A single-center retrospective study of neonatal acute respiratory distress syndrome based on the Montreux definition
GUO Jing-Yu, CHEN Long, SHI Yuan
Department of Neonatology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics Chongqing 400014, China
Abstract Objective To investigate the epidemiology, clinical features, treatment, and prognostic factors of neonatal acute respiratory distress syndrome (NARDS) through a retrospective study of NARDS based on the Montreux definition. Methods A retrospective analysis was performed on the medical records of neonates who were hospitalized from January 2017 and July 2018, among whom 314 neonates who met the Montreux definition were enrolled as subjects. According to oxygen index, they were divided into a mild NARDS group with 130 neonates, a moderate NARDS group with 117 neonates, and a severe NARDS group with 67 neonates. The clinical features were compared among the three groups to investigate the influencing factors for the severities of NARDS and the length of hospital stay. Results The neonates with NARDS accounted for 2.46% (314/12 789) of the neonates admitted to the neonatal ward during the same period of time and had a mortality rate of 9.6% (30/314). The multivariate ordinal logistic regression analysis showed that the neonates who used pulmonary surfactant (PS) or had a long duration of assisted ventilation tended to have a higher risk of severe NARDS (P < 0.05). The Cox regression analysis showed that the neonates with low birth weight/macrosomia, preterm birth, invasive ventilation, PS therapy, or positive pathogenic detection had a higher risk of prolonged hospital stay (P < 0.05). Conclusions Preterm birth, low birth weight/macrosomia, and perinatal infection may be associated with an increased risk of severe NARDS. The neonates requiring invasive ventilation, prolonged assisted ventilation, or PS therapy tend to have a poor prognosis.
GUO Jing-Yu,CHEN Long,SHI Yuan. A single-center retrospective study of neonatal acute respiratory distress syndrome based on the Montreux definition[J]. CJCP, 2020, 22(12): 1267-1272.
GUO Jing-Yu,CHEN Long,SHI Yuan. A single-center retrospective study of neonatal acute respiratory distress syndrome based on the Montreux definition[J]. CJCP, 2020, 22(12): 1267-1272.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome:the Berlin definition[J]. JAMA, 2012, 307(23):2526-2533.
[2]
Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome:consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference[J]. Pediatr Crit Care Med, 2015, 16(5):428-439.
[3]
De Luca D, van Kaam AH, Tingay DG, et al. The Montreux definition of neonatal ARDS:biological and clinical background behind the description of a new entity[J]. Lancet Respir Med, 2017, 5(8):657-666.
Schouten LR, Veltkamp F, Bos AP, et al. Incidence and mortality of acute respiratory distress syndrome in children:a systematic review and meta-analysis[J]. Crit Care Med, 2016, 44(4):819-829.
[9]
Foglia EE, Jensen EA, Kirpalani H. Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants[J]. J Perinatol, 2017, 37(11):1171-1179.
Seethala RR, Hou PC, Aisiku IP, et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients[J]. Ann Intensive Care, 2017, 7(1):11.
[12]
Nanchal RS, Truwit JD. Recent advances in understanding and treating acute respiratory distress syndrome[J]. F1000Res, 2018, 7:F1000 Faculty Rev-1322.
[13]
Mokra D, Calkovska A. Experimental models of acute lung injury in the newborns[J]. Physiol Res, 2017, 66(Suppl 2):S187-S201.
[14]
Marseglia L, D'Angelo G, Granese R, et al. Role of oxidative stress in neonatal respiratory distress syndrome[J]. Free Radic Biol Med, 2019, 142:132-137.
[15]
Cools F, Offringa M, Askie LM. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants[J]. Cochrane Database Syst Rev, 2015(3):CD000104.
Schmidt A, Sempsrott J. Surfactant for acute respiratory distress syndrome caused by near drowning in a newborn[J]. Pediatr Emerg Care, 2016, 32(1):e1.
[20]
Natarajan CK, Sankar MJ, Jain K, et al. Surfactant therapy and antibiotics in neonates with meconium aspiration syndrome:a systematic review and meta-analysis[J]. J Perinatol, 2016, 36(Suppl 1):S49-S54.
[21]
Taut FJ, Rippin G, Schenk P, et al. A search for subgroups of patients with ARDS who may benefit from surfactant replacement therapy:a pooled analysis of five studies with recombinant surfactant protein-C surfactant (Venticute)[J]. Chest, 2008, 134(4):724-732.
[22]
Duggal A, Ganapathy A, Ratnapalan M, et al. Pharmacological treatments for acute respiratory distress syndrome:systematic review[J]. Minerva Anestesiol, 2015, 81(5):567-588.
LI Qian-Qian, DONG Xiao-Yue, QIAO Yu, YIN Yu-Jie, GAO Yan, ZHOU Jin-Jun, YANG Li, ZHU Rong-Ping, WANG Fu-Dong, WAN Jun, XU Yan, PAN Zhao-Jun, WANG Wei-Yuan, YAN Jun-Mei, HAN Shu-Ping, LU Hong-Yan, HU Yu-Hua, LI Shuang-Shuang, WANG Jin-Xiu, WU Ming-Fu, WANG Jun, DENG Xiao-Yi, YU Zhang-Bin. An investigation of severe neonatal hyperbilirubinemia in 13 hospitals of Jiangsu Province, China[J]. CJCP, 2020, 22(7): 690-695.
