354 - Respiratory Distress Score for Early Prediction of Failure of Non-Invasive Respiratory Support in Preterm Infants with Respiratory Distress Syndrome

Publication Number: 2343.354

Jacob J. Elliott, University of Wisconsin School of Medicine and Public Health, cross Plains, WI, United States; Dinushan C. Kaluarachchi, University of Wisconsin - Madison, Madison, WI, United States; Patrick J. Peebles, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Jens Eickhoff, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Megan Christensen, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Kimberly Wentela, Unity Point Health - Meriter, Madison, WI, United States

Background: Respiratory distress syndrome (RDS) due to surfactant deficiency is a major cause of respiratory failure in preterm infants. Noninvasive respiratory support (NRS) is critical in initial management of preterm neonates with RDS. Many infants will require escalation of respiratory support with invasive ventilation1, which is associated with adverse outcomes. Early identification of infants failing NRS may help in criteria for surfactant administration in clinical trials.

Objective: To identify neonates at high risk of NRS failure at hours of life through a novel respiratory distress score based upon demographic and clinical variables. We hypothesized that neonates with higher respiratory distress scores are more likely to fail NRS.

Design/Methods: A prospective cohort study of infants born between 290/7 and 366/7weeks gestation with RDS on NRS admitted to UnityPoint Health Meriter NICU between 1/1/2025-6/20/2026. An interim analysis was completed September 2025. Neonates intubated within 2 hours of life or who didn’t require respiratory support were excluded. A respiratory distress score was calculated at 2 hours of age. The cohort was divided into two groups; NRS failure and NRS success. NRS failure was defined as administration of surfactant and/or need for mechanical ventilation in the first 72 hours of life. Per unit protocol, surfactant was typically administered when FiO2 reached 30-40% on CPAP of 6-7 cm H2O. Univariate analysis was performed to compare characteristics and outcomes between the two groups and a multivariable logistic regression analysis was performed to evaluate for odds of failure while adjusting for confounding variables.

Results: 87 neonates were included. Median gestational age (GA) and birthweights (BW) were 33.5 weeks and 2.04 kg respectively. For the entire cohort, mean respiratory distress score at 2 hours of age was 4 (IQR 3,5). 12 infants (14%) developed NRS failure including 5 infants (6%) who needed mechanical ventilation. Respiratory distress score at 2 hours showed a strong association with NRS failure, with each point of score showing a 70% increase odds of NRS failure (OR 1.7, CI 1.2-2.5, p=0.007). This association remained significant after adjusting for GA, BW, sex and antenatal steroids (OR 2.1, CI 1.3-3.6, p=0.003). The optimal score cutoff for predicting NRS failure was 3.5 (sensitivity 92%, specificity 48%).

Conclusion(s): The respiratory distress score is an easily available bedside clinical tool that can be helpful for early prediction of NRS failure. This can be utilized in future studies aimed at clinical interventions for prevention of NRS failure.

Table 1. Respiratory Distress Score
Table 1 Resp distress score.pdf

Table 2. Comparison of baseline and clinical characteristics between NRS failure versus no failure
table 2 NRS failure.pdf

Table 3. Respiratory distress score association with NRS Failure
Table 3 RDS association with NRS.pdf