Neonatal Med.  2018 May;25(2):66-71. 10.5385/nm.2018.25.2.66.

Causes of Transfer of Neonates (Born after ≥34 Weeks of Gestation) to the Neonatal Intensive Care Unit Owing to Respiratory Distress and their Clinical Features

• Jung YJ

• KMID: 2437900
• DOI: http://doi.org/10.5385/nm.2018.25.2.66

Abstract

PURPOSE
Respiratory morbidity is the most common problem among neonates admitted to neonatal intensive care units. Therefore, the aim of this study was to make a differential diagnosis between transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and pneumonia through comparison of clinical features and test results.
METHODS
This retrospective study was conducted in 86 infants with TTN, RDS, or pneumonia. These were infants who had respiratory distress, were born after ≥34 weeks of gestation, and transferred to the neonatal intensive care unit of Kosin University Gospel Hospital between June 1, 2011 and June 30, 2016.
RESULTS
The numbers (percentage) of infants with TTN, RDS, and pneumonia were 51 (59.3%), 20 (23.3%), and 15 (17.4%), respectively. Late-preterm and early-term newborns accounted for 65.1% of the infants. Tachypnea was observed in 74.4% of the neonates. The median age at admission was 4 hours (0 to 116) after birth. The infants with RDS had significantly lower birth weights, pH levels, base excess and oxygen saturation levels at admission, longer duration of total ventilator therapy, and hospital stay than those in the other two groups. The infants with pneumonia showed significantly high initial high-sensitivity C-reactive protein levels and significant chest radiographic findings.
CONCLUSION
Early differential diagnosis for TTN, RDS, and pneumonia is challenging because they show similar respiratory symptoms at an early stage. Clinical features and test results can be used to determine the etiology of respiratory distress and early antibiotic treatment.

Keyword

Etiology; Infant; Respiration disorders

MeSH Terms

Birth Weight
C-Reactive Protein
Diagnosis, Differential
Humans
Hydrogen-Ion Concentration
Infant
Infant, Newborn*
Intensive Care Units, Neonatal
Intensive Care, Neonatal*
Length of Stay
Oxygen
Parturition
Pneumonia
Pregnancy
Radiography, Thoracic
Respiration Disorders
Retrospective Studies
Tachypnea
Transient Tachypnea of the Newborn
Ventilators, Mechanical
C-Reactive Protein
Oxygen

Figure

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  Figure 1. Flowchart of the infants. Abbreviations: TTN, transient tachypnea of the newborn; RDS, respiratory distress syndrome.

Reference

1. Parkash A, Haider N, Khoso ZA, Shaikh AS. Frequency, causes and outcome of neonates with respiratory distress admitted to Neonatal Intensive Care Unit, National Institute of Child Health, Karachi. J Pak Med Assoc. 2015; 65:771–5.

2. Gallacher DJ, Hart K, Kotecha S. Common respiratory conditions of the newborn. Breathe (Sheff). 2016; 12:30–42.

3. Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013; 14:29–36.

4. Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician. 2007; 76:987–94.

5. Agrawal V, David RJ, Harris VJ. Classification of acute respiratory disorders of all newborns in a tertiary care center. J Natl Med Assoc. 2003; 95:585–95.

6. Consortium on Safe Labor, Hibbard JU, Wilkins I, Sun L, Gregory K, Haberman S, et al. Respiratory morbidity in late preterm births. JAMA. 2010; 304:419–25.

7. Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev. 2010; 31:487–95.

8. Sengupta S, Carrion V, Shelton J, Wynn RJ, Ryan RM, Singhal K, et al. Adverse neonatal outcomes associated with early-term birth. JAMA Pediatr. 2013; 167:1053–9.

9. Alderdice F, McCall E, Bailie C, Craig S, Dornan J, McMillen R, et al. Admission to neonatal intensive care with respiratory morbidity following 'term' elective caesarean section. Ir Med J. 2005; 98:170–2.

10. Donaldsson SF, Dagbjartsson A, Bergsteinsson H, Hardardottir H, Haraldsson A, Thorkelsson T. Respiratory dysfunction in infants born by elective cesarean section without labor. Laeknabladid. 2007; 93:675–9.

11. Derbent A, Tatli MM, Duran M, Tonbul A, Kafali H, Akyol M, et al. Transient tachypnea of the newborn: effects of labor and delivery type in term and preterm pregnancies. Arch Gynecol Obstet. 2011; 283:947–51.

12. Bak SY, Shin YH, Jeon JH, Park KH, Kang JH, Cha DH, et al. Prognostic factors for treatment outcomes in transient tachypnea of the newborn. Pediatr Int. 2012; 54:875–80.

13. Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev. 2014; 35:417–28.

14. Nissen MD. Congenital and neonatal pneumonia. Paediatr Respir Rev. 2007; 8:195–203.

15. Ersch J, Roth-Kleiner M, Baeckert P, Bucher HU. Increasing incidence of respiratory distress in neonates. Acta Paediatr. 2007; 96:1577–81.