This is in reference to the article titled ’Incidence and Etiology of Respiratory distress in newborn’.
Following comments are offered for review by authors.
The clinical diagnosis of respiratory distress in a neonate is usually assessed by the Downe's score which is as under :-
This scoring criterion is usually adopted for making initial diagnosis and also for management protocols.
There are several reports on the incidence of respiratory distress syndrome in Indian literature. In fact in a similar study from the same center , the authors have observed similar pattern of etiological factors (respiratory distress was hyaline membrane disease (18%), followed by wet lung syndrome (14%), meconium aspiration (12%), asphyxia (12%) and septicemia (8%). In 8 babies, a lung biopsy (postmortem) was done to confirm the diagnosis. In a study on neonatal autopsy, the authors correlated clinical and autopsy findings. There were 23 neonatal autopsy studies out of 43 neonatal deaths during the period from Jan 1991 to Sept 93. Common antemortem diagnosis included meconium aspiration syndrome, respiratory distress syndrome and aspiration syndrome. Hyaline membrane disease was confirmed on autopsy study . In an another epidemiological study, the single most important factor contributing to the mortality was respiratory distress (29.3%) followed by sepsis (24.4%) and birth asphyxia (16.2%) .
Inclusion criteria for hyaline membrane disease need to be specified. Usual criteria adopted is clinical and radiographic diagnosis of RDS, requiring mechanical ventilation and FI02 > 0.3. The reason for variation in reporting RDS is highlighted by the fact that there is no uniform protocol for diagnosis as has been well brought out by the authors in their introductory comments.
The study has been designed in the format of a descriptive cross sectional one. This design gives an idea of prevalence of disease and not incidence. To be scientifically correct, such study should define the population from whom the study sample will be selected, period of study, methodology of selection of study sample, define the disease to be studied and lay down the diagnostic criteria.
1. Nagendra K, Wilson CG, Ravichader B, Sood S, Singh SP. Incidence and etiology of respiratory distress in newborn. MJAFI. 1999;55:331–333.
2. Malhotra AK, Nagpal R, Gupta RK, Chhujta DS, Arora RK. Respiratory distress in new born: treated with ventilation in a level II nursery. Indin Pediatr. 1995;32(2):207–211.[PubMed]
3. Sarna MS, Saili A, Dulla AK, Kumari S. Neonatal mortality patterns in an urban hospital. Indian Pediatr. 1991;28(7):719–724.[PubMed]