Browsing by Author "Basnet, Srijana"
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Publication Incidence, Outcome and Predictors of Mortality in Respiratory distress syndrome (RDS): A Prospective Cohort Study at Tertiary Care Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Aryal, Surabhi; Shrestha, LaxmanAbstract Introduction: With advances in therapies during antenatal and perinatal period, there has been apparent decrease in incidence and mortality due to respiratory distress syndrome (RDS). However, there is paucity of data on exact incidence and outcome of RDS in resource limited setting. This study was conducted with the primary aim to describe the outcome of RDS and analyze the predictors for mortality. Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) and Neonatal Unit of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2019 to April 2021. Results: A total of 94 preterm newborns developed RDS giving prevalence of 20.5 per 1000 live birth cohort at TUTH. Incidence of RDS among preterm babies was 14.6%. The median duration of continuous positive airway pressure (CPAP) was 48 hours (Range 8 - 192 hours). Inhospital mortality rate was 15 (15.96%). Lower gestational age and premature rupture of membrane (PROM) were significantly associated with higher mortality whereas Normal Vaginal delivery (NVD) was associated with lower mortality. Logistic regression analysis for risk of dying for the cohort predicted that lower birth weight (AOR = 0.99; 95% CI = 0.99 - 0.99; P = 0:01), sepsis (AOR = 145.14; 95% CI = 5.04 - 4175.15; P = 0:004) are independently associated with increased risk of dying whereas increase duration of NICU stay decreased the risk (AOR = 0.71; 95% CI = 0.54 - 0.91; P = 0:01). Conclusions: The mortality rate decreases with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortalityPublication Incidence, Outcome and Predictors of Mortality in Respiratory distress syndrome (RDS): A Prospective Cohort Study at Tertiary Care Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Aryal, Surabhi; Shrestha, LaxmanAbstract: Introduction: With advances in therapies during antenatal and perinatal period, there has been apparent decrease in incidence and mortality due to respiratory distress syndrome (RDS). However, there is paucity of data on exact incidence and outcome of RDS in resource limited setting. This study was conducted with the primary aim to describe the outcome of RDS and analyze the predictors for mortality. Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) and Neonatal Unit of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2019 to April 2021. Results: A total of 94 preterm newborns developed RDS giving prevalence of 20.5 per 1000 live birth cohort at TUTH. Incidence of RDS among preterm babies was 14.6%. The median duration of continuous positive airway pressure (CPAP) was 48 hours (Range 8 - 192 hours). Inhospital mortality rate was 15 (15.96%). Lower gestational age and premature rupture of membrane (PROM) were significantly associated with higher mortality whereas Normal Vaginal delivery (NVD) was associated with lower mortality. Logistic regression analysis for risk of dying for the cohort predicted that lower birth weight (AOR = 0.99; 95% CI = 0.99 - 0.99; P = 0:01), sepsis (AOR = 145.14; 95% CI = 5.04 - 4175.15; P = 0:004) are independently associated with increased risk of dying whereas increase duration of NICU stay decreased the risk (AOR = 0.71; 95% CI = 0.54 - 0.91; P = 0:01). Conclusions: The mortality rate decreases with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortalityPublication Outcome of Improvised Bubble Continuous Positive Airway Pressure (bCPAP) in Respiratory Distress Syndrome (RDS) and Factors Associated with its Failure: A Prospective Observational Study(Nepal Paediatric Society (JNPS), 2023) Basnet, Srijana; Aryal, Surabhi; Poudel, Daman Raj; Shrestha, LaxmanAbstract: Introduction: Bubble CPAP (bCPAP) is the standard treatment for newborn with RDS but is challenged by availability of proper bCPAP delivery devices. The improvised bCPAP using modified nasal prong with expiratory limb immersed in water is commonly used to deliver pressurized air to the neonate’s lungs. The primary objective of the study was to evaluate effectiveness of improvised bCPAP in treating Respiratory distress syndrome (RDS) and to identify factors that may be associated with its failure. Methods: In this prospective observational study, all consecutively born preterm neonates delivered before 37 weeks of gestation, admitted to the neonatal intensive care unit (NICU) with diagnosis of RDS and needed bCPAP were included in the study. Early rescue surfactant was given according to NICU protocol of the hospital. Those neonates failed to improve despite treatment with Continuous Positive Airway Pressure (CPAP) and needed MV within 96 hours of life are considered as CPAP failure (CPAP-F). Results: 119 preterm newborn with mean gestational age was 31.95 ± 2.05 weeks and birth weight 1614.33 ± 454.32 gm were enrolled. bCPAP was successful in 22 (18.5%) preterm infants. The mean duration of Continuous Positive Airway Pressure (CPAP) was 61.21 ± 41.81 hours and NICU stay was 12.34 ± 8.12 days. Surfactant was given in 51 (42.9%) and mortality rate was 17 (14.29%). Multivariable logistic regression analysis showed gestational age less than 32 weeks 0.534 (95%CI: 0.340-0.839) and pneumothorax 22 (95%CI: 2.122 - 228.070) are independent risk factors associated with CPAP-F. Conclusions: Improvised bCPAP is effective in the management of respiratory distress syndrome (RDS). Pneumothorax and gestational age < 32 weeks are independent risk factor for its failure.