TOP 34 - Behavioral Signs of Respiratory Instability in Preterm Infants: A Validation Study in an Expanded Cohort

Publication Number: 1794.TOP 34

Colton Merrill, Phoenix Children's Hospital, Mesa, AZ, United States; Lauren Ridgway, Phoenix Children's Hospital, Phoenix, AZ, United States; Mohammed Elkhwad, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Bronchopulmonary dysplasia (BPD) is common among premature infants and is associated with chronic lung disease into childhood, difficulty weaning from respiratory support, and prolonged hospitalization. There is currently no standardized protocol for weaning respiratory support in infants diagnosed with BPD. A Behavioral Signs of Respiratory Instability (BSRI) scoring tool was previously developed to evaluate tolerance to physical therapy and developmentally appropriate activities in infants with BPD at term-corrected gestational age and has been shown to correlate with respiratory severity. However, a similar assessment tool has not yet been validated in preterm infants. Thus, the decision to wean respiratory support in preterm infants is often nuanced and based on perceived tolerance of minimum ventilatory settings. A 2023 pilot study of 26 preterm infants found that a modified Preterm Infant Behavioral Signs of Respiratory Instability (PiBSRI) scoring tool was effective in quantifying signs of respiratory instability, with PiBSRI scores correlating negatively with pulmonary severity scores and positively with advancing postmenstrual age and clinical weaning of respiratory support.

Objective: The objective of this study is to validate and expand upon prior pilot study findings demonstrating correlations between PiBSRI scores, corrected gestational age, respiratory severity, and clinical weaning of respiratory support in a larger cohort of preterm infants with evolving BPD. Validation of this scoring tool may support broader clinical adoption to guide evidence-based weaning of respiratory support in this population.

Design/Methods: This is a prospective single-center study of 74 infants born at less than 32 weeks gestational age who were subsequently diagnosed with BPD at 36 weeks corrected gestational age. PiBSRI scores were obtained during routine therapy sessions conducted by physical, occupational, or speech therapists. Data regarding corrected gestational age (CGA) and respiratory support was also collected. We plan to analyze correlations between CGA, weaning of respiratory support, and predictive values for PiBSRI scores associated with successful weaning using Spearman's or Pearson's correlation coefficients, as appropriate. The median trajectory of PiBSRI scores across individual NICU courses will also be plotted. Data analysis will be completed by January 2026.

Table 1.0
Premature Infant Behavioral Signs of Respiratory Instability Scoring System