Modality of Respiratory Support in Preterm Neonates with Respiratory Distress and its Outcome: Experience of a Tertiary Care Hospital in Bangladesh

Abdul Mannan — 2023-05-12

Background: Preterm neonates are at increased risk of developing respiratory distress after birth. In order to reduce preterm death and their morbidity, identification of etiology and optimum management of respiratory distress is crucial.

Objective: To determine causes of respiratory distress, pattern of respiratory modality used and its outcome among admitted preterm newborns.

Patients and methods: This study included 142 preterm neonates admitted with respiratory distress and required respiratory support in the NICU of Bangabandhu Sheikh Mujib Medical University, during the period from January 2020 to December 2021. Causes of respiratory distress and pattern of respiratory support was observed. Morbidities and in-hospital mortality were compared between invasive and non-invasive support group in the study.

Results: Mean gestational age among the studied neonates was 32.39 ± 2.46 weeks. Male was predominant (54.2%) and mean birth weight was 1631.44 ± 578.57 g. About 62% belonged to the gestational age within 28 - <34 weeks category. Respiratory distress syndrome (RDS) was the most common cause which was 50.0% following TTN 24.6%, congenital pneumonia 19.0% and PNA 6.3%. Sepsis, septic shock, DIC, NEC and in-hospital mortality, nasal trauma, ROP and IVH occurred significantly higher in the mechanical ventilator support group in comparison to the NIV support group and the p-value were <0.05.

Conclusion: In our study Respiratory distress syndrome is the commonest cause of respiratory distress. Invasive ventilation was associated with significant morbidity and mortality in preterm neonates when compared with those required non-invasive ventilation.

AN UNUSUAL CAUSE OF CYANOSIS

BALAJI SUSARLA — 2023-04-27

t
Methaemoglobinemia is an uncommon haemoglobinopathy but potentially fatal if unrecognized or
untreated at the earliest. It can either be congenital or acquired. Acquired can be after using topical
anaesthetics such as nitrates, benzocaine, and lidocaine. The present study reports a rare case of
benzocaine induce Methaemoglobinemia. A 20 days old male baby presented to the emergency room
with complaints of seizure like activity in the past hour, bluish discoloration of skin since past 1 day and
loose watery stools since 3 days. Baby was irritable, crying with central cyanosis, had 2 episodes of
seizures upon arrival. He was tachypnoeic with saturations were 85% on room air along with
tachycardia. Perianal rash with excoriation of overlying skin was present. Rest of the examination was
unremarkable. He was managed with supplemental oxygen, IV antiepileptic and supportive treatment.
His septic screen was normal; Chest x-ray was unremarkable, 2D Echo showed a structurally normal
heart with normal biventricular function. His percutaneous oxygen saturation remained 85-88% despite
administration of 100% oxygen. His arterial blood sample had a dark chocolate color appearance, with
normal PaO2 levels on blood gases. His methaemoglobin levels were 21.7%. After, two doses of
methylene blue (1 mg/kg/dose) were administered, his cyanosis abated and oxygenation improved.
Repeat methaemoglobin levels were 1.3%. A relook into the history revealed use of Mucopaine gel for
perianal rash which contains Benzocaine confirming it as Benzocaine induced Methaemoglobinemia.

Pediatric Review: International Journal of Pediatric Research

Modality of Respiratory Support in Preterm Neonates with Respiratory Distress and its Outcome: Experience of a Tertiary Care Hospital in Bangladesh

AN UNUSUAL CAUSE OF CYANOSIS