Department of Neonatology, MetroHealth Medical Center, Cleveland, OH, USA.
Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(23):4620-4627. doi: 10.1080/14767058.2020.1858277. Epub 2020 Dec 6.
Extremely low birth weight (ELBW) infants have significant morbidities and higher mortality. The major morbidities are bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP). Release of proinflammatory cytokines has been implicated in the development of systemic inflammation that contributes to BPD aND ROP. Also, cumulative oxygen exposure in the first 3 days of life and use of mechanical ventilation was associated with 3-fold increase in severe IVH. Therefore, early ventilation and oxygenation may contribute significantly to morbidities in ELBW infants. Respiratory severity score (RSS), a product of Mean airway pressure (MAP) and FiO2, is a steady-state noninvasive assessment tool useful in infants to monitor the severity of respiratory failure. We used RSS, in the first 3 days of life of ELBW infants, to predict neonatal morbidities and mortality.
In a single-center retrospective cohort study in an urban setting, convenience sampling of ELBW infants meeting the study criteria who were mechanically ventilated at birth for the first 3 days of life were included. Time-weighted average RSS was plotted on receiver-operating characteristic (ROC) curve in the first 3 days of life to predict outcomes. Sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios were calculated.
A total of 69 infants qualified for the study. RSS in the first 3 days significantly predicted the composite outcome of death, ROP, IVH or BPD with an area under the curve (AUC) of 0.82 ( < 0.001). Individually, RSS predicted death, severe ROP and IVH with an AUC of 0.86, 0.77 and 0.71 respectively; but did not predict severe BPD (AUC 0.61). RSS was more sensitive and specific than each of its component; FiO and MAP. Weighted RSS in the first 3 days had high-negative predictive value of 98.1% for death between 7 days and 36 weeks, 94.6% for ROP and 91.7% for IVH.
This study is the first to show that RSS in the first 3 days of life is a good predictor of composite neonatal outcomes: severe IVH, BPD, ROP, or mortality. Early RSS had a high positive predictive value for the composite outcome of morbidities/mortality and a high specificity for mortality, ROP, and IVH individually.
极低出生体重（ELBW）婴儿存在显著的发病率和更高的死亡率。主要的发病率有支气管肺发育不良（BPD）、脑室内出血（IVH）和早产儿视网膜病变（ROP）。促炎细胞因子的释放与全身炎症的发展有关，全身炎症会导致 BPD 和 ROP。此外，出生后前 3 天内的累积吸氧和机械通气的使用与严重 IVH 的发生率增加 3 倍有关。因此，ELBW 婴儿的早期通气和氧合可能会显著导致发病率增加。呼吸严重程度评分（RSS）是平均气道压（MAP）和 FiO2 的乘积，是一种用于监测呼吸衰竭严重程度的稳态无创评估工具，可用于婴儿。我们使用 RSS 来预测 ELBW 婴儿在出生后前 3 天的新生儿发病率和死亡率。
在一项城市环境中的单中心回顾性队列研究中，我们对出生后前 3 天需要机械通气的符合研究标准的 ELBW 婴儿进行了便利抽样。在出生后前 3 天内绘制时间加权平均 RSS 的接收者操作特征（ROC）曲线，以预测结局。计算了灵敏度、特异性、阳性预测值、阴性预测值和似然比。
共有 69 名婴儿符合研究标准。RSS 在出生后前 3 天显著预测了死亡率、ROP、IVH 或 BPD 的复合结局，曲线下面积（AUC）为 0.82（ < 0.001）。单独来看，RSS 预测死亡率、严重 ROP 和 IVH 的 AUC 分别为 0.86、0.77 和 0.71，但未预测严重 BPD（AUC 为 0.61）。与 FiO 和 MAP 相比，加权 RSS 在出生后前 3 天的预测值具有更高的特异性和敏感性。出生后前 3 天的 RSS 对 7 天至 36 周之间的死亡率、94.6%的 ROP 和 91.7%的 IVH 具有 98.1%的高阴性预测值。
这项研究首次表明，出生后前 3 天的 RSS 是新生儿复合结局（严重 IVH、BPD、ROP 或死亡率）的良好预测指标。早期 RSS 对复合发病率/死亡率的阳性预测值较高，对死亡率、ROP 和 IVH 的特异性较高。
