Clinical Profile, Risk Factors and Outcomes of Neonates with Respiratory Distress at a Rural Tertiary Care Setting, Tamil Nadu, India: A Prospective Cohort Study

Abstract

Introduction: Neonatal Respiratory Distress (RD) is one of the leading causes of Neonatal Intensive Care Unit (NICU) admissions and contributes significantly to neonatal morbidity and mortality, particularly in resource-limited rural settings. Early identification of aetiological factors and timely respiratory support are crucial for improving outcomes. Aim: To study the clinical profile, associated risk factors, and outcomes of neonates admitted with RD in a rural tertiary care centre. Materials and Methods: The present hospital-based prospective cohort study was conducted in the NICU of Government Villupuram Medical College, Tamil Nadu, India between April 2020 and March 2021. A total of 120 neonates presenting with RD were included. Demographic data, perinatal risk factors, clinical presentation, aetiology, severity scores, respiratory support requirements, and outcomes were recorded and analysed. Statistical analysis was performed using the chi-square test to assess the association between risk factors and adverse outcomes. A p-value <0.05 was considered statistically significant. Results: Among the 120 neonates, 72 (60%) were male and 62 (51.7%) were preterm. Low-birth-weight was observed in 66 (55%) neonates. Caesarean section was the predominant mode of delivery, accounting for 74 (61.7%) deliveries. The most common aetiology was Transient Tachypnoea of the Newborn (TTN) in 38 (31.7%) neonates, followed by RD Syndrome (RDS) in 34 (28.3%), birth asphyxia in 22 (18.3%), and meconium aspiration syndrome in 14 (11.7%). Among term neonates, moderate to severe RD was seen in 38 (65.5%) neonates. Mechanical ventilation was required in 30 (25%), while 46 (38.3%) were managed with Continuous Positive Airway Pressure (CPAP). The overall survival rate was 92 (76.7%), with a mortality rate of 16 (13.3%). Prematurity, severe RD, sepsis and requirement of mechanical ventilation were significantly associated with adverse outcomes (p <0.05). Conclusion: Neonatal RD remains a major contributor to morbidity and mortality in rural tertiary care settings, with TTN being the most common cause. Strengthening antenatal care, early CPAP initiation, and strict infection-control practices may improve survival outcomes.