Clinical profile and outcome of premature neonates with respiratory distress syndrome: An experience from a tertiary care neonatal unit in Delhi

Background: Respiratory distress continues to be a significant cause of admission to the NICU. It also contributes significantly to morbidity and adverse outcome during the clinical course of the disease. Advances in the field of neonatal care like the use of antenatal corticosteroids, CPAP and noninvasive Ventilation, surfactant, gentle mechanical ventilation, a better understanding of the disease process and early enteral nutrition have resulted in improved survival of premature neonates. Methods: This was a prospective observational study done between January 2015 and September 2016 in a tertiary care NICU which included 209 preterm neonates between 26 weeks to 34 weeks of gestation with respiratory distress. The demographic, clinical, treatment profile and outcome were documented till discharge or death. Result: Out of 209, nearly 61% of the admitted neonates received any course of antenatal corticosteroid. About 43% of the infants had one of the antenatal risk factors for early-onset sepsis. Overall survival was 72.7%. CPAP was used as the primary mode of respiratory support in 88% of cases and the incidence of CPAP failure within 7 days was 29.6%. Almost 56% of neonates required surfactant therapy. INSURE method was used for surfactant administration in 80% cases. The failure rate of the INSURE method of surfactant administration was 27.1% and 37.5% at 72 hours and 7 days of life respectively. Sepsis was the commonest complication and accounted for nearly two-thirds of the mortality. The most common morbidity was sepsis (64.6%) followed by hemodynamically significant patent Ductus Arteriosus (25.8%). The culture positivity rate was 9.6% and Klebsiella was the most common organism isolated (45%). Nearly 11.5% of all cases developed any grade of IVH and 5.7% cases had severe IVH (IVH grade ≥ 3). About 11.5% of the cases had NEC of any stage and nearly one-third of these cases had NEC stage ≥ 2. Retinopathy of prematurity was identified in 6.2% of all cases and nearly 47% of these infants required therapy. Only 7.2% of the cases required oxygen therapy beyond 36 weeks PMA. Conclusion: Nasal continuous positive airway pressure is a safe and effective mode of respiratory support in preterm neonates with respiratory distress with a failure rate of around 30%. Nearly onethird of neonates who receive INSURE method of surfactant administration may subsequently require mechanical ventilation.