Respiratory distress is a common condition in neonates requiring admission in a neonatal care unit (NCU) [1]. It can occur in both preterm and full-term neonates affecting both morbidity and mortality rates [2] [3]. The main medical diagnoses related to these conditions are transient tachypnea, meconium aspiration syndrome, respiratory distress syndrome also known as hyaline membrane disease and pneumonia [4]. Due to increasing meconium inhalation, respiratory distress syndrome, although seen primarily in preterm babies, is also seen increased in full-term neonates and deserves more attention [5].

Sparse data of surgical causes of RD are available in sub-Saharan Africa, maybe due to shortage in antenatal diagnosis, including limited performance of routine third trimester echographies during pregnancy plus low capacity of clinical diagnosis in the labor room. Consequently, many RD cases are medical pulmonary diseases and/or due to congenital cardiovascular conditions [4]. In recent years, the widely used antenatal corticosteroids have resulted in a reduction of hyaline disease especially in preterm babies. However, in parallel the increasing rate of caesarian section has led to more recorded cases of RD in full-term neonates [6]. In Cameroon, the General Hospital-Douala team, JN Tochie et al. in 2016, reported that RD was representing the main cause of neonatal admission (47.5%) in the NCU [7]. Elsewhere, in Nepal, RD contributed to a third of NCU admissions, with an incidence around 4% [8]. Overall, data remain scarce in low resource settings especially for full term neonates with an incidence rate recorded between 1.2% to 7.2% in term live births. In addition, RD morbidity in low resource settings seems to be greater compared to data of high-income countries [9]. As epidemiological trends show an increasing rate of RD in full-term newborns [10] [11], we designed this study with the primary objective to assess and describe clinical features, causes and management of RD in full and post-term neonates in a tertiary facility in Yaoundé.

From January 2017 to December 2018, 2312 newborn babies were admitted in NCU of Essos hospital Centre of which 186 presented an RD giving a prevalence rate of 8%.

This study could be a pioneering one in analyzing the profile of RD in neonates born after 37 weeks of gestation in Cameroon. As first finding, our rate of RD admissions in NCU of 8% was slightly higher than the global record, around 5 to 7% of term live births including data observed in Saudi Arabia and Baghdad in a tertiary level NCU of 1.64% - 2.78% [12] [13]; these discrepancies can be explained by exclusion of post term neonates and/or inclusion in neonatal units versus maternities. On the other hand, our prevalence rate was lower than those recorded in Egypt and Karachi [3] [14], where neonates were included irrespective of gestational age. Of note, we found a preeminence of RD in males in our setting. This finding was consistent with two studies showing susceptibility of the male gender for RD without any clear explanation [14] [15]. With regards to the causes, pneumonia stood as the first cause of RD in this setting, thus confirming previous data; this is easily understandable as neonatal infection is a leading cause of morbidities and mortality in our environment [16]. In second position, transient tachypnea was posting a rate concordant with the level of practice of caesarian sections in this population, though the specific rate of elective caesarian sections was not known. In fact, this preeminent TT among this population also fits with the 10% of mothers having a history of maternal diabetes and/or foetal macrosomia [17] [18] [19]. Following TT, meconium aspiration syndrome (MAS), was the third cause of RD; unfortunately this diagnosis of MAS can lead to respiratory distress syndrome in full-term neonates and can be challenging to manage in absence of exogenous surfactant and bubble CPAP [20] [21]. We can attest that other causes of RD (diaphragmatic hernia, esophageal atresia, choanal atresia) were relatively scarce. This scarcity can be attributed to the delay in diagnosis and/or limited access to antenatal diagnosis; including feeble neonatal networks and low capacity of neonatal transfer. Regardless of the very limited means available for optimal management of infants with RD (oxygen and antibiotics), notably the lack of positive expiratory pressure known to be helpful in many cases of RD, the mortality rate observed around 10%, though high, could appear laudable in our context [22] [23]. Looking at the associated factors of severity, a surprising finding in this study was the protection conferred by caesarian sections, but we can explain this, by the fact that many C-sections were not elective but done emergently, to alleviate the risk of perinatal asphyxia thus appearing to be protective for the newborn.

This study records some limitations due to its design. As a retrospective study, some files were lacking information for accuracy of the diagnosis and etiology. In addition, in some cases, the chest X-ray was not performed timely.

RD in neonates born after 37 weeks gestation was mainly due to neonatal infection and pneumonia; the outcome was still critical with 10.4% mortality rate due to lack of optimal management thus supporting extended access to positive expiratory pressure devices.

We are grateful to both health care providers and managers of Esssos Hospital Centre for their contributions to the data collection for this study.

No funding was received for this study.

Data underlying these findings are provided in the manuscript tables and figures. Complete dataset could be provided upon reasonable request from the corresponding author. This dataset represents a core of the hospital database and may not be deposited in a public repository.

Designed the study: DSMK and AENN Collected data JEN and ACNM. Analysed the data: ASN. Interpreted the data: DSMK and AENN. Initiated the manuscript: DSMK. Revised the manuscript: AENN. All authors read and approved the final version of the manuscript.

Ethics approval and consent to participate. Ethical clearance for this study was obtained from the Institutional review board (IRB) of the Essos Hospital Centre; the Hospital Directorate provided an administrative authorization; and all data were processed under strict confidentiality and privacy by using unique identifiers.

N/A.

The authors declare that they have no competing interests.

Kue, D.S.M., Ngoue, J.E., Motaze, A.C.N., Nanfack, A.S. and Njom-Nlend, A.E. (2021) Respiratory Distress in Full and Post Term Neonates: Prevalence, Etiologies and Outcomes in a Tertiary Health Center in Yaoundé. Open Journal of Pediatrics, 11, 351-359. https://doi.org/10.4236/ojped.2021.113032