Respiratory Severity Score and Its Association with Adverse Outcomes in Extremely Low Birth Weight Infants Undergoing Invasive Mechanical Ventilation

Abstract

Background: Respiratory severity score (RSS) is a simple, non-invasive respiratory failure assessment tool that its appropriateness for lung disease severity is well-established. Objectives: This study aimed to investigate the potential value of early-life RSS values in predicting mortality or severe bronchopulmonary dysplasia (BPD) in infants with extremely low birth weight (ELBW) undergoing invasive mechanical ventilation. Methods: Following a retrospective approach, the current multi-center study intended to estimate the RSS and RSS/kg values in the first three days of life and time-weighted means of these values in ELBW babies who received invasive mechanical ventilation. Participants were categorized into two groups of survival without severe BPD and those with severe BPD or death. All RSS values and other risk factors were compared between groups. A multivariate logistic regression analysis was used to identify factors affecting severe BPD or death. The sensitivity and specificity of RSS values in predicting severe BPD or death were estimated using receiver operating characteristic (ROC) curves. Results: A total of 101 infants met the inclusion criteria. All RSS and RSS/kg values in the first three days of life were found to be significantly higher in the severe BPD or death group. The maximum area under the curve (AUC) in the ROC curves created for the respiratory severity score values was determined as RSS/kg mean with a cut-off value of 3.62 (85.3%), (P = 0.001). According to the multivariate logistic regression analysis, which included risk factors that may affect the development of severe BPD or mortality, both the mean RSS/kg score and the duration of invasive mechanical ventilation maintained statistically significant. [RSS/kg mean; OR = 2.28 (1.37 – 3.78), P = 0.001], [invasive MV duration; OR = 1.08 (95% CI, 1.03 – 1.14), P = 0.003]. Conclusions: This study demonstrated that high RSS/kg mean values in the early periods of life are valuable in predicting severe BPD or death in ELBW babies undergoing invasive mechanical ventilation. Furthermore, mean RSS had more predictive power than single RSS determinations, and incorporating body weight was associated with improved sensitivity of the score.

Risk Prediction of Severe Bronchopulmonary Dysplasia (BPD) Using the Respiratory Severity Score (RSS) in Extremely Preterm Infants: A Retrospective Study From Saudi Arabia

“…This study has demonstrated that RSS values can be used at 14, 21, and 28 days to predict the severe BPD and mortality risk. Similar to our study, Dursun et al reported that RSS values are elevated during the first three days of life in infants suffering from severe BPD [27].…”

Respiratory Severity Score and Neurodevelopmental Outcomes at Age 3 Years in Extremely Preterm Infants

“…We selected possible potential confounders based on previous studies, including gestational age (22)(23)(24)(25), and 26-27 gestational weeks, categorical), sex (dichotomous), small for gestational age (dichotomous), antenatal corticosteroids (dichotomous), Clinical Risk Index for Babies (CRIB) II score (≤9, 10-14, and ≥15, categorical), and maternal age (≤24, 25-29, 30-34, ≥35, categorical). 7,18 In the sensitivity analysis, we assessed the association between RSS category and neurodevelopmental outcomes using an RSS value of 3.0 as a cutoff.…”

“…6 Furthermore, lung injury that occurs within the first days of life has the potential to modulate the clinical course of these infants. 7 Additionally, neonatal mortality is highest within the first 24 hours of life, which is the most critical and unstable period for preterm infants. [8][9][10] The oxygenation index is a well-established respiratory parameter that can be used to accurately quantify the severity of oxygen desaturation.…”

“…15,16 Moreover, several studies have provided compelling evidence linking the RSS during the acute period of less than age 3 days to neonatal mortality and morbidity in very low birth weight infants. 7,17 A retrospective cohort study in the United States demonstrated an association between high RSS during the first day of life and neonatal mortality and morbidity in infants born weighing 1,250 g. 18 However, to our knowledge, no studies have examined the association between RSS during the first day of life and neurodevelopmental outcomes in extremely preterm infants.…”