Refractory respiratory distress syndrome risk factors in newborns with very low birth weights

The present study was aimed to assess refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).

Data from very low birth weight infants (VLBWIs) born between January 2013 and December 2020 in the Korean Neonatal Network (KNN) were analyzed. Infants who died within the first 5 postnatal days or did not receive surfactant therapy were excluded. The remaining infants were divided into a well-responding respiratory distress syndrome (RDS) group, receiving surfactant replacement therapy (SRT) once, and a refractory RDS group, receiving SRT twice or more. Multivariate logistic regression analysis was used to investigate the associations between perinatal characteristics and refractory RDS.

The findings of the study revealed:

·       Multivariate logistic regression analysis indicated that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval [CI] [1.23, 1.26]), male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section delivery (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorders (aOR = 1.54, 95% CI [1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly linked to refractory RDS.

·       Conversely, antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly negatively associated with refractory RDS.

·       In comparison to well-responding RDS, refractory RDS showed a significantly higher risk of major neonatal morbidity and mortality by 5 postnatal days.

Thus, the study concluded that maternal hypertensive disorders are a significant risk factor for refractory RDS, which is linked to poor neonatal outcomes.

Source:Shin J, Choi CW, Lee BK. Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants. BMC Pediatr. 2024 Oct 24;24(1):677. doi: 10.1186/s12887-024-05138-7. PMID: 39448962; PMCID: PMC11515632.