Clinical predictive score of CPAP failure in preterm neonates with respiratory distress
Keywords:
Continuous positive airway pressure, Preterm infants, Respiratory distress, Surfactant replacement therapyAbstract
Background: Immediate administration of continuous positive airway pressure (CPAP) after birth, followed by selective surfactant replacement therapy, is a recommended approach for preterm infants. Infants who experienced CPAP failure are at an increased risk of death and complications. To make accurate decisions regarding respiratory support may improve treatment outcomes.
Objective: To develop the clinical predictive score for CPAP failure in preterm infants.
Method: This prospective cohort study enrolled inborn preterm infants with a gestational age of ≤ 32 weeks, who presented with respiratory distress and were initially managed with CPAP at our hospital between April 2020 and April 2021. The CPAP failure group was defined as infants requiring intubation within the first 48 hours of life. Clinical characteristics between the CPAP failure and CPAP success groups were compared. Subsequently, a multivariable logistic regression analysis was performed to develop a clinical predictive score.
Results: Among the 107 infants included in this cohort, 32.7% experienced CPAP failure. The significant predictive factors of CPAP failure included gestational age, CPAP level, FiO2, and pCO2 at 1 hour of age. Utilizing these four factors, a clinical predictive score was constructed, yielding an area under the curve (AUC) of 89.2% (95%CI 82.6‒95.8). In the low-risk category, the positive likelihood ratio for CPAP failure was 0.12 (95%CI 0.03-0.45), whereas in the high-risk category, it increased to 5.02 (95%CI 2.72‒9.25).
Conclusion: There were 4 variables that could be used to indicate the risk of CPAP failure including gestational age, CPAP level, FiO2 level, and pCO2 level within 1 hour after birth. These variables could be utilized to establish a clinical predictive score for diagnosing CPAP failure, which might be applied for early intervention to provide appropriate respiratory support treatment.
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