Clinical Profile and In-hospital outcomes of neonates managed with Mechanical Ventilation at the NICU of Kawempe National Referral Hospital: A retrospective study

Abstract

Background: Neonatal mechanical ventilation and its judicious use play a significant role in preventing neonatal mortality, which is an important contributor to infant and under-5 mortality. However, mechanical ventilation is not without adverse effects. There is scarcity of data on the In-patient outcomes of neonates managed with mechanical ventilation in Uganda, despite the increasing use of this mode of management in the country. This study aimed to determine the clinical profile and In-hospital outcomes of neonates being managed with mechanical ventilation at Kawempe National Referral Hospital. Methods: This was a retrospective hospital-based cohort study conducted in the Neonatal Intensive Care Unit of Kawempe National Referral Hospital. Patient files for neonates who were mechanically ventilated between 1st August 2023 and 31st July 2025 were reviewed. Data collected included neonatal characteristics, maternal characteristics, primary morbid conditions, clinical and laboratory findings, mechanical ventilation and care related factors, and in hospital outcomes. The primary outcome was survival to discharge. Data were analyzed using STATA version 19.0. Modified Poisson regression was used to estimate crude and adjusted risk ratios for predictors of survival. Results: A total of 384 neonates managed with mechanical ventilation were included in the study. Most neonates were male, 228 (59.4%), low birth weight; 260 (67.7%), and preterm; 265 (69.0%). Respiratory distress syndrome; 293 (76.3%) was the commonest indication for mechanical ventilation followed by perinatal asphyxia, 164 (42.7%) & neonatal sepsis, 139 (36.2%). Overall, 80 (20.8%) neonates survived to discharge. In the multivariable analysis, neonates without apnea of prematurity (aRR = 2.84, 95% CI: 1.304-6.185; p = 0.009), neonates without haemorrhagic disease of the newborn (aRR = 2.93, 95% CI: 1.080-7.938; p = 0.035), those who did not require resuscitation prior to mechanical ventilation (aRR = 4.05, 95% CI: 2.298-7.148; p < 0.001), and neonates who did not receive anticonvulsants (aRR = 1.64, 95% CI: 1.018-2.629; p = 0.042) were more likely to survive. Conclusion: Neonates requiring mechanical ventilation at Kawempe National Referral Hospital represented a critically ill population with poor in-hospital outcomes. Only 1 in 5 neonates survived after MV. Respiratory distress syndrome is the commonest cause of Mechanical ventilation. Survival was mainly influenced by markers of respiratory immaturity, bleeding complications, compromise before ventilation, and neurological instability, highlighting the need to prevent premature births and improve early management of those born preterm. There’s urgent need to improve comprehensive neonatal critical care.