VENTILATORY MANAGEMENT OF NEONATES WITH RESPIRATORY DISTRESS SYNDROME UNDERGOING DIVERSION COLOSTOMY

Abstract

Background:Patient safety in neonatal surgery depends on precise ventilatory management, particularly in neonates diagnosed with Respiratory Distress Syndrome (RDS) undergoing diversion colostomy. These infants present with underdeveloped lungs, low surfactant levels, and fragile respiratory physiology, making them extremely vulnerable during surgical procedures. Effective infection control, anesthesia selection, and postoperative respiratory strategies such as CPAP, conventional ventilation, and high-frequency ventilation are crucial to reducing mortality and preventing complications including pneumonia, sepsis, pulmonary edema, and prolonged ventilation.

Methods : A quantitative, descriptive, cross-sectional methodology was employed to assess ventilatory management practices among neonates with RDS undergoing diversion colostomy. Data from one hundred neonates were collected through a structured proforma documenting demographic variables, preoperative respiratory condition, intraoperative parameters, and postoperative ventilatory requirements.  Non-parametric tests, such as the Mann–Whitney U test and Kruskal–Wallis test, were applied to detect variations in ventilatory duration and stability across different groups. A p-value of <0.05 was considered statistically significant.

Results : Most neonates underwent surgery within the first week of life, and more than half were male. Moderate prematurity (28–32 weeks) and low birth weight were common. RDS diagnosis was most frequently supported by both clinical assessment and chest X-ray, and a majority of neonates received preoperative surfactant therapy. CPAP emerged as the most common initial respiratory support, followed by conventional ventilation. General anesthesia dominated surgical practice, and most procedures lasted between 30–60 minutes. Postoperatively, a large proportion (68%) required mechanical ventilation, particularly for 24–72 hours.  Hospital stay commonly ranged between 7–14 days, and the survival rate was high at 88%.

Conclusion :This study concludes that ventilatory management is a critical determinant of postoperative outcomes in neonates with Respiratory Distress Syndrome undergoing diversion colostomy. The majority of neonates required postoperative ventilation, highlighting the need for structured respiratory support pathways. CPAP and conventional ventilation were the primary modes contributing to stabilization, especially in premature and low-birth-weight infants, while high-frequency ventilation was reserved for more complex cases. The high survival rate reflects the positive impact of timely diagnosis, surfactant administration, appropriate choice of ventilation, and careful intraoperative monitoring. Significant associations between ventilatory types, surgery duration, and postoperative complications underscore the importance of customized ventilatory strategies.

Recommendations :Based on study findings, several important recommendations are proposed. Early surfactant therapy must continue to be prioritized to reduce respiratory compromise. Continuous postoperative monitoring through saturation, ventilator adjustments, and regular respiratory assessments is essential to prevent avoidable complications.  Future research should focus on long-term respiratory outcomes, cost-effective ventilatory strategies, and predictive factors associated with prolonged ventilation in neonates with RDS.