Neonatal Respiratory Distress in Misan: Causes, Risk Factors, and Outcomes

Document Type : Original Article


Pediatrics Department, College of Medicine, Misan University, Misan, Iraq


Background: Respiratory distress is considered one of the most frequent causes of admission in the neonatal unit. Additionally, it is the leading cause of neonatal morbidity and mortality. This study aimed to determine the incidence of neonatal respiratory distress and its causes, risk factors, and outcomes to have a baseline data about the magnitude of respiratory distress with a further step toward the development of the neonatal field.
Methods: This cross-sectional study was conducted in the neonatal care unit of Misan Hospital for Child and Maternity in Misan, Iraq, during one year. All the neonates who developed respiratory distress were included in this study according to the World Health Organization criteria.
Results: The total number of neonatal admission during the study period was 870 cases among whom 738 (84.8%) subjects developed respiratory distress. The fatality rate was 21%, and the majority of deaths were found in respiratory distress syndrome (RDS) (67.1%). The RDS, transient tachypnea, and birth asphyxia were the major causes of neonatal respiratory distress. Statistically, prematurity, type of delivery, and number of babies at the delivery time were significantly associated with respiratory distress development.
Conclusion: The incidence rate of neonatal respiratory distress was apparently high in Misan forming the most common cause of neonatal admission associated with a high mortality rate. Efforts toward preventing the causes and risk factors for neonatal respiratory distress, as well as, improving the efficacy of neonatal care unit are the significant challenges to improve the neonatal care and outcome.


1. Baeckert P, Ackermann-Liebrich U, Duc G. Neonatal respiratory distress syndrome in Switzerland. Data for 1984 and comparison with 1974. Schweiz Med Wochenschr. 1987; 117(27-28):1021-7.
2. McCormick M, Cooper P. Managing newborn problems: a guide for doctors, nurses, and midwives. Geneva: World Health Organization; 2003.
3. Swarnkar K, Swarnkar M. Neonatal respiratory distress in early neonatal period and its outcome. Int J Biomed Adv Res. 2015;6(09):643-7.
4. Pramanik AK, Rangaswamy N, Gates T. Neonatal respiratory distress: a practical approach to its diagnosis and management. Pediatr Clin North Am. 2015; 62(2):453-69.
5. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013; 14(1):29-36.
6. Hermansen CL, Mahajan A. Newborn respiratory distress. Am Fam Physician. 2015; 92(11):994-1002.
7. John EB, Carlo WA. Respiratory distress syndrome in VLBW infants: changes in management and outcomes observed by the NICHD Neonatal Research Network. Semin Perinatol. 2003; 27(4):288-92.
8. Crowley P. Withdrawn: prophylactic corticosteroids for preterm birth. Cochrane Database Syst Rev. 2006; 3:CD000065.
9. Sinn JK, Ward MC, Henderson‐Smart DJ. Developmental outcome of preterm infants after surfactant therapy: systematic review of randomized controlled trials. J Paediatr Child Health. 2002; 38(6):597-600.
10. American Academy of Pediatrics Committee on Fetus and Newborn. Levels neonatal care. Pediatrics. 2012; 130(3):587-97.
11. Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med. 2011; 8(8):e1001080.
12. Hameed NN, Abdul Jaleel RK, Saugstad OD. The use of continuous positive airway pressure in preterm babies with respiratory distress syndrome: a report from Baghdad, Iraq. J Matern Neonatal Med. 2014; 27(6):629-32.
13. Ali EA. Neonatal mortality rate in aseptic neonatal care unit of Al-Sadder teaching hospital in missan province from 2011 to 2014. Eur Sci J. 2016; 12(27):55-62.
14. Ballard JL, Khoury JC, Wedig KL, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991; 119(3):417-23.
15. Ersch J, Roth-Kleiner M, Baeckert P, Bucher HU. Increasing incidence of respiratory distress in neonates. Acta Paediatr. 2007; 96(11):1577-81.
16. Tochie JN, Choukem SP, Langmia RN, Barla E, Koki-Ndombo P. Neonatal respiratory distress in a reference neonatal unit in Cameroon: An analysis of prevalence, predictors, etiologies and outcomes. Pan Afr Med J. 2016; 24:152.
17. Jasso-Gutiérrez L, Durán-Arenas L, Flores-Huerta S, Cortés-Gallo G. Recommendations to improve healthcare of neonates with respiratory insufficiency beneficiaries of Seguro Popular. Salud Publica Mex. 2012; 54:S57-64.
18. Qari SA, Alsufyani AA, Muathin SH, El Margoushy NM. Prevalence of respiratory distress syndrome in neonates. Egypt J Hosp Med. 2018; 70(1):257-64.
19. Fedakar A, Aydoğdu C. Clinical features of neonates treated in the intensive care unit for respiratory distress. Turk J Pediatr. 2011; 53(2):173-9.
20. Abdelrahman SM, Hamed SM, Nasr A. Neonatal respiratory distress in Omdurman Maternity Hospital, Sudan. Sudan J Paediatr. 2014; 14(1):65-70.
21. Sabzehei M, Basiri B, Shokouhi M, Fayyazi A. Causes and outcomes of respiratory distress in neonates hospitalized in the neonatal intensive care unit of Beâ sat hospital in Hamadan, Iran. Int J Pediatr. 2017; 5(12):6253-60.
22. Palod PH, Lawate BB, Sonar MN, Bajaj SP. A study of clinical profile of neonates with respiratory distress and predictors of their survival admitted in neonatal intensive care unit of tertiary care hospital. Int J Contemp Pediatr. 2017; 4(6):2027-31.
23. Saboute M, Kashaki M, Bordbar A, Khalessi N, Farahani Z. The incidence of respiratory distress syndrome among preterm infants admitted to neonatal intensive care unit: a retrospective study. Open J Pediatr. 2011; 5(4):285-9.
24. Santosh S, Kushal KK, Adarsha E. A clinical study of respiratory distress in newborn and its outcome. Indian J Neonatal Med Res. 2013; 1(1):2-4.
25. Hibbard JU, Wilkins I, Sun L, Gregory K, Haberman S, Hoffman M, et al. Respiratory morbidity in late preterm births. JAMA. 2010; 304(4):419.
26. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. 2001; 97(3):439-42.
27. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1. safe prevention of the primary cesarean delivery. Obstet Gynecol. 2014; 123(3): 693-711.
28. Hameed NN, Al-janabi MK, Al-reda YI. Respiratory distress in full term newborns. Iraqi Postgraduate J. 2007; 6(3):233-9.
29. Ross MG, Beall MH. Cesarean section and transient tachypnea of the newborn. Am J Obstet Gynecol. 2006; 195(5):1496-7.
30. Gouyon JB, Ribakovsky C, Ferdynus C, Quantin C, Sagot P, Gouyon B, et al. Severe respiratory disorders in term neonates. Paediatr Perinat Epidemiol. 2008; 22(1):22-30.
31. Stutchfield P, Whitaker R, Russell I. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ. 2005; 331(7518):662.
32. Chandrasekhar R, Mohan MM, Lakshmi BV. Clinical study of respiratory distress in newborn. Int J Contemp Pediatr. 2016; 10:2349-91.
33. Anadkat JS, Kuzniewicz MW, Chaudhari BP, Cole FS,
Hamvas A. Increased risk for respiratory distress among white, male, late preterm and term infants. J Perinatol. 2012; 32(10):780-5.
34. Oyelese Y, Culin A, Ananth CV, Kaminsky LM, Vintzileos A, Smulian JC. Meconium-stained amniotic fluid across gestation and neonatal acid-base status. Obstet Gynecol. 2006; 108(2):345-9.
35. Dargaville PA, Copnell B. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics. 2006; 117(5):1712-21.
36. Arafa MA, Alshehri MA. Predictors of neonatal mortality in the intensive care unit in Abha, Saudi Arabia. Saudi Med J. 2003; 24(12):1374-6.
37. Assembly OG. Road map towards the implementation of the United Nations millennium declaration: report of the secretary-general. In: Road Map Towards The Implementation of The United Nations Millennium Declaration: Report of the Secretary-General, New York, United Nations; 2001.