Spectrum of Respiratory Distress in Neonates delivered in Tripoli Medical Center

Abstract

  Neonatal respiratory distress (NRD) is a main cause of neonatal morbidity and mortality . Early detection of its risk factors and early treatment of its etiologies are major challenges in the developing countries. However, few studies in the developing countries have provided data needed to tackle it.   Aim : this study carried out to determine the admission rate, etiologies, related intervention  and outcome of NRD in Tripoli Medical Center (TMC) as the main referral center in Tripoli-Libya. Method: Case series study was carried out  from 1st January  to 31th March 2010, and was based on reviewing the hospital files of all newborns admitted to the N.I.C.U. because of  neonatal respiratory distress(NRD) irrespective of to the underlying cause.  NRD was diagnosed based on the presence of one or more of the following signs: an abnormal respiratory rate, expiratory grunting, nasal flaring, chest wall recessions and thoraco- abdominal asynchrony with or without cyanosis These data included: clinical  variables of  newborns and their mothers in addition to results of  their investigations . These variables were cross-checked to make sure that they were in line with the etiology of  NRD  in the hospital files. The related intervention ,and outcome were studied. Statistical data were coded and SPSS software was used for analysis. Result : In the 3 months studied and out of 2815 births ,and 448 newborns admitted in NICU, there were 337 newborns were admitted in NICU because of NRD giving  admission rate of 11.9%  from total births , and 75% from the total number of admission in NICU in the same period. The main etiologies of NRD were Transient Tachypnoea of Newborn( TTN) 33.2%, followed by Respiratory Distress Syndrome ( RDS) 26.4% , then Meconium Aspiration Syndrome (MAS) 13.1%  and Perinatal Asphyxia 12.2% from the total No. of  NRD. During admission period , 11.2% of NRD newborns were managed by mechanical ventilation; and only 0.6% were intervented by continuous positive airway pressure CPAP; where surfactant therapy was given to 3% . During this period the mortality rate of NRD was 11% , which was significantly related to RDS as it account 66.7% of total deaths (p 0.001).Taking in consideration that RDS account only 26.4% from total admission . Conclusion: NRD is a frequent emergency and causes high morbidity and significant mortality. Most of its risk factors and etiologies are preventable. Adequate follow-up during pregnancy and labor for timely intervention may improve the neonatal outcomes.  Overall, our results emphasize the urgent need of improving obstetric care , equipping neonatal care units by noninvasive ventilatory support measures like CPAP  machines ,and availability of surfactant.