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  • Author: Jeerawan Wannaro x
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Narongsak Nakwan, Jeerawan Wannaro and Pornpreenun Chaiwiriyawong

Abstract

Background

Respiratory failure is a most serious neonatal disorder. A severity of illness assessment should be performed for mechanically ventilated infants to predict the probability of hospital mortality and to assist clinical decision making.

Objectives

To evaluate the ability of the Score for Neonatal Acute Physiology, version II (SNAP-II) to predict the mortality risk for the infants who are mechanically ventilated with positive pressure ventilation (PPV) at a neonatal intensive care unit (NICU).

Methods

A prospective observational cohort study was performed in a 12-bed level III NICU at Hat Yai Hospital between January 2010 and December 2010.

Results

During the study period, 46 infants were ventilated with PPV at admission. Of these, 8 died (17%) and 30 survived (83%). The overall mean SNAP-II score was significantly higher in the group of infants who died compared with those who survived (36.5 ± 11.5 vs. 22.3 ± 13.6, P < 0.01, respectively).The area under the receiver operating characteristic curve for the SNAP-II was 0.79 (95% confidence interval (CI) 0.66 to 0.92, P = 0.01). Every one-point increment of SNAP-II was associated with an odds ratio of 1.08 (95% CI 1.02 to 1.14, P < 0.01). The stratification of the two sets of scores when compared between groups showed that infants who had SNAP-II scores of ≥32 had the highest mortality risk with an odds ratio of 9.7 (95% CI 1.7 to 56.5) with sensitivity of 75.0% and specificity of 76.3%.

Conclusion

SNAP-II scores can significantly predict mortality in infants requiring mechanical PPV.

Open access

Narongsak Nakwan, Jeerawan Wannaro and Narongwit Nakwan

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN) is one of the most serious conditions in neonates, and has high mortality and morbidity rates. New alternative therapies have been sought for improving survival and reducing morbidity for PPHN.

Objective: To report an initial experience of using intravenous iloprost to treat infants with PPHN, and assess its effect on oxygenation and hemodynamic stability over a 96-hour study.

Methods: The clinical data of infants who received intravenous iloprost as first line adjunctive therapy for PPHN at our institution between March 2009 and June 2010 were retrospectively reviewed.

Results: During the study period, 10 PPHN infants received intravenous iloprost as the first line of adjunctive therapy. The median gestational age was 40 weeks (range: 38-42), and birth weight was 3,250 grams (range: 2,310-3,900 g). Intravenous iloprost was initiated at an average age of 38 ± 26 hours (median: 32 h, range: 6-79 h), with an average baseline oxygen index (OI) of 25 ± 18 (median: 18, range: 8-65). Two infants who died while receiving the intravenous iloprost were excluded from our analysis because of incomplete data. Of the 8 who survived, the baseline OI was 24 ± 20 (median: 17, range: 8-65), and the mean OIs at 24 and 72 hours following treatment were significantly improved (16 ± 18 (median: 6, range: 4-50) (p = 0.02), and 9 ± 5 (median: 8, range: 3-18) (p = 0.02), respectively). No clinically significant changes in heart rate or blood pressure were noted during the iloprost therapy. At discharge, 6 of the infants were clinically normal, and 2 were complicated with cholestatic jaundice. No neurodevelopmental or cardiopulmonary disorders were observed in the 8 surviving infants at hospital discharge or later follow-up visits.

Conclusion: Intravenous iloprost may be a useful adjunctive therapy in PPHN, and should be investigated in a larger controlled study.

Open access

Narongsak Nakwan, Jeerawan Wannaro, Narongwit Nakwan, Wichian Patungkalo and Kulkanya Chokephaibulkit

Abstract

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) infection have been increasingly observed and are associated with mortality in neonatal population.

Objective: We determined risk factors for and outcome of bacteremia caused by CRAB in neonates.

Methods: The clinical data of neonates who developed A. baumannii bacteremia from January 2005 to December 2010 were retrospectively reviewed.

Results: During the study period, 22 neonates developed A. baumannii bacteremia, 13 were CRAB at an incidence of 0.5 case/1000 patients-day. Compared with carbapenem-sensitive A. baumannii (CSAB), patients with CRAB bacteremia had lower birth weight, lower gestational age and were more often receiving mechanical ventilation at the onset of bacteremia. Most of the CSAB isolates were susceptible to cefoperazone/sulbactam (89%) and aminoglycosides (50-75%). In contrast, CRAB strains were all resistant to cephalosporins, carbapenems, quinolones, with 39% susceptible to cefoperazone/sulbactam and 8% susceptible to amikacin. Most cases of CRAB bacteremia were treated with cefoperazone/sulbactam or meropenem and in some cases, with the addition of colistin. The all cause morality rates were 54% in CRAB and 11% in CSAB bacteremia, respectively (p = 0.07).

Conclusions: Neonatal bacteremia caused by A. baumannii was not common but caused high mortality, particularly from CRAB. Lack of effective antibiotics was the major challenge in treating these patients.