Respiratory Severity Score and Oxygen Saturation Index during the First 2 Hours of Life as Predictors for Noninvasive Respiratory Support Failure in Respiratory Distress Syndrome

Abstract

Objective Noninvasive respiratory support (NRS) failure is common in preterm infants with respiratory distress syndrome (RDS). We evaluated the utility of respiratory severity score (RSS) and oxygen saturation index (OSI) during the first 2 hours of life (HOL) as predictors for NRS failure in moderate preterm infants.

Study Design We conducted a retrospective cohort study of infants born between 28^0/7 and 33^6/7 weeks with RDS. Univariate and multivariable logistic regression analyses were used to assess whether the RSS and OSI summary measures were associated with NRS failure.

Results A total of 282 infants were included in the study. Median gestational age and birth weights were 32 weeks and 1.7 kg, respectively. Fifty-eight infants (21%) developed NRS failure at the median age of 10.5 hours. RSS and OSI summary measures in the first 2 HOL were associated with NRS failure within 72 HOL.

Conclusion RSS and OSI during the first 2 HOL can predict NRS failure. Optimal RSS and OSI cutoffs for the prediction of NRS failure need to be determined in large cohort studies.

Key Points

• Nearly one in five moderate preterm infants on NRS at 2 hours of life developed NRS failure.

• RSS and OSI during the first 2 HOL can predict NRS failure.

• Optimal RSS and OSI cutoffs for the prediction of NRS failure need to be determined.

Keywords

respiratory distress syndrome - surfactant - noninvasive respiratory support failure - CPAP - respiratory severity score - oxygen saturation index

Authors' Contributions

H.A.Z.: involved in designing of the study, drafted the project proposal, reviewed, and approved final manuscript as submitted.

J.K.: involved in designing of the study, reviewed, and approved final manuscript as submitted.

M.R.L.: involved in designing the study, did the data analysis, reviewed, and approved final manuscript as submitted.

H.B.: involved in designing of the study, reviewed, and approved final manuscript as submitted.

S.O.G.: involved in designing of the study, reviewed, and approved final manuscript as submitted.

D.K.: designed the study, drafted the project proposal, obtained data, drafted, and approved final manuscript as submitted.

All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Publication History

Received: 28 February 2024

Accepted: 05 June 2024

Accepted Manuscript online:
06 June 2024

Article published online:
24 June 2024

• References

• 1 Warren JB, Anderson JM. Core concepts: respiratory distress syndrome. Neoreviews 2009; 10: 351-361
• 2 Polin RA, Carlo WA. Committee on Fetus and Newborn, American Academy of Pediatrics. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics 2014; 133 (01) 156-163
• 3 Sweet DG, Carnielli VP, Greisen G. et al. European Consensus guidelines on the management of respiratory distress syndrome—2022 update. Neonatology 2023; 120 (01) 3-23
• 4 Ng EH, Shah V. Fetus and Newborn Committee. Guidelines for surfactant replacement therapy in neonates. Paediatr Child Health 2021; 26 (01) 35-49
• 5 Bhandari V, Black R, Gandhi B. et al. RDS-NExT workshop: consensus statements for the use of surfactant in preterm neonates with RDS. J Perinatol 2023; 43 (08) 982-990
• 6 Banerjee S, Fernandez R, Fox GF. et al. Surfactant replacement therapy for respiratory distress syndrome in preterm infants: United Kingdom national consensus. Pediatr Res 2019; 86 (01) 12-14
• 7 Dargaville PA, Gerber A, Johansson S. et al; Australian and New Zealand Neonatal Network. Incidence and outcome of CPAP failure in preterm infants. Pediatrics 2016; 138 (01) e20153985
• 8 Dargaville PA, Aiyappan A, De Paoli AG. et al. Continuous positive airway pressure failure in preterm infants: incidence, predictors and consequences. Neonatology 2013; 104 (01) 8-14
• 9 Challis P, Nydert P, Håkansson S, Norman M. Association of adherence to surfactant best practice uses with clinical outcomes among neonates in Sweden. JAMA Netw Open 2021; 4 (05) e217269
• 10 Glaser K, Bamat NA, Wright CJ. Can we balance early exogenous surfactant therapy and non-invasive respiratory support to optimise outcomes in extremely preterm infants? A nuanced review of the current literature. Arch Dis Child Fetal Neonatal Ed 2023; 108 (06) 554-560
• 11 Jung YH, Jang J, Kim HS. et al. Respiratory severity score as a predictive factor for severe bronchopulmonary dysplasia or death in extremely preterm infants. BMC Pediatr 2019; 19 (01) 121
• 12 Malkar MB, Gardner WP, Mandy GT. et al. Respiratory severity score on day of life 30 is predictive of mortality and the length of mechanical ventilation in premature infants with protracted ventilation. Pediatr Pulmonol 2015; 50 (04) 3633-69
• 13 Zapata HA, Becker HL, Lasarev MR, Fort P, Guthrie SO, Kaluarachchi DC. Respiratory Severity Score during the first 3 hours of life as a predictor for failure of noninvasive respiratory support and need for late rescue surfactant administration. Am J Perinatol 2024; 41 (S 01): e2613-e2621
• 14 Muniraman HK, Song AY, Ramanathan R. et al. Evaluation of oxygen saturation index compared with oxygenation index in neonates with hypoxemic respiratory failure. JAMA Netw Open 2019; 2 (03) e191179
• 15 Gopal SH, Martinek KF, Holmes A, Hagan JL, Fernandes CJ. Oxygen saturation index: an adjunct for oxygenation index in congenital diaphragmatic hernia. J Perinatol 2024; 44 (03) 354-359
• 16 Kaluarachchi DC, Zapata HA, Becker HL, Lasarev MR, Fort P, Guthrie SO. Response to aerosolized calfactant in infants with respiratory distress syndrome; a post-hoc analysis of AERO-02 trial. J Perinatol 2023; 43 (08) 99810-03
• 17 Kielt MJ, Logan JW, Backes CH. et al. Noninvasive respiratory severity indices predict adverse outcomes in bronchopulmonary dysplasia. J Pediatr 2022; 242: 129-136.e2
• 18 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44 (03) 837-845
• 19 Trembath AN, Payne AH, Colaizy TT, Bell EF, Walsh MC. The problems of moderate preterm infants. Semin Perinatol 2016; 40 (06) 370-373
• 20 Ammari A, Suri M, Milisavljevic V. et al. Variables associated with the early failure of nasal CPAP in very low birth weight infants. J Pediatr 2005; 147 (03) 341-347
• 21 De Jaegere AP, van der Lee JH, Canté C, van Kaam AH. Early prediction of nasal continuous positive airway pressure failure in preterm infants less than 30 weeks gestation. Acta Paediatr 2012; 101 (04) 374-379
• 22 Fuchs H, Lindner W, Leiprecht A, Mendler MR, Hummler HD. Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of <29 weeks gestational age. Arch Dis Child Fetal Neonatal Ed 2011; 96 (05) F343-F347
• 23 Tagliaferro T, Bateman D, Ruzal-Shapiro C, Polin RA. Early radiologic evidence of severe respiratory distress syndrome as a predictor of nasal continuous positive airway pressure failure in extremely low birth weight newborns. J Perinatol 2015; 35 (02) 99-103
• 24 Kakkilaya V, Wagner S, Mangona KLM. et al. Early predictors of continuous positive airway pressure failure in preterm neonates. J Perinatol 2019; 39 (08) 1081-1088
• 25 Brat R, Yousef N, Klifa R, Reynaud S, Shankar Aguilera S, De Luca D. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr 2015; 169 (08) e151797
• 26 De Martino L, Yousef N, Ben-Ammar R, Raimondi F, Shankar Aguilera S, De Luca D. Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics 2018; 142 (03) e20180463
• 27 Isayama T, Chai-Adisaksopha C, McDonald SD. Noninvasive ventilation with vs without early surfactant to prevent chronic lung disease in preterm infants: a systematic review and meta-analysis. JAMA Pediatr 2015; 169 (08) 731-739
• 28 Herting E, Härtel C, Göpel W. Less invasive surfactant administration: best practices and unanswered questions. Curr Opin Pediatr 2020; 32 (02) 228-234
• 29 Dargaville PA, Kamlin COF, Orsini F. et al; OPTIMIST-A Trial Investigators. Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome: the OPTIMIST—a randomized clinical trial. JAMA 2021; 326 (24) 2478-2487
• 30 Zapata HA, Fort P, Roberts KD, Kaluarachchi DC, Guthrie SO. Surfactant administration through laryngeal or supraglottic airways (SALSA): a viable method for low-income and middle-income countries. Front Pediatr 2022; 10: 853831
• 31 Roberts KD, Brown R, Lampland AL. et al. Laryngeal mask airway for surfactant administration in neonates: a randomized, controlled trial. J Pediatr 2018; 193: 40-46.e1
• 32 Gallup JA, Ndakor SM, Pezzano C, Pinheiro JMB. Randomized trial of surfactant therapy via laryngeal mask airway versus brief tracheal intubation in neonates born preterm. J Pediatr 2023; 254: 17-24.e2
• 33 Cummings JJ, Gerday E, Minton S. et al; AERO-02 STUDY INVESTIGATORS. Aerosolized calfactant for newborns with respiratory distress: a randomized trial. Pediatrics 2020; 146 (05) e20193967
• 34 Hojnicki M, Zapata HA, Kaluarachchi DC. et al. Predictors of successful treatment of respiratory distress with aerosolized calfactant. J Perinatol 2023; 43 (08) 991-997
• 35 Sood BG, Thomas R, Delaney-Black V, Xin Y, Sharma A, Chen X. Aerosolized beractant in neonatal respiratory distress syndrome: a randomized fixed-dose parallel-arm phase II trial. Pulm Pharmacol Ther 2021; 66: 101986
• 36 Minocchieri S, Berry CA, Pillow JJ. CureNeb Study Team. Nebulised surfactant to reduce severity of respiratory distress: a blinded, parallel, randomized controlled trial. Arch Dis Child Fetal Neonatal Ed 2019; 104 (03) F313-F319
• 37 Gaertner VD, Thomann J, Bassler D, Rüegger CM. Surfactant nebulization to prevent intubation in preterm infants: a systematic review and meta-analysis. Pediatrics 2021; 148 (05) e2021052504
• 38 Kidman AM, Manley BJ, Boland RA. et al. Higher versus lower nasal continuous positive airway pressure for extubation of extremely preterm infants in Australia (ÉCLAT): a multicentre, randomised, superiority trial. Lancet Child Adolesc Health 2023; 7 (12) 844-851
• 39 Buzzella B, Claure N, D'Ugard C, Bancalari E. A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants. J Pediatr 2014; 164 (01) 46-51
• 40 Lemyre B, Deguise MO, Benson P, Kirpalani H, De Paoli AG, Davis PG. Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation. Cochrane Database Syst Rev 2023; 7 (07) CD003212