RISK FACTORS ASSOCIATED WITH NEONATAL RESPIRATORY DISTRESS SYNDROME: INSIGHTS FROM A CASE-CONTROL STUDY IN PESHAWAR'S TERTIARY CARE HOSPITALS (2024-2025)
Main Article Content
Keywords
Neonates · Respiratory Distress Syndrome, Maternal Risk Factors, Antenatal Care, Peshawar, Pakistan
Abstract
Neonatal Respiratory Distress Syndrome (NRDS) is a leading cause of neonatal morbidity and mortality among late preterm infants. Despite ongoing improvements in maternal and neonatal care, NRDS remains a burden in various healthcare settings across Peshawar. Identifying its associated risk factors is essential for guiding future prevention and clinical interventions.
Objective: This study aimed to identify maternal and neonatal factors associated with Neonatal Respiratory Distress Syndrome among neonates in tertiary care hospitals of Peshawar.
Methods: Unmatched case-control study was conducted among 300 neonates (150 cases and 150 controls) admitted to neonatal intensive care units of tertiary hospitals in Peshawar from September 2024 to February 2025. Data was collected through structured questionnaires based on previous research and medical records, focusing on maternal and neonatal factors. Neonates with major congenital anomalies or serious comorbidities were excluded. SPSS version 23 was used for descriptive, comparative, and multivariate analyses. Logistic regression and chi- square tests were applied. Variables with p-value < 0.05 in multivariable analysis were considered significant.
Results: A total of 150 cases and 150 controls were included in this study. Maternal antenatal care visits were associated with NRDS [AOR = 1.139; 95% CI (1.065–1.217)]. Substance exposure during pregnancy showed strong association [AOR = 4.795], while administration of steroids before 30 weeks appeared protective [AOR = 19.872]. Congenital anomalies reduced the likelihood of NRDS [AOR = 0.293]. Neonates requiring immediate respiratory support had higher odds of NRDS, with the strongest association seen in those with ongoing respiratory issues [AOR = 213.2].
Conclusions and recommendations: Substance exposure during pregnancy and lack of antenatal care were identified as maternal risk factors for NRDS. Absence of congenital anomalies, administration of maternal steroids before 30 weeks, and consistent ANC visits were found to reduce the risk. Strengthening prenatal care services and minimizing harmful exposures during pregnancy are essential for reducing the burden of NRDS.
References
2. Mwita, S., Jande, M., Katabalo, D. et al. Reducing neonatal mortality and respiratory distress syndrome associated with preterm birth: a scoping review on the impact of antenatal corticosteroids in low- and middle-income countries. World J Pediatr 17, 131–140 (2021). https://doi.org/10.1007/s12519-020-00398-6
3. American Journal of Obstetrics and Gynecology,Volume 193, Issue 3, Supplement, 2005.
4. Tita AT, et al. "Maternal diabetes and respiratory distress syndrome in the newborn." Am J Obstet Gynecol.
5. Taffel SM, et al. "Maternal diabetes and preterm birth: a meta-analysis." Diabetes Care.
6. Vasilevsky S, et al. "Inflammation and lung maturity: maternal factors influencing neonatal outcomes." Pediatr Pulmonol.
7- Blencowe, H., Cousens, S., Oestergaard, M. Z., Chou, D., Moller, A. B., Narwal, R., Adler, A., Garcia, C. V., Rohde, S., Say, L., & Lawn, J. E. (2013). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. *The Lancet*, *379*(9832), 2162-2172.
8- Kim, D., Jeong, Y. G., & Chang, Y. S. (2018). Maternal and fetal factors associated with neonatal respiratory distress syndrome in late preterm infants.*Journal of Perinatology*, *38*(10), 1240-1246.
9- Lean, S. C., Derricott, H., Jones, R. L., & Heazell, A. E. P. (2017). Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta- analysis. *PLOS ONE12*(10), e0186287.
10- Ray, J. G., Vermeulen, M. J., Shapiro, J. L., & Kenshole, A. B. (2020).*American Journal of Obstetrics & Gynecology*, *223*(2), 230.e1-230.e12.- World Health Organization.
11- Morgan, A. S., Thomas, G., & Smith, J. (2016). The relationship between advanced maternal age and neonatal outcomes in a preterm population. *Journal of Neonatal-Perinatal Medicine *9*(3), 305-311.
12.He Y, Zhang M, Tang J, Liu W, Hu Y, Shi J, Wang H, Xiong T, Zhang L, Ying J, Mu D. Mortality, morbidity, and care practices for 1750 very low birth weight infants, 2016-2021. Chin Med J (Engl). 2024 Oct 20;137(20):2452-2460. doi:10.1097/CM9.0000000000002923. Epub 2024 Feb 26. PMID: 38404117; PMCID: PMC11479399.
13.1. Laube M, Thome UH. Y it matters-sex diferences in fetal lung development. Biomolecules. 2022;12(3):437.
14. . Fiaturi N, Russo JW, Nielsen HC, Castellot JJ Jr. CCN5 in alveolar epithelial proliferation and diferentiation during neonatal lung oxygen injury.J Cell Commun Signal. 2018;12(1):217–29. https://doi.org/10.1007/s12079-017-0443-1.
15. . Li X, et al. (2020). Maternal hypertension and risk of neonatal respiratory distress syndrome: A systematic review and meta-analysis. Journal of Maternal-Fetal & Neonatal Medicine, 33(10), 1753-1760. PMID: 31663585
16. https://www.thesciencepublishers.com/science_letters/files/v5i1-10-2017004-SL.pdf
17. Li, Y., Zhang, C. & Zhang, D. Cesarean section and the risk of neonatal respiratory distress syndrome: a meta-analysis. Arch Gynecol Obstet 300, 503–517 (2019).
18. https://doi.org/10.1007/s00404-019-05208-7
19. https://www.ucsfbenioffchildrens.org/-/media/project/ucsf/ucsf- bch/pdf/manuals/20_vlbw_elbw.pdf
20. Fang, K., Yue, S., Wang, S. et al. The association between sex and neonatal respiratory distress syndrome. BMC Pediatr 24, 129 (2024). https://doi.org/10.1186/s12887-024-04596-3
21. https://doi.org/10.3390/children8040281
22. https://www.who.int/publications/i/item/9789240057296
23. https://iris.who.int/bitstream/handle/10665/352441/1020-3397-2021-2703-269-278- eng.pdf?sequence=1
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Sareer Haider
Student Kabir Medical College
Syed Azhar Ali shah
Student Kabir Medical College
Ghazala Yasmin
Assistant Professor Department of community medicine Kabir Medical College Samrun Shaheen
Samrun Shaheen
Department of Statistics University of Peshawar
Kashmaine Saani
Student Kabir Medical College
Babar Ahad
Institute of Public Health Gandhara University
Rabia Gul
Department of Community Medicine Kabir Medical College
Hamid Hussain
Department of Community Medicine Kabir Medical College
Zonaisha Zia
Student Kabir Medical College
Hammad Ali Khan
Student Kabir Medical College
