Comparison of the Assessment of Respiratory Disorders Using the Downes and Silverman Scales in the Delivery Room in Newborns Over 35 Weeks of Gestation with CPAP Respiratory Therapy as a Predictor of Transfer to the Intensive Care Unit. Cohort Study

Abstract

Rationale. Respiratory distress (RD) aſter birth is the leading cause of neonatal intensive care unit (NICU) admission. To determine the degree of RD, scales based primarily on clinical symptoms have been developed, but the prognostic value of RD scales remains incompletely studied.Purpose of the study — to determine and compare the prognostic value of the Downes and Silverman RD scoresin the delivery room in neonates ≥35 0 weeks of gestation with CPAP therapy as a predictor of NICU admission.Materials and methods. The study included newborns ≥35 0 weeks of gestation with RDin the delivery room. The study was conducted at the Ekaterinburg Clinical Perinatal Center from March 1 to August 15, 2023. The predicted outcome was hospitalization from the delivery room to the NICU. In the general sample (n = 73), subgroups were identified according to the studied predictor at the start of CPAP therapy: subgroup D1 — Downes scale score n = 24); subgroup D2 — Downes scale score ≥4 points (n = 49); subgroup S1 — Silverman scale score n = 31); subgroup S2 — Silverman score ≥4 points (n = 42).Results. In subgroup D2, the relative risk of NICU admission was 3.9with a 95 % confidenceinterval (CI) of 1.3–11.7, sensitivity of 88.9 % and specificity of 45.7 %; in subgroup S2–2.1with 95 % CI 1.021–4.300, sensitivity 74.1 % and specificity 52.2 %.Conclusion. Assessment of RD in newborns ≥35 0 weeks of gestation in the delivery room on the Downes scale ≥4 points at the start of CPAP therapy allows predicting the ineffectiveness of respiratory therapy and transfer of the child to the NICU. The accuracy of the forecast when assessed using the Downes scale is higher than that using the Silverman scale.