Survival of Respiratory Failure within the First ۷۲ Hours in Preterm Infants with Respiratory Distress Based on the Downes Score Assessment

Background: Respiratory distress in neonates is the most common condition of preterm infants receiving treatment in the neonatal intensive care unit. As a clinical assessment of respiratory distress, the Downes score can predict the risk of respiratory failure. The present study aimed to determine the survival of respiratory failure in the first ۷۲ h in preterm infants with respiratory distress based on the Downes score assessment.Methods: A prospective cohort survival analysis was performed at three hospitals in Indonesia (Al-Islam Hospital, Bandung, Al-Ihsan Hospital, Bandung, and Cibabat Hospital, Cimahi) from April to July ۲۰۲۱. Subjects were infants aged ۲۸-۳۶ weeks, with respiratory distress based on the Downes score within the first ۲, ۶, ۱۲, ۲۴, ۴۸, and ۷۲ h after delivery. The analyzed variables included birth weight ([BW], <۱۵۰۰ vs. ۱۵۰۰-۲۵۰۰ g), gestational age ([GA], ۲۸-۳۲ vs. ۳۲-۳۷ weeks), and ۵-min APGAR score (<۷ vs. >۷). Bivariate and multivariate analyses were conducted with Cox regression proportional hazard and the Kaplan-Meier estimate of survival rate was also performed. In addition, the adjusted hazard ratio (aHR) was calculated, and a P-value of less than ۰.۰۵ was considered statistically significant.Results: Of the ۸۹ subjects who met the criteria, ۲۰ (۲۲.۴۷%) experienced respiratory failure. The multivariate analysis including BW (aHR: ۱.۸۴۶, ۹۵%CI: ۰.۵۷۰-۵.۹۷۹, P> ۰.۰۵), GA (aHR: ۲.۲۷۳, ۹۵ %CI: ۰.۶۹۷-۷.۴۱۶, P>۰.۰۵), and the ۵-min APGAR score (aHR: ۲.۰۴۹, ۹۵%CI: ۰.۸۱۱-۵.۱۷۹, P>۰.۰۵) estimated the survival rate for respiratory failure at the age of ۷۲ h at ۷۴.۷% (standard error: ۰.۰۵%).Conclusion: A GA of <۳۲ weeks, a BW of <۱۵۰۰ g, and the condition of asphyxia simultaneously increased the aHR of respiratory failure, with an estimated survival rate of ۷۴.۷%.  

Keywords:

Downes score , preterm infants , Respiratory failure