weeks with mean of (33.27), and their admission’s weights varied from 0.75 to 3.18 kg with mean of (1.96). The admission ages of the patients ranged from few hours to 28 days. with mean of (4.7).
The commonest causes of admission were respiratory distress syndrome, followed by transient tachypnea of the newborn and hypoxic ischaemic encephalopathy.Most of the patients (82%) were on mechanical ventilator while 18% were on CPAP.
The incidence of Ventilation associated pneumonia (VAP) among our studied was group (50.8 %).The diagnosis of VAP was difficult and depends on x- ray and clinical picture.
Risk factors are gestational age, reintubation, duration of mechanical ventilation and RDS.
The patient’s blood cultures which were positive revealed an excess of gram negative infections (92%) of these cultures.
Sepsis specifically VAP can be attributed to shortage of nursing staff and deficient infection control practices, but also to the fact that cases referred to us were outborn, which may contribute to the increase incidence of sepsis
Most of the patients who received antibiotics were started on ampicillin and an aminoglycoside (first line regimen). The need to change the antibiotic regimen later (72%) was due to clinical deterioration or resistant organisms.
The rate of mortality was (58%). The commonest causes of death were sepsis (51%)and respiratory disorders(43%) of the deaths. Other causes included: intracranial hemorrhage, MOSF and others. but no relation between VAP and mortality.
Alive cases (42%) were discharged with recommendations for follow up in the neonatal clinic and / or special clinics according to their condition on discharge.