Browsing by Author "Karmacharya, Shailendra Bir"
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Publication Clinical Profile and Outcome of Mechanically Ventilated Neonates: Evidence from a Prospective Study(Perinatal Society of Nepal (PESON), 2023) Gupta, Neelam; Subedi, Kalpana; Vaidya, Swechhya; Karmacharya, Shailendra Bir; Paudel, Prajwal; Mishra, Megha; Tamrakar, Asia; Ligal, Grishma; Shrestha, Shuvechhcha; Thagunna, Sanjay Bikram; Sah, Pavan Kumar; Bhattarai, PratikshaAbstract: Introduction: Many sick neonates admitted to neonatal intensive care unit (NICU) require mechanical ventilation but it is associated with various complications and the outcome of neonates is unpredictable. This study aims to identify the indications for mechanical ventilation, complications, co-morbid conditions and outcome of those neonates in terms of survival. Materials and Methods: Retrospective observational study of all neonates who underwent mechanical ventilation from 1 January 2014 to 31 December 2014 in NICU, Tribhuvan University Teaching Hospital. Medical records of the patients were retrieved from hospital record section to collect the relevant data. Results: One-third of admitted neonates in NICU required mechanical ventilation (MV). Commonest indication was severe respiratory distress (70%) followed by perinatal asphyxia (12%) and recurrent apnea (8%). Disease pattern were sepsis (37.2%), RDS of prematurity (17.6%), perinatal asphyxia (11.7%), meconium aspiration syndrome (9.8%), apnea of prematurity (7.8%) and congenital pneumonia (4%). Hospital acquired sepsis was a major complication occurring in 47% patients on mechanical ventilation. Survival rate among neonates on MV was 33%. Survival was better with increasing birth weight and gestational age. Survival was 100% in congenital pneumonia, 50% in perinatal asphyxia, 50% in recurrent apnea, 26% in sepsis, 20% in MAS and 0% in RDS of prematurity. Conclusion: Survival rate of neonates on mechanical ventilation in NICU was 33%. Sepsis was a major problem in NICU, which must be addressed to improve outcome. Keywords: Mechanical ventilation, RDS of prematurity, sepsisPublication Determinants of Mortality in Preterm Newborns Admitted in a Neonatal Intensive Care Unit: Findings from a Tertiary Level Maternity Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Karmacharya, Shailendra Bir; Subedi, Kalpana Upadhyaya; Agrawal, Sumit; Pradhan, Noora; Barnwal, Ritesh; Paudel, PrajwalAbstract: Introduction: Prematurity is a major cause of admission in the NICU in most hospitals. Premature babies are likely to face complications. Understanding the factors contributing to preterm mortality is needed to identify interventions required to reduce neonatal mortality rate. This study aims to determine the causes of mortality in preterm babies. Methods: A retrospective study was carried out in Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal. All the preterm babies admitted in the sick newborn units were included. Descriptive statistics were performed using frequency and percentage. The bivariate and multivariate analyses were performed to determine the causes of mortality in preterm. Results: Total 205 (71.4%) admitted preterm babies had complications at the time of admission. LBW babies were three times more likely to have mortality among preterm admission (p – value < 0.0001). Co-morbidities such as sepsis (p - value < 0.05) and perinatal asphyxia (p – value < 0.0001) were significantly associated with preterm mortality. The duration of stay among preterm babies was higher compared to term babies. The mortality rate was higher among preterm admission compared to term admission (60% vs 40%). Conclusions: Preterm babies with LBW, neonatal sepsis and perinatal asphyxia are at greater risk of mortality. Improved antenatal and perinatal care, quality newborn care and appropriate infection prevention measures can help reduce preterm birth, prematurity related complications and mortality among these vulnerable group of newborns.