EVALUATION OF A PRACTICE GUIDELINE (OXYGEN THERAPY) FOR THE MANAGEMENT OF RESPIRATORY DISTRESS SYNDROME IN NICU.

Abstract

Background- Respiratory Distress is one of the commonest causes of NICU admissions. Respiratory distress is among the most common symptom complexes seen in newborn infants and accounts for half of all the neonatal deaths. Worldwide, among the Total newborns, about 3% have had some sort of respiratory distress and which is manifested by a variety of respiratory and non-respiratory disorders. 
Aims- Evaluation of a practice guideline for the management of respiratory distress syndrome.
Methods and materials- This is a prospective study done in NICU, Department of Pediatrics, Dr. B.R.A.M hospital, Raipur from Feb 2023 to Feb 2024 in 182 patients. Both in-born and out-born neonate admitted in NICU with respiratory distress within 72 hrs of birth. Neonates with all the information (neonate & maternal information) contained in proforma will be included. Newborn babies admitted in NICU Of Dr B.R.A.M. Hospital, Raipur with Respiratory Distress, during a period of 12 months, will be assessed using standard scores such as Downes score for term neonates and Silverman Anderson score in preterm neonates and appropriate treatment according to the scoring will be provided to the concerned neonates.
Results- In present study among neonates with respiratory distress majority 57.14% were male and 42.86% were females. Mean gestational age was 34.71±3.72 weeks. Mean birth weight was 1925.91±649.82 gms. Comorbid illness among mothers of study subjects showed that 19.23% had anemia, 8.24% had GDM, 4.40% had hypothyroidism. 
The Silverman Anderson Score among preterm showed that majority 13.26% had SAS-7, followed by 8.29% each had SAS-5 and SAS-6. DOWNE Score among preterm showed that majority 13.74% had score-4, followed by 11.54% had score-3. Blood culture sensitivity showed that growth was seen in only 14% cases.
The diagnosis showed that majority 43.96% had RDS found in both term and preterm, 29% had birth asphyxia, 8.24% had MAS, 7.14% had sepsis, 9.89% had TTN and 2.2% had pneumonia. The mode of oxygen showed that 56.59% were given CPAP, 20.33% were given by Nasal prongs and 23.08% were kept on ventilator. Majority 84.62% were discharged after treatment and 15.38% were died. In Term neonates, maximum deaths occur due to Sepsis (14%) and in preterm neonates, maximum deaths occur due to RDS (69%).
Conclusion- on blood culture 4.5% had Klebsiella pneumonia growth on discharged patients and 7.1% had MRSA growth which is maximum among deaths. 11.7% cases of TTN, 31.81% Birth asphyxia, 8.4% MAS, 5.8% of sepsis, 2.4% cases of sepsis and pneumonia and 39.6% cases of RDS were discharged. The main cause for mortality is RDS 67.9%, Sepsis 14.3%, Birth asphyxia 10.71% and MAS 7.1%. Fetal risk factors were low birth weight and preterm period of gestation. For treatment most commonly mode of oxygen given via CPAP 65.6%, nasal prongs 24% and 10.4% via mechanical ventilation. Similarly, among 28 deaths 7.1% cases were given oxygen by CPAP, whereas 26(92.9%) were mechanically ventilated. In Term neonates, maximum deaths occur due to Sepsis and in preterm due to RDS. Early detection and appropriate management of the condition is essential to ensure better outcome in all newborns presenting with respiratory distress.