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

Henry A Zapata; Heather L Becker; Michael R Lasarev; Prem Fort; Scott O Guthrie; Dinushan C Kaluarachchi

doi:10.1055/s-0043-1772747

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. 2023 Aug 24. doi: 10.1055/s-0043-1772747. Online ahead of print.

Authors

Henry A Zapata¹, Heather L Becker², Michael R Lasarev³, Prem Fort⁴, Scott O Guthrie⁵, Dinushan C Kaluarachchi¹

Affiliations

¹ Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
² Department of Respiratory Therapy, UnityPoint-Meriter, Madison, Wisconsin.
³ Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
⁴ Department of Pediatrics, Division of Neonatology, Johns Hopkins All Children's Hospital, St. Peterburg, Florida.
⁵ Department of Pediatrics, Division of Neonatology, Vanderbilt University School of Medicine, Nashville, Tennessee.

PMID: 37619600
DOI: 10.1055/s-0043-1772747

Abstract

Objective: Preterm infants often develop failure of noninvasive respiratory support. These infants miss the advantages of early rescue surfactant therapy. In this study, we evaluate the utility of respiratory severity score (RSS) during the first 3 hours of life (HOL) as a predictor for failure of noninvasive respiratory support.

Study design: We conducted a post hoc analysis of infants between 23 and 40 weeks' gestational age who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression analysis were used to assess whether the RSS summary measures were associated with the odds of surfactant administration.

Results: Study involved 146 infants. Sixty-four infants (45%) received surfactant within the first 72 hours. Administration of surfactant was associated with the mean RSS (p < 0.01) and the linear trend (p < 0.01).

Conclusion: We demonstrated that RSS during the first 3 HOL can predict failure of noninvasive respiratory support and need for late rescue surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies.

Key points: · Early recognition of infants at risk of failure of noninvasive ventilation is important to prevent complications.. · It is desirable to identify patients who would benefit from early rescue surfactant treatment.. · RSS in first 3 hours can be used as a predictor of failure of noninvasive respiratory support..