In India, neonatal fatalities represent 50% of newborn mortality and approximately 64% of all baby deaths. The top causes of neonatal mortality in our nation include birth asphyxia, congenital pneumonia, immaturity, hyaline membrane disease, intraventricular haemorrhage, and neonatal infections [1]. Cardiopulmonary resuscitation is required for a large number of critically ill neonates who have life-threatening apnoea or circulatory collapse for a variety of reasons [2]. The neonatal intensive care unit cannot function without assisted ventilation. Facilities for assisted ventilation can help and save infants who are experiencing escalating respiratory distress and are on the verge of respiratory failure [2]. Mechanical ventilation is necessary for a sizable majority of newborns admitted to the NICU, and mechanically ventilated neonates have a high mortality rate. A sufficient gas exchange is what mechanical ventilation attempts to achieve. An increasing corpus of research supports the idea that endo-tracheal tubes should be avoided wherever possible when performing invasive mechanical ventilation [3]. Instances of circulatory failure and significant impairment of oxygenation and alveolar ventilation, as well as decreased respiratory effort, are grounds for intubation and invasive mechanical ventilation. Even though non-invasive therapies like nasal cannula oxygen and CPAP can adequately manage the majority of infants, severe RDS calls for mechanical breathing. The most common reasons for neonates to need mechanical ventilation are post-resuscitation, following surgery, and respiratory failure caused by respiratory distress syndrome (RDS), apnea, hypoxia, meconium aspiration syndrome (MAS), sepsis, pneumonia, and transient tachypnea of the newborn (TTN) [4]. Present-day International Newborn Guidelines It is recommended by resuscitation that the first 30 to 60 seconds after delivery be set aside for evaluating spontaneous respiratory and cardiac activity before starting intermittent positive-pressure ventilation if necessary [5].

Literature review

Many of the neonates who are admitted are severely ill and need artificial ventilation. The extensive use of mechanical ventilation in NICUs has dramatically increased the survival of ill newborns [6]. Weight and gestational age are significant predictors of newborn death, according to numerous studies [7]. Additionally, it is linked to the degree of disease at the time of admission, difficulties with ventilator use, and the prevalence of co-morbid disorders such sepsis, coagulopathy, multiple organ failure, congenital abnormalities, etc. [8] 141 newborns who were mechanically ventilated were investigated by Monsef AR et al. [9] The average gestational age was 35.51 weeks, the average birth weight was 2779.37 grams, and the average neonatal age was 4.67 days. The most typical reason for mechanical ventilation was respiratory distress syndrome (58.9%). The overall percentage of newborns who recovered was 51.8%. Indicators of mechanical ventilation, gestational age, newborn birth weight, acidosis (pH <7.1), duration of mechanical ventilation, length of hospital stay, and disease outcomes were all significantly correlated, according to the results of univariate analysis. 50 ventilated babies were investigated by Yadav et al. [10] Compared to births via standard vaginal delivery, lower segment caesarean section babies had a higher survival rate (46.7 percent vs. 37.1 percent). A better outcome was seen in the initial evaluation of APGAR scores of >7 (56.3 %; p = 0.03). Hyaline membrane illness was the most frequent cause of ventilation (38%) although neonates with meconium aspiration syndrome had the highest survival rates (54.5%). Sepsis was the most frequent complication, with a 60% survival rate, compared to 100% fatality rates for shock, intraventricular haemorrhage, disseminated intravascular coagulation, air leak syndrome, and pulmonary haemorrhage. As a result, several factors, including the newborn's profile, the circumstances of birth, and postnatal resuscitation, limit the outcome as survival. One-third of infants admitted to NICUs needed mechanical ventilation, according to Shrestha P et al., who made this observation [11]. The most frequent cause was severe respiratory distress (70%) and was followed by prenatal asphyxia (12%), recurrent apnea, and (8%). Sepsis (37.2%), respiratory distress syndrome of prematurity (17.6%), perinatal asphyxia (11.7%), meconium aspiration syndrome (9.8%), apnea of prematurity (7.8%), and congenital pneumonia constituted the disease pattern (4%). Sepsis acquired in the hospital was a serious complication that affected 47% of patients receiving mechanical breathing. On mechanical ventilation, the neonatal survival rate was 33%. Growing birth weight and gestational age improved survival. Congenital pneumonia had a 100% survival rate, perinatal asphyxia had a 50% survival rate, recurrent apnea had a 50% survival rate, sepsis had a 26% survival rate, meconium aspiration syndrome had a 20% survival rate, and respiratory distress syndrome of prematurity had the worst survival rate. Neonatal patients using mechanical ventilation in the NICU had a survival rate of 33%. In the NICU, sepsis was a serious issue that needed to be resolved in order to improve outcomes. Males made up 56.8% of the ventilated neonates in a study conducted by Prajakta D et al. [12] on 206 neonates. Birth asphyxia, which affected 29.1% of newborns, was the most frequent cause of ventilation, followed by neonatal infection (22.3%), respiratory distress syndrome (18.4%), and meconium aspiration syndrome (13.1%). Complications were observed in 35.9% of newborns, with ventilator-associated pneumonia (50%) and sepsis (40.5%) as well as pneumothorax being the most prevalent (16.2 %). The neonates who were ventilated had a 45.6 % survival rate. The main issues in the NICU were infections and neonates with birth asphyxia, both of which must be treated to enhance outcomes. In a study by Shah et al. [13] done in Nepal, it was discovered that sepsis (30.8%) and birth asphyxia (34%) were the most typical causes of assisted ventilation. In a Bangladeshi tertiary care hospital, Sultana et al. [14] also investigated the clinical characteristics and prognosis of newborns who required mechanical ventilation. 53 (8.6%) of the admitted newborns in the NICU throughout the research period got mechanical ventilation. 53 newborns were present, and 69.8% of them were males (2.3:1 male to female ratio). The average gestational age was 33.34 weeks, the average birth weight was 1852.55 grams, and the average age was 3.58 days. Refractory apnea (35.8%) and severe respiratory distress with a Downe score >6 (20.8%) were the two most common reasons for starting mechanical ventilation (17.0%). Sepsis (35.8%), respiratory distress syndrome (20.8%), congenital pneumonia (18.9%), perinatal asphyxia (15.1%), meconium aspiration syndrome (3.8%), and meningitis made up the disease pattern (3.8%). A survival rate of 35.8%[SV5] was recorded.

Since mechanical ventilation lowers infant mortality, neonatal ventilation services should be available in central and regional hospitals that provide intensive care for newborns. The best respiratory support for critically ill newborn infants should be given only if the various assisted mechanical ventilation modes and the pathophysiology of lung conditions are well understood.

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9. Monsef A.R. et al. "Evaluating the short-term outcome of mechanically ventilated neonates admitted to the neonatal intensive care unit of Besat Hospital, Hamadan, Iran." Int J Pediatr vol. 7, no. 9, 2019, pp. 10029-34.

10. Yadav M. et al. "Clinicoetiological pattern and outcome of neonates requiring mechanical ventilation: Study in a tertiary care center." Indian J Crit Care Med vol. 22, no. 1, 2018, pp. 361-363.

11. Shrestha P. et al. "Clinical profile and outcome of mechanically ventilated neonates in a tertiary level hospital." J Nepal Paediatr Soc vol. 35, no. 3, 2015, pp. 218-223.

12. Dekate P. et al. "Clinical profile and short-term outcome of neonates requiring assisted mechanical ventilation." New Indian J Paediatr vol. 8, no. 2, 2019, pp. 1-6.

13. Shah B.K. et al. "Mechanical ventilation in neonates: Experience at a tertiary care center in Eastern Nepal." BJMMR vol. 5, no. 1, 2015, pp. 75-80.

14. Sultana S.N. et al. "Clinical profile and outcome of neonates requiring mechanical ventilation." Int J Med Res Prof vol. 6, no. 1, 2020, pp. 100-106.