Srinagar- Amidst the hushed corridors of a private hospital in south Kashmir’s Anantnag, a newborn baby girl fought her first battle for breath. Born through C-section into a world of uncertainty, her cries were muffled by the urgency of her rapid breathing. As her tiny chest heaved beneath the weight of a silent struggle, the newborn found refuge beneath the glass canopy of an oxygen hood.
As the clock ticked relentlessly, despair tightened its grip until the decision was made to shift her to the Children’s Hospital in Bemina, where she was admitted in the Neonatal Intensive Care Unit (NICU). Diagnosed with Infant Respiratory Distress Syndrome, she was immediately put under oxygen therapy. As the steady chorus of beeping monitors filled the air, the newborn lay ensconced under the gentle grip of a nasal cannula.
Days turned into nights, until finally, the newborn emerged victorious from the clutches of life threatening disorder. Yet, as one story found its resolution, countless others continued to unfold within the confines of the hospital ward. Each newborn, a warrior in their own right, battled against the invisible foe that threatened to steal their breath away.
“The most frequent reason for a newborn to be admitted to the intensive care unit (NICU) is respiratory distress which has various etiologies but similar clinical presentations,” Senior Consultant Physician, Dr Suhail Ahmad Naik said.
Dr. Suhail added, “We cannot say how prevalent it may be, since the rate of any condition is determined by its denominators, which is impractical given that RDS is a frequent disorder in newborns.”
A research on the morbidity profile and outcome of low-birth-weight infants conducted by Department of Pediatrics, Government Medical College Baramulla, found respiratory distress as one of the major causes of morbidity and mortality.
Another study titled, “The epidemiology of neonatal respiratory distress in a tertiary care neonatal centre Kashmir India” conducted by the department of pediatrics, Government College of Medicine, Srinagar, revealed a significant rate of respiratory distress and NICU hospitalizations in Kashmir. However, the study shows that the risk of Newborn Respiratory Distress Syndrome (NRDS) was shown to be higher in neonates born via Lower Segment Cesarean Section (LSCS)—the most common mode of delivery—than in the babies delivered via normal spontaneous vaginal delivery (NSVD).
According to the study, Transient Tachypnea of Newborn (TTN) was the most common cause of distress in term newborns, followed by perinatal asphyxia, meconium aspiration, neonatal sepsis, and congenital heart diseases (CHD).
Various studies conducted worldwide have pointed out that cesarean section is a risk factor for RDS because the fetus absorbs about one-third of the fetal lung fluid during vaginal delivery,whereas proper absorption of fetal lung fluid is not achieved in infants delivered through a cesarean section.
Head of the Department of Pediatrics at the Government Children Hospital, Dr. Khurshid Wani, endorsed the Government College of Medicines study and said that caesarean section increases the risk of respiratory distress syndrome (RDS) because, in normal mode of delivery, the fetus absorbs approximately one-third of the fetal lung fluid, but in an elective caesarean operation, normal fetal lung fluid absorption is not attained.
“Since their lungs are undeveloped, preterm infants are more likely to have transient tachypnea in their newborns,” Dr Khurshid told Kashmir Observer.
He added that the task is made more difficult by the fact that fluid in the fetal lungs needs to be quickly removed in order to allow for gas exchange. Failure to remove fetal lung fluid frequently results in respiratory morbidity, which can be especially troublesome for some newborns delivered via LSCS.
Notably, there’s a surge in C-sections in Jammu and Kashmir. While C-sections can save lives during childbirth, there are worries about their increasing rates worldwide, including in Kashmir. In May 2022, J&K administration admitted to the rise in C-section surgeries, promising a C-section audit.
In 2023, J&K’s C-section deliveries were reported as 42.7%, the second highest in the country. This rise continues in Kashmir, with official data showing 22,146 C-sections out of 42,737 deliveries in district hospitals from April 2022 to March 2023.
This alarming surge in cesarean sections has increasingly worried medical experts about the implications for infant health.
“Early diagnosis of specific causes for respiratory distress is very important as different etiologies have different specific treatment and require altogether different ventilatory strategies. Therefore, timely diagnosis and management of these conditions is very imperative to discharge an intact neonate from the NICU,” Dr Suhail said.
“Newborns can have a variety of breathing issues, including pneumonia, apnea, meconium aspiration syndrome, bronchopulmonary dysplasia (BPD), chronic pulmonary hypertension of the newborn and transitory tachypnea of the newborn,” Dr Naik added.
Another possible cause of neonatal RDS is genetic lung development issues. The majority of RDS instances affect newborns delivered before 37 to 39 weeks. The likelihood of RDS after birth increases with the baby’s preterm.
Long-term developmental abnormalities, such as learning challenges, mobility issues, hearing impairments, and visual impairments, can result from brain damage caused by bleeding or oxygen deprivation during Newborn Respiratory Distress Syndrome (NRDS) in babies.
“Newborns experiencing respiratory distress benefit from ventilators and oxygen-based respiratory therapy. However, prolonged usage can harm the lungs of a preterm infant. A long-term requirement for oxygen assistance is experienced by certain prematurely born newborns, which can result in bronchopulmonary dysplasia (BPD), commonly referred to as chronic lung disease,” Dr Naik added.
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