A Study to Evaluate Respiratory Distress in Term Neonates in Early Neonatal Period

Abstract

Background: Respiratory distress is one of the most common causes of neonatal morbidity and admission to neonatal intensive care units, particularly among term neonates. Although more frequently associated with prematurity, its occurrence in term neonates often signals significant underlying pathology such as infection, meconium aspiration, pulmonary hypertension, or delayed clearance of fetal lung fluid. This study evaluated the clinical profile, etiological spectrum, associated risk factors, and outcomes of respiratory distress in term neonates admitted to a tertiary care center. Methods: This prospective observational study was conducted in the Department of Pediatrics and Neonatal Intensive Care Unit (NICU) of Saraswathi Institute of Medical Sciences, Hapur, over 18 months. A total of 150 full-term neonates (gestational age ≥37 weeks), both inborn and outborn, admitted with respiratory distress (defined as any two of: respiratory rate >60/min, subcostal/intercostal retractions, expiratory grunt) within 7 days of age were consecutively enrolled after informed parental consent. Severity was graded using Downe’s scoring system (mild ≤3, moderate 4–6, severe ≥7). Etiology was established from history, clinical examination, and radiological (chest X-ray) findings, supported by C-reactive protein and blood culture where indicated. Data were analyzed in SPSS version 29.0 using descriptive statistics and the chi-square test, with p<0.05 considered significant. Results: Transient tachypnea of the newborn (TTN) was the most common etiology (89, 59.3%), followed by meconium aspiration syndrome (28, 18.7%), respiratory distress syndrome (13, 8.7%), pneumonia (10, 6.7%), birth asphyxia (9, 6.0%), and congenital heart disease (1, 0.7%). By Downe’s score, 58 neonates (38.7%) had mild, 64 (42.7%) had moderate, and 28 (18.7%) had severe respiratory distress. Severity was significantly associated with etiology (χ² = 138.88, df = 10, p<0.001): severe distress predominated in birth asphyxia, respiratory distress syndrome, and congenital heart disease, whereas TTN was largely mild to moderate. Overall, 134 neonates (89.3%) recovered, 12 (8.0%) died, and 4 (2.7%) were discharged against medical advice. Severity of distress was significantly associated with outcome (χ² = 61.98, df = 4, p<0.001): all 58 neonates with mild distress recovered, while 12 of 28 (42.9%) neonates with severe distress died. Conclusion: Respiratory distress in term neonates remains a significant cause of early NICU admission. TTN is the most frequent etiology, followed by meconium aspiration syndrome, while infectious and structural causes are less common but carry a disproportionately severe course. Downe’s score at presentation correlates strongly with both underlying etiology and final outcome, supporting its use as a simple bedside tool to triage term neonates with respiratory distress for the level of care required.