Characteristics of infants requiring mechanical reventilation in those previously ventilated during the neonatal period

Abstract

Background. Factors predisposing ventilated neonates to the risk for reventilation during infancy are largely unknown.

Objective. To identify factors that predispose previously mechanically ventilated neonates to reventilation.

Methods. Mechanically ventilated infants at the Inkosi Albert Luthuli Central Hospital paedicatric intensive care unit (PICU), South Africa, who were also ventilated during the neonatal period were compared with age-, gender-, timing-, and site-matched controls who were not reventilated during infancy. Neonatal and postnatal records of the two cohorts and data on their clinical presentation and outcomes of the ICU admission were collected and analysed using descriptive and comparative statistics.

Results. Thirty-one reventilated index cases were identified at the PICU over a 15-month period and were matched with 31 non‑reventilated controls. Ex-preterm babies (n=26; 84%), males (n=19; 61.3%), chronic lung disease (CLD) of infancy (n=5; 16.7%) and prolonged neonatal length of stay (LOS) were common neonatal factors in reventilated neonates. Pneumonia (n=22; 71%), sepsis (n=11; 35.5%) and upper airway obstruction (UAO) (n=8; 25.8%) were common reasons for reventilation in neonates. There were no HIV‑positive cases. Of the 31 reventilated cases, 5 (16.1%) demised and 15 (57.6%) survivors had morbidities, commonly seizures (n=8; 30.8%) and short bowel syndrome (n=3; 11.5%).

Conclusion. Pre-term birth, male, CLD of infancy and prolonged LOS were associated with an increased risk for mechanical reventilation in infancy. Pneumonia, sepsis, CLD of infancy and UAO were common indications for reventilation post neonatal ICU discharge.