Respiratory severity score as a predictive factor for severe bronchopulmonary dysplasia or death in extremely preterm infants

Abstract

Background Despite significant advances in neonatology, bronchopulmonary dysplasia (BPD) remains the most common cause of serious morbidity and mortality in premature infants. The aim of the present study was to determine associations between the respiratory severity score (RSS) with death or BPD in premature infants. Methods This was a retrospective study conducted between January 2010 and December 2014. We enrolled preterm infants with a gestational age of less than 28 weeks who were supported by mechanical ventilation for more than a week during the first 4 weeks of life. We collected the RSS scores on day of life 2, 7, 14, 21 and 28. The correlations between postnatal RSSs and death or severe BPD were analyzed using multivariate logistic regression. Results Of the 138 eligible infants, 66 infants (47.8%) either died or developed severe BPD. The RSS cut-off values for predicting severe BPD or death were 3.0 for postnatal day (PND) 14 with an odds ratio (OR) of 11.265 ( p = 0.0006, 95% confidence interval (CI), 2.842 to 44.646), 3.6 for PND 21 with an OR of 15.162 ( p = 0.0003, 95% CI, 3.467 to 66.316), and 3.24 for PND 28 with an OR of 10.713 ( p = 0.0005, 95% CI, 2.825 to 40.630). Conclusion Strong correlations were observed between the RSSs on PND 14, 21, and 28 and death or subsequent severe BPD. The RSS could provide a simple estimate of severe BPD or death., Further research with a larger study population is necessary to validate the usefulness of the RSS for predicting severe BPD or death. Electronic supplementary material The online version of this article (10.1186/s12887-019-1492-9) contains supplementary material, which is available to authorized users.

Safety, Feasibility, and Impact of Enalapril on Cardiorespiratory Physiology and Health in Preterm Infants with Systemic Hypertension and Left Ventricular Diastolic Dysfunction

“…Data regarding respiratory status [ventilation mode, positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO 2 )] were collected for each infant at the time of each TnECHO evaluation; immediately prior to initiation of enalapril, and then weekly for up to four weeks. Since most patients were on noninvasive respiratory support, a modified respiratory severity score (mRSS) [ 17 ] was calculated as PEEP*FiO 2 for the patients who were on continuous positive airway pressure (CPAP) or non-invasive neurally adjusted ventilatory assist (NIV-NAVA). In patients receiving supplemental oxygen by low flow nasal cannula, the effective FiO 2 was recorded [ 18 ].…”

The challenge of accurately describing the epidemiology of bronchopulmonary dysplasia (BPD) based on the various current definitions of BPD

“…One of the most well‐known is the oxygen challenge test proposed by Walsh 29,30 . Others are the Respiratory Severity Score (RSS = FiO 2 × MAP), 50,51 the Pulmonary Score (PS = (FiO 2 × respiratory score) + medication score), 52 and the right shift of the SpO 2 / P I O 2 curve which was first measured in neonates with pulmonary failure 53 . This is a continuous measurement of pulmonary gas exchange capacity and can be assessed non‐invasively at any PMA 54–56 .…”

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

“…RSS has been shown to closely correlate with OI in newborns receiving mechanical ventilation (12) and has been utilized as a measure of disease severity in several large-scale, multi-center studies (13,14). Further areas of previous research include the role of RSS in preparation for extubation as well as in the prediction of BPD, mortality, and short-term complications (15)(16)(17). Also, it has been found that RSS/kg is correlated more closely with pulmonary hypertension than RSS alone (18).…”