DEMOGRAPHICS
Mechanical ventilation is a complex labour intensive industry and an expensive proposition in developing countries. Neonatal ventilators require an initial investment of at least 30,000 USD per ventilator. In addition it requires a multidisciplinary team to provide e the required standards of care. The daily cost of neonatal ventilator support has been reported to be RS.2000-5000 per day.in India and Pakistan.
The magnitude of the need of ventilator support in India is beyond comprehension with our existing resources. With the number of annual deliveries of 25 million and estimated rate of prematurity of around 7 % in India , 1.75 million premature will be born every year. At least a million of them would be expected to experience respiratory distress requiring various forms of respiratory support. Currently India neither has the resources nor the capability of providing the required ventilator care.
In US the available ventilators are estimated to be around be 1:500 whereas in India may be just one per 80.000 deliveries. Fortunately not all premature babies require mechanical ventilation Most of them can be managed with minimal support to overcome transient hypoxemia .These include oxygen therapy and general support:warmth,IV fluids and judicious use of CPAP .Early use of CPAP appears to be a very cost effective intervention in very low birth weight babies.
Demographic requirements for Ventilator care
EVEN IF YOU DON'T DO ANY GOOD, DON'T DO ANY HARM
The art of assisted ventilation is a serious enterprise and should be undertaken only in those centers where the five critical factors interlinked to its operational successes are present optimally.
Technology
ventilators and monitoring devices.
Infrastructure
optimal space allocation per bed of 10 m2 or 100 sq.foot.
Doctors
Expertise and accountability round the clock.
Nursing
Trained manpower ratio 1: 1 ventilated bed 1:2 to 1:4 non-ventilated beds ,available round the clock. In service training is an important activity to retain trained nurses.
Infection Control Policies
hand washing, sterile techniques. The survival of level II babies should exceed 70% if ventilatory care is to be instituted. If infection control practices are poor, ventilatory care is costly and hazardous to a newborn baby's life.
Morbidity of the babies ventilated viz. ROP, BPD and Neurodevelopmental abnormalities present a gruesome spectre in neonatal care in developing countries. Intact neonatal survival should be the center point in the application of ventilatory care in developing countries.
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