Is management of neonatal respiratory distress syndrome feasible in developing countries? Experience from Karachi (Pakistan)

There is a marked paucity of data on the prevalence, management, and outcome of respiratory distress syndrome (RDS) among newborn infants born in developing countries. We reviewed the clinical profile, presentation, mode of therapy, and immediate and 12-month outcomes in 200 consecutive infants with documented RDS admitted to the Neonatal Intensive Care Unit at Aga Khan University Hospital, Karachi. One hundred fifty-six (79%) of these infants required assisted ventilation. Infants requiring ventilatory assistance had higher rates of maternal antenatal complications, were more frequently asphyxiated at birth, and were hypothermic on admission. The overall mortality was 39%, and a further 3 infants died in early infancy after discharge. The mean duration of hospitalization for ventilated survivors (n = 122) was 24.6 ± 21.1 days, with an average cost of therapy per survivor of Rs 50,067 (US $1,391). While our experience from Karachi indicates that it is possible to provide successful respiratory support at comparatively low cost to newborn infants weighing >1,000 g with severe RDS, there is considerable room for improvement in outcome with the use of preventive measures such as antenatal steroids, appropriate intrapartal care, and attention to early stabilization after birth.