Is Management of Neonatal Respiratory Distress Syndrome Feasible in Developing Countries? Experience From Karachi (Pakistan) Zulfiqar Ahmed Bhutta, MB, BS, FRCP, FCPS, PhD,* Kamran Yusuf, MB, BS, FCPS, and Iqtidar A. Khan, MB, BS, MRCP Summary. 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 out- comes 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 fre- quently 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 hospi- talization 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. Pediatr Pulmonol. 1999; 27:305–311. © 1999 Wiley-Liss, Inc. Key words: cost of care; developing country; outcome; respiratory distress syndrome; mechanical ventilation; neonatology; epidemiology. INTRODUCTION Respiratory distress syndrome (RDS) is a leading cause of mortality among newborn infants in the Western world, with an estimated incidence of 1% of all live births. 1 Prior to the introduction of surfactant replace- ment therapy, the mortality associated with the disorder ranged from 14–30%. 2,3 The introduction of surfactant replacement therapy in developed countries has resulted in a significant reduction in morbidity and mortality in this high-risk group. 4–6 However, the situation in the developing world is very different. Although early neonatal deaths have been clearly identified as a major component of infant mor- tality, 7,8 the contribution of RDS to neonatal morbidity in the developing world is unknown. This is mainly due to inadequate epidemiological information as to the preva- lence and severity of this disorder, as most very low birth weight (VLBW) infants die soon after birth, and causes of death other than prematurity are poorly recognized. In some series from developing countries where informa- tion is available on the early course of VLBW infants, RDS has been documented in 2–3% of all births, 9,10 with extremely high mortality rates. 11,12 While therapeutic strategies for managing RDS in most developing coun- tries consist primarily of basic supportive measures, in recent years improved training in obstetric management of high-risk pregnancies and perinatal care has resulted in an improvement in standards of newborn care. Several centers have thus begun to explore the possibility of im- Department of Paediatrics, Aga Khan University Hospital, Karachi, Pakistan. *Correspondence to: Zulfiqar Ahmed Bhutta, M.B., B.S., F.R.C.P., F.C.P.S., Ph.D., Director of Neonatal Services, Department of Paedi- atrics, Aga Khan University Hospital, P.O. Box 3500, Stadium Road, Karachi 74800, Pakistan. E-mail: zulfiqar.bhutta@aku.edu Received 3 January 1996; accepted 31 October 1997. Pediatric Pulmonology 27:305–311 (1999) Original Articles © 1999 Wiley-Liss, Inc.