A Hospital Based Prospective Study to Find Out the Etiology of Respiratory Distress in Early Term Neonates Admitted in Neonatal Intensive Care Unit (NICU) at NICE Hospital

Abstract

Background: The aim of this study to find out the etiology of respiratory distress in early term neonates admitted in Neonatal Intensive Care Unit (NICU). Material & Methods: A hospital based prospective study done on all early term neonates 37-38+6 weeks with Respiratory distress  within first 28 days of life at Tertiary Care Neonatal unit, NICE Hospital for Women, Newborns & Children,  Hyderabad during one year period. The babies left against medical advice were excluded from the study. We defined respiratory morbidity as any form of respiratory distress that necessitated admission of the neonate to the NICU irrespective of the need for any diagnostic tests or therapeutic intervention. We further identified cases that required surfactant use, mechanical ventilation (non invasive /invasive), high-frequency ventilation and inhaled nitric oxide. The duration of ventilation, both invasive and noninvasive, maximum FiO2 requirement and total duration of hospitalization and the outcomes, discharge or death were studied for all the neonates included in the study. Patients who left against medical advice were excluded from the outcome analysis.  Results: Our study showed that out of 812 babies admitted during the study period, 100 (12%) neonates were early term (37 – 38^6/7) having respiratory distress. The most common cause of respiratory distress in early term neonates was transient tachypnea of new born 42%, followed by meconium aspiration syndrome 24%and respiratory distress syndrome 16%.Out of 41 unindicated cesarean section, 11 (26.8%) were done in the early gestational age group and 30 (73.2%) in the late gestational age group. Previous LSCS was the indication in 32 deliveries, out of which 18 (56%) were done in 37-37^6/7 group and 14 (43.8%) were done in 38-38^6/7 group. In 37 to 37+6/7 group most of the patients were discharged within 3 days and no one stay beyond one week. In 2^nd group most of the patients were discharged within first 7 days. So we found that in later gestational age group if baby had respiratory distress it required prolong hospital stay as compared with early gestational age group.

Conclusion: We concluded that major causes of respiratory distress in early term neonates were transient tachypnea of newborn, meconium aspiration syndrome and respiratory distress syndrome. No antenatal steroid coverage and elective cesarean section at early gestation were found to be most significant risk factors.