Incidence, aetiology and adverse outcomes associated with respiratory distress in term neonates admitted to a tertiary care centre

Introduction: Respiratory distress (RD) is a leading cause of admission of all gestational ages to neonatal intensive care units. RD develops in 7% of neonates and causes significant morbidity and mortality. The aetiology of RD could be a variety of respiratory and non-respiratory causes and the presence of some risk factors may predict the development of RD.  Newborns with RD are at 2-4 times higher risk of death. 

Objectives: To determine the incidence and aetiology of RD and to identify risk factors and adverse outcomes of RD in term neonates.

Method: A descriptive cross-sectional study was conducted at Sri Jayewardenepura General Hospital for a period of eighteen-months, including 105 term newborns with RD, defined by the Silverman score of more the 3. Statistical analysis was done with the SPSS beta version.

Results: The incidence of RD with Silverman score of more than 3 was 2.2%. Aetiologies of RD in decreasing order of frequency were congenital pneumonia, transient tachypnoea of the newborn (TTN), early-onset sepsis (EOS) without pneumonia, respiratory distress syndrome (RDS), meconium aspiration syndrome, persistent pulmonary hypertension of the newborn and critical congenital heart disease. There were significant associations between prolonged rupture of membranes (PROM), 3 or more vaginal examinations, congenital pneumonia and EOS. Caesarean delivery increased the risk of developing TTN and RDS. There were 4 neonatal deaths and 2 babies developed ventilator-associated pneumonia. None had chronic lung disease. Mean duration of hospital stay was 8.8 days and mean duration to establish breastfeeding was 5.1 days.  

Conclusions: Incidence of RD with Silverman score more than 3 was 2.2% and the commonest aetiology was congenital pneumonia. PROM and 3 or more vaginal examinations were associated with increased risk of congenital pneumonia and EOS. Caesarean delivery had significant association with TTN. Elective caesarean section and gestational diabetes mellitus were risk factors for RDS. Mean duration of hospital stay and duration to establish breastfeeding were 8.8 and 5.1 days respectively.   

Sri Lanka Journal of Child Health, 2022: 51(4): 578-583