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Pediatric Review - International
Research Article
Journal of Pediatric Research
Distress
2020 Volume 7 Number 1 January www.medresearch.in

An etiological study of respiratory distress in neonates in a tertiary

care medical college hospital
Harshini B.P.1, Kumar T.S. A.2*, Kumar G.3, Khan I.4
DOI: https://doi.org/10.17511/ijpr.2020.i01.04
1
Harshini B.P., Post Graduate Student, Department of Pediatrics, Sri Siddhartha Medical College, Sri Siddhartha Academy of Higher
Education, Tumakuru, Karnataka, India.
2*
Ananda Kumar T.S., Professor, Department of Paediatrics, Sri Siddhartha Medical College, Sri Siddhartha Academy of Higher Education,

Tumakuru, Karnataka, India.

3
G.V. Kumar, Professor, Department of Paediatrics, Sri Siddhartha Medical College, Sri Siddhartha Academy of Higher Education, Tumakuru,

Karnataka, India.
4
Imthyas Khan, V.H, Post Graduate Student of Paediatrics, Department of Paediatrics, Sri Siddhartha Medical College, Sri Siddhartha

Academy of Higher Education, Tumakuru, Karnataka, India.

Introduction: Respiratory distress is the most common cause of NICU admissions in newborns.
Early diagnosis of cause of respiratory distress is important in the management of neonatal distress
for better outcome. The high incidence of maternal risk factors and newborn receiving poor
antenatal care continues to test the abilities of the neonatologist. Inspite of re­cent advance in
clinching diagnosis and management there are very less clinical studies on the neonatal respiratory
distress in our country. Materials and methods: A descriptive study of 150 neonates admitted to
NICU of Sri Siddhartha Medical College and Hospital with clinical features suggestive of respiratory
distress. All the newborn babies who developed respiratory distress within 72 hours of life were
included in the study and those who developed respiratory distress after 72 hours of life was
excluded from the study. Results: The commonest cause of neonatal respiratory distress in the
present study was Respiratory distress syndrome (34%), followed by Transient tachypnoea of the
newborn (30%), and Meconium aspiration syndrome (22.66%). LSCS was most common mode of
delivery. Conclusion: The most common causes of respiratory distress were RDS, TTNB, MAS, and
birth asphyxia. Proper antenatal care and early diagnosis of the antenatal complication and avoiding
preterm deliveries will aid in the better outcome of the newborns. Early detection and appropriate
management are essential to ensure better outcome in all infants presenting with respiratory
distress.

Keywords: Newborn, Respiratory Distress, Risk Factors, Respiratory distress syndrome, RDS

Corresponding Author How to Cite this Article To Browse

Ananda Kumar T.S., Professor, Department of Harshini BP, Ananda Kumar TS, Kumar GV, Khan I.

Paediatrics, Sri Siddhartha Medical College, Sri An etiological study of respiratory distress in

Siddhartha Academy of Higher Education, Tumakuru, neonates in a tertiary care medical college hospital.

Karnataka, India. Pediatric Rev Int J Pediatr Res. 2020;7(1):22-26.

Email: Available From

https://pediatrics.medresearch.in/index.php/ijpr/arti

cle/view/566

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted

2020-01-10 2020-01-20 2020-01-26 2020-01-30

Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note

No Nil Yes 8%

© 2020 by Harshini B.P., Ananda Kumar T.S., G.V. Kumar, Imthyas Khan and Published by Siddharth Health Research and Social
Welfare Society. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License
https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

22 Pediatric Review - International Journal of Pediatric Research 2020;7(1)

 Harshini B.P. et al: An etiological study of respiratory distress

Introduction Materials and Methods

Respiratory difficulties constitute the commonest Study design: A descriptive study for a period of
cause of morbidity in new-born. It is the most One year (2018-2019)
common cause of admission in a NICU. Early
Study participants: Neonates admitted with signs
diagnosis of cause of respiratory distress is very
of respiratory distress.
important in the management of neonatal distress
for better clinical outcome [1]. Respiratory distress Study setting: NICU of Sri Siddhartha Medical
is a symptom complex arising from disease College and Hospital
processes that cause failure to maintain gaseous
Inclusion criteria: All new-borns admitted to NICU
exchange [2]. The first breath and first cry have
of Sri Siddhartha medical College, within 72 hrs of
always been the mystical signalling the beginning of
birth due to respiratory distress.
a new life. A variety of disorders of respiratory
system like Transient tachypnea of the newborn, Exclusion criteria: All new-borns admitted to NICU
Hyaline membrane disease, Meconium aspiration Sri Siddhartha Medical College and Hospital with
syndrome, Pneumonia, Septicemia, Persistent onset of respiratory distress after 72 hrs.
pulmonary hypertension and non-respiratory
disorders like intracranial injury, cardiac failure, Method of data collection: All the newborns
metabolic disorders, septicemia and congenital enrolled in the study had their clinical and the
malformations can manifest clinically with demographic information recorded based on a pre-
respiratory distress. [2,3]. structured proforma, weight of neonates was
recorded by electronic weighing machine, the
Definition Respiratory Distress is diagnosed clinically maturity was assessed based on new Ballard’s
by the presence of at least two of the following score, the distress was assessed based on downe’s
criteria: Respiratory rate of >60/minute, Retractions score. The relative investigations were done and
(sub costal, xiphoid and suprasternal recession), treatment as per unit protocol was followed. All
Flaring of the alae nasi, Expiratory grunt and neonates were examined daily till discharge from
Cyanosis at room air on two consecutive hospital or death. Mortality was documented to
examinations at least 1 hour apart [4]. There are assess the clinical outcome against the final
various factors which determine the progress and diagnosis.
outcome in neonatal respiratory distress. The birth
weight, gestational age and the degree of Statistical analysis: All the data were tabulated in
respiratory compromise are the key factors which Microsoft Excel and Statistical analysis was done
decide the level of care the neonate would require using SPSS program (version23), data was
[5]. There has been a tremendous advance in the tabulated and comparison of proportions were
management of respiratory distress such as performed using appropriate test, P-value of < 0.05
ventilator therapy with different modes such as was considered as statistically significant.
CPAP, conventional mechanical ventilation; ultra-
Ethical clearance was obtained from the
high frequency jet ventilation, liquid ventilation,
institution.
surfactant replacement therapy, sophisticated
monitoring and extracorporeal membrane Consent: Informed consent was obtained from
oxygenation all have improved the outcome among parents of all the babies enrolled in the study.
the babies with respiratory distress [6].
Nonetheless, the continued high incidence of Results
maternal risk factors and newborn receiving poor
Among the 810 newborn delivered during the study
antenatal care continues to test the abilities of the
period, 512 (63.2%) newborn were admitted to
neonatologist [7]. Inspite of the varying re­cent
NICU, 150 of them developed respiratory distress
advance in clinching diagnosis and management
comprising 30.73% of all NICU admissions and with
there has been very less clinical studies on the
a frequency of 18.51%.
neonatal respiratory distress in our country.
Therefore, there is a need to know the etiological Out of 150 newborns studied, it was seen that 135
factors and outcome of the babies with respiratory (90%) of the cases were of respiratory origin and
distress. 15 (10%) were of non-respiratory in origin.

Pediatric Review - International Journal of Pediatric Research 2020;7(1) 23

 Harshini B.P. et al: An etiological study of respiratory distress

Severity based on Downe’s score 74 babies had (82.2%) followed by MAS (61.8%) and in late pre-
moderate to severe respiratory distress and 8 had terms RDS (60%) was most commonly seen. (Table
impending respiratory failure, i.e., 3 of TTNB, 4 of 1).
RDS, 1 of MAS, and 2 cases of congenital
Threatened scar rupture was the most common
diaphragmatic hernia cases developed impending
indication for LSCS with 41% of the total cases
respiratory distress. Male predominance was seen
developing respiratory distress. 62% of the babies
and severity of respiratory distress was more in
with MAS were born with meconium stained
male babies compared to female babies. In the
amniotic fluid. Maternal hypertension was seen in
present study majority of the Term babies had TTNB
36% of the total cases (Table 2).

Table-1: Fetal factors associated with respiratory distress in neonates.

Neonatal and maternal Transient tachypnea of the Respiratory distress Meconium aspiration Birth

characteristics newborn syndrome syndrome asphyxia

Period of gestation Term 37 (82.2%) 1 (2%) 21 (61.8%) 5 (83.3%)

Late preterm 8 (17.8%) 30 (60%) 11 (32.3%) 1 (16.7%)

Early preterm 0 (0%) 19 (38%) 2 (5.9%) 0 (0%)

Birth weight NBW 27 (60%) 6 (12%) 23 (67.7%) 5 (83.3%)

LBW 18 (40%) 35 (70%) 9 (26.3%) 1 (17.7%)

VLBW 0 (0%) 7 (14%) 1 (3%) 0 (0%)

ELBW 0 (0%) 2 (4%) 1 (3%) 0 (0%)

Sex (M/F) 23/22 30/20 18/17 1/5

Table-2: Maternal Factors associated with respiratory distress in neonates

Maternal risk factors (%) Transient tachypnea of the Respiratory distress Meconium aspiration Birth asphyxia

newborn syndrome syndrome

Premature rupture of membrane 3 (6.7%) 3 (6%) 0 (0%) 0 (0%)

Hypertension 4 (8.9%) 12 (24%) 1 (3%) 0 (0%)

Diabetes Mellitus 2 (4.4%) 0 (0%) 0 (0%) 0 (0%)

Threatened Scar Rupture 6 (13.3%) 11 (22%) 2 (6%) 0 (0%)

Meconium Stained Amniotic 0 (0%) 0 (0%) 21 (62%) 0 (0%)

Fluid

Table-3: Type of delivery associated with Out of 57 babies both in maternal age group 26-33
respiratory distress in neonates. years, 31 (33.7%) of them developed moderate to
Diagnosis Type of delivery severe respiratory distress. Primigravida mothers
Normal Elective Emergency were predominant in the present study.
LSCS LSCS
There were 7 deaths in the study. Overall outcome
Transient tachypnea of the 12 (26.7) 3 (6.7%) 30 (66.7%)
of Neonatal Respiratory Distress was cure in 90%,
newborn
Neonatal mortality rate of 4.66%, and maximum
Meconium aspiration syndrome 8 (23.5%) 6 (17.6%) 20 (58.8%)
mortality was seen in cases with Respiratory
Respiratory distress syndrome 13 4 (8.0%) 33 (66.0%)
Distress Syndrome.
(26.0%)

Birth asphyxia 1 (16.7%) 0 (0%) 5 (83.3%)

Discussion
Pneumonia - - 3 (100%)

Neonates with respiratory distress are 2 to 4 times

LSCS was most common mode of delivery in the more likely to die than those without respiratory
present study, comprising 113 of the deliveries. distress [8]. Frequency of respiratory distress in the
Majority of the TTNB, RDS, MAS cases were present study was 18.51% whereas in study done
delivered through LSCS (Table 3). The study by Swarnakar Et al, it was 2.83% [9]. Out of 150
comprised of 93 babies born to mothers in the age neonates the most common cause of neonatal
group 18-25 years 61 (66.3%) of them developed respiratory distress in the present study was
moderate to severe respiratory distress.
24 Pediatric Review - International Journal of Pediatric Research 2020;7(1)
 Harshini B.P. et al: An etiological study of respiratory distress

Respiratory distress syndrome (34%), Transient In the present study, out of 93 babies born to
tachypnea of the newborn (30%), and Meconium mothers in the age group 18-25 years 61 (66.3%)
aspiration syndrome (22.66%). of them developed moderate to severe respiratory
distress and out of 57 babies born in maternal age
In study done by Kommawar et al., the most
group 26-33 years, 31 (33.7%) of them developed
common cause of neonatal respiratory distress was
moderate to severe respiratory distress. In the
TTN 160 (40%) followed by 107 (26.75%)
Brahmaiah et al., [2] study only 2% of mothers
respiratory distress syndrome and birth asphyxia
belong to age group above 30 years whose babies
was seen in 49 (12.25%) babies.[10]
had severe Respiratory Distress which was found to
Chandrashekar et al., studied that the commonest
be a risk factor. Similar results were seen with the
cause for respiratory distress was Transient
studies by C Dani [12] and Alwyn Smith [13].
tachypnea of Newborn (60%) followed by Meconium
Aspiration Syndrome (31%) and RDS (6%) in their In the present study, 59% of the babies in the study
study [3]. (Table 4) showing comparison of the were normal birth weight, 35% were low birth
current study results with other studies. weight, 5% were very low birth weight and 1%
were extremely low birth weight. In the Brahmaiah
Table-4: Comparison of Respiratory distress
et al.,[2] study the birth weight of <2.5 kg were
with other studies
59%, 2.5- 4kg were 40% and >4kg were 1%,
Swarnakar Santosh S et Kommawar Current
severe RD was observed in <2.5 kg (41.4%). These
et al., [9] al., [18] et al., [10] study
results were in accordance with studies done by M
Respiratory distress 24(17.14%) 24(31.5%) 107(26.75%) 50(34%)
Lureti et al [14], Kwang Sunlee et a [15], C Dani et
syndrome
al [12], Chandrashekar et al [3] and Brahmaiah et
Transient tachypnea 57(40.7%) 35(46%) 160(40%) 45(30%)
al.,[2] where increased Respiratory Distress was
of the newborn
observed with decrease in birth weight especially of
Meconium aspiration 13(9.28%) 6(7.8%) (15%) 33(22.66
<2.5 kg.
syndrome %)

Birth ashyxia 16(11.42%) 19(25%) 49(12.25%) 6(4%) In the present study, it was observed that a
pneumonia 11(7.85%) 19(25%) 3(2%)
majority of term babies in TTNB (82.8%) and MAS
(61.8%) followed by late preterm (60%) in RDS.
In the present study, out of 150 neonates 113 Birth asphyxia was seen mostly term babies.
(75%) were born through LSCS. Among them 33 Incidence of TTNB was higher in late preterm and
(74%) born through LSCS developed TTNB, 26 term babies in Brahmaiah et al study [2] and similar
(77%) developed MAS, 37 (74%) developed RDS. results were seen in study done by Jain et al [17].
Similar results were seen in study done by Brahmaiah et al [2] also observed that in their study
Swarnakar et al.,[9] where majority of cases of incidence of MAS was high in more than 37weeks.
TTNB (52.6%) and RDS (66.7%) were delivered by
In the present study, it was observed that
elective caesarean section. According to Tudehope
threatened scar rupture was the most common
et al TTNB is the commonest cause of RD
indication for emergency LSCS (55.55%), followed
accounting for 41%, he also showed TTNB was more
by fetal distress (23.23%), pre-ecclampsia
common following caesarean section than the
(22.22%) and MSAF (20.20%). Most common risk
normal vaginal delivery. [11].
factor for TTNB was threatened scar rupture
In the present study, it was observed that 83 babies (13.3%) was found in the present study. Maternal
were born to primigravida mothers and 51 (57.3%) hypertension (28%) was most common risk factor
of them developed moderate to severe respiratory for developing RDS. 21 (62%) babies has meconium
distress and 38 (42.7%) babies born to 67 staining of amniotic fluid that developed meconium
multigravida mothers developed moderate to severe aspiration syndrome. Brahmaiah et al [2] observed
respiratory distress. In study by Brahmaiah et al., in their study that HTN was mostly associated with
there were primigravida (56.5%), second gravida TTNB (17.4%), MAS (17.4%), Birth asphyxia
(35.5%), and multi gravida (8%). There is (17.4%), and Sepsis (17.4%). GDM was most
increased risk of respiratory distress in primigravida commonly associated with development of TTNB.
probably due to prolonged delivery. Similar results Oligohydramnios most commonly associated with
were obtained in a study conducted by C Dani. Et al TTNB (54.5%) followed by Pneumonia (36.4%) and
[12] and Chandrashekar et al., [3]. HMD (9.1%). PROM was significantly associated
with pneumonia (50%), and HMD (50%).

Pediatric Review - International Journal of Pediatric Research 2020;7(1) 25

 Harshini B.P. et al: An etiological study of respiratory distress

Chandrashekar et al [3] studied that 68.4% of new-

borns (26 out of 38) born to mothers with
What this study adds to the
meconium stained liquor developed severe existing knowledge?
respiratory distress when compared to 35.40% of
Respiratory distress syndrome is the increasing
the new-borns (22 out of 62) born to mother who
cause of neonatal morbidity and mortality in
had clear liquor.
developing country and its increasing frequency in
In the present study, there were 7 deaths. Cure rate late preterm babies prompt for more studies in late
of Neonatal Respiratory Distress was 90%, with preterm babies.
Neonatal mortality rate of 4.66%, and a maximum
mortality of 12% in Respiratory Distress Syndrome Author’s Contribution
cases. Majority of the deaths were seen in male
babies. Santosh S Et al.,[18] studied that 92.2% of Dr. Harshini BP: Data collection and statistical
the cases survived with 6 deaths. 4 deaths were due analysis
to prematurity with RDS, 1 due to preterm with BA
Dr. TS Ananda Kumar: Study design and study
with RDS and 1 due to BA with RDS and sepsis.
format and manuscript review
Majority of the deaths were due to RDS (83%). Our
results are in accordance with study done by Dr. Kumar GV and Dr. Imthyas Khan: Manuscript
Brahmaiah et al.,[2] they noted mortality of 17% preparation
and deaths are due to Hyaline membrane disease
(47%), Septicaemia (23%), Severe birth asphyxia Reference
(12%), Pulmonary haemorrhage (12%) and CHD
(6%). 01. Bajad M, Goyal S, Jain B. Clinical profile of
neonates with respiratory distress. Int J Contemp
Limitations of the study: The present study was
Pediatr. 2016;3(3)1009-1003. doi: 10.18203/2349-
conducted on 150 neonates in a tertiary care
3291.ijcp20162382 [Crossref][PubMed][Google
hospital. Most of them were referred cases from
Scholar]
peripheral hospitals. The same study should be
done in community based setting with more 02. Brahmaiah P, Reddy KR. Etiological Study of
samples in multicentre and the meta-analysis of the respiratory distress in newborn. Int J Contemp Med
results will give clear spectrum of respiratory Res. 2017;4(10)2202-2206. [Crossref][PubMed]
distress in our community. [Google Scholar]

03. Chandrasekhar R, Mohan MM, Lakshmi BV.

Conclusion Clinical study of respiratory distress in newborn. Int
Respiratory distress syndrome was found to be the J Contemp Pediatr. 2016;10;2349-3291. doi:
most common causes of respiratory distress and 10.18203/2349-3291.ijcp20162364 [Crossref]
NICU admission in newborns in the present study [PubMed][Google Scholar]
which was followed by transient tachypnea of the 04. Guha D. NNF Recommended basic perinatal-
newborn, meconium aspiration syndrome and birth neonatal nomenclature. Neonatology-Principles and
asphyxia. Caesarean section was the associated risk Practice. 1998;1;131-132. [Crossref][PubMed]
factor in developing respiratory distress in most of [Google Scholar]
the neonates. Maternal hypertension and threatened
scar rupture was the most common associated 05. John BM, Venkateshwar V, Dagar V. Predictors of
maternal risk factor in the study. Outcome in Neonates with Respiratory Distress. J
Nepal Paediatr Soc. 2015;35(1)31-37. doi: [Article]
Fetal risk factors were low birth weight and late [Crossref][PubMed][Google Scholar]
preterm period of gestation. Proper antenatal care
and early diagnosis of the antenatal complication 06. Rao GC, Rao MS. Etiological profile of
and avoiding preterm deliveries will aid in the better respiratory distress in first day of life of a newborn
outcome of the newborns. Early detection and baby. Int J Contemp Pediatr. 2017;4(1)210-214.
appropriate management of the condition is doi: 10.18203/2349-3291.ijcp20164606 [Crossref]
essential to ensure better outcome in all infants [PubMed][Google Scholar]
presenting with respiratory distress.

26 Pediatric Review - International Journal of Pediatric Research 2020;7(1)

 Harshini B.P. et al: An etiological study of respiratory distress

07. Amarendra M, Rama G, Kiran CR, Raju DV. 13. Malhotra AK, Nagpal R, Gupta RK, Chhajta DS,
Aetiology of respiratory distress and risk factors Arora RK. Respiratory distress in newborn: treated
associated with development of respiratory distress with ventilation in a level II nursery. Indian Pediatr.
in term newborns. Hernia. 2017;1(1)100. doi: 1995;32;207-207. [Crossref][PubMed][Google
10.18410/jebmh/2017/163 [Crossref][PubMed] Scholar]
[Google Scholar]
14. Luerti M, Parazzini F, Agarossi A, Bianchi C,
08. Misra PK. Respiratory distress in newborn- A Rocchetti M, Bevilacqua G. Risk factors for
prospective study. Indian pediatrics. 1987;24(1)77- respiratory distress syndrome in the newborn- a
80. [Crossref][PubMed][Google Scholar] multicenter Italian survey. Acta Obstetricia et
Gynecologica Scand. 1993;72(5)359-364. doi:
09. Swarnkar K, Swarnkar M. Neonatal respiratory
10.3109/00016349309021113 [Crossref][PubMed]
distress in early neonatal period and its outcome.
[Google Scholar]
Int J Biomed Adv Res. 2015;6(09)643-647. doi:
10.7439/ijbar [Crossref][PubMed][Google Scholar] 15. Lee KS, Eidelman AI, Tseng PI, Kandail SR,
Gartner LM. Respiratory distress syndrome of the
10. Kommawar A, Borkar R, Vagha J, Lakhkar B,
newborn and complications of pregnancy. Pediatr.
Meshram R, Taksandae A. Study of respiratory
1976;58(5)675-80. [Crossref][PubMed][Google
distress in newborn. Int J Contemp Pediatr.
Scholar]
2017;4(2)490-494. doi: [Article][Crossref][PubMed]
[Google Scholar] 16. Jain L, Dudell GG. Respiratory transition in
infants delivered by cesarean section. Seminars in
11. Tudehope DI, Smyth MH. Is transient
Perinatol. 2006;30(5)296-304. doi:
tachypnoea of the newborn” always a benign
10.1053/j.semperi.2006.07.011 [Crossref][PubMed]
disease?- Report of 6 babies requiring mechanical
[Google Scholar]
ventilation. Aust Paediatr J. 1979;15(3)160-165.
doi: 10.1111/j.1440-1754.1979.tb01215.x 17. Santosh S, Kushal KK, Adarsha E. A clinical
[Crossref][PubMed][Google Scholar] study of respiratory distress in newborn and its
outcome. Indian J Neonatal Med Res. 2013;1(1)2-4.
12. Dani C, Reali MF, Bertini G, Wiechmann L,
[Crossref][PubMed][Google Scholar]
Spagnolo A, Tangucci M, et al. Risk factors for the
development of respiratory distress syndrome and
transient tachypnoea in newborn infants. Italian
Group of Neonatal Pneumology. Europe Resp J.
1999;14(1)155-159 [Crossref][PubMed][Google
Scholar]

Pediatric Review - International Journal of Pediatric Research 2020;7(1) 27