DOI: https://doi.org/10.36347/sasjm.2026.v12i02.001

Pages: 82-87

Introduction: Despite significant reductions in overall neonatal mortality in Bangladesh, outcomes among mechanically ventilated neonates remain suboptimal. Mortality in this high-risk population is influenced by multiple interrelated clinical and biochemical factors. Identifying these determinants is critical for risk stratification and targeted interventions in resource-constrained healthcare settings. Aim of the Study: This study aimed to determine the clinical and biochemical factors associated with outcomes in mechanically ventilated neonates admitted to the neonatal intensive care unit. Methods: This case-control study included 60 outborn neonates [0–28 days] who required mechanical ventilation between June 2007 and March 2008. Neonates who died following ventilation were classified as cases [n=37], while those who survived were controls [n=23]. Demographic, clinical, ventilatory, and biochemical parameters were collected at admission. Bivariate analysis and multivariate logistic regression were used to identify factors independently associated with mortality. Results: Overall mortality was 61.7%. Deceased neonates had lower birth weight [1970 ± 735 g vs 2509 ± 752 g, p=0.01] and more frequent gestational age <28 weeks [29.7% vs 4.3%, p=0.02]. Septicemia [48.6% vs 21.7%, p=0.04] and delayed ICU admission >12 hours [64.9% vs 21.7%, p<0.01] were significantly more common among deaths. Severe metabolic acidosis [pH <7.1] increased mortality risk [OR 7.50], as did base excess ≤–10 [OR 7.56], hyponatremia [OR 6.39], and hypokalemia [OR 7.16]. Higher initial ventilator settings, including peak inspiratory pressure [22.1 vs 20.8 cmH₂O, p=0.01] and FiO₂ [82.5% vs 72.2%, p<0.001], were also associated with mortality. Multivariate analysis identified septicemia [aOR 219.6], respiratory distress syndrome/pneumonia [aOR 111.3], base deficit [aOR 1.79 per unit decrease], and delayed ICU admission [aOR 8.29] as independent predictors of death. Conclusion: Mortality among me