Respiratory Severity Score greater than or equal to 2 at birth is associated with an increased risk of mortality in infants with birth weights less than or equal to 1250 g

Shah, Shetal; Aboudi, David; Gamma, Edmund F. La; Brumberg, Heather L.

doi:10.1002/ppul.25069

Cited by 9 publications

(12 citation statements)

References 44 publications

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“…An arterial access may not be routinely performed in mildly to moderately ill newborns due to the risks associated with it. Studies have assessed the e cacy of using modi ed versions of OI, such as oxygenation saturation index (OSI, replacing PaO 2 with blood oxygen saturation using pulse oximetry, or SpO 2 , in index calculation) or respiratory severity scores (RSS, the product of MAP and FiO 2 ) as surrogate markers for pulmonary illness [28][29][30][31][32][33][34]. One recent study showed a strong correlation between OI and OSI in the neonatal population [32].…”

Section: Discussionmentioning

confidence: 99%

Oxygenation index in the first 21 days of life is a predictor for bronchopulmonary dysplasia grade in very preterm infants

Chou

Leigh

Rao

et al. 2022

Preprint

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Background BPD grades are associated with long-term respiratory and neurodevelopmental outcomes. Identification of additional early-life predictors is in need to improve the performance of their early prediction. The objective of the study was to assess the association of the oxygenation index (OI) trajectory in the first three weeks of life with BPD grades. Methods A single-center retrospective study was performed. Generalized additive mixed modeling was used to model OI trajectories for each BPD grade subgroup. A multinomial regression model was then developed to quantify the relationship between OI dynamics and the odds of BPD grades. Results 254 infants were identified for inclusion in the trajectory modeling, including 242 infants with sufficient OI data for multinomial regression analysis. A total of 6,243 OI data points were available for modeling. Average OI change was − 0.33 ± 0.52 (n = 85) in the No-BPD group, -0.04 ± 0.75 (n = 82) in the Low-Grade BPD group, and 0.22 ± 0.65 (n = 75) in the High-Grade BPD group. OI modeling showed distinct trajectory patterns for the No-BPD, Low-Grade, and High-Grade BPD subgroups. A multinomial regression analysis showed that the initial OI value and the average OI daily change in the first 3 weeks of life both independently correlated with BPD grade outcomes after adjusting for birth gestation, birth weight z-score, and sex. Conclusion Early-life OI trajectory is a useful marker for BPD grade prediction. Prospective studies are needed to further validate the findings. Alternatives to OI, such as respiratory severity score or oxygen saturation index, also merit further studies to improve clinical usability.

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Section: Discussionmentioning

confidence: 99%

Oxygenation index in the first 21 days of life is a predictor for bronchopulmonary dysplasia grade in very preterm infants

Chou

Leigh

Rao

et al. 2022

Preprint

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“…[ 18 , 19 ] Furthermore, several studies have shown its predictive value for mortality, BPD, and other short-term morbidities. [ 20 , 21 , 23 ] Mhanna et al . [ 22 ] investigated the utility of RSS for predicting extubation readiness in very-low-birth-weight infants and found that it was the only statistically significant risk factor for extubation failure.…”

Section: Discussionmentioning

confidence: 99%

“…It has been used as a measure of disease severity in some large-scale multicenter studies. [ 18 , 19 ] In addition, its association with BPD, mortality, and short-term complications has been investigated,[ 20 , 21 ] and high RSS values were found to be associated with extubation failure. [ 22 ] A study in which the RSS was analyzed by weight (RSS/kg) found that RSS/kg was more useful for predicting the development of pulmonary hypertension than the RSS.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between the Respiratory Severity Score and Extubation Failure in Very-low-birth-weight Premature Infants

2021

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Objective: The objective of the study is to investigate the utility of the respiratory severity score (RSS), an easy-to-use, non-invasive respiratory failure assessment tool that does not require arterial blood sampling, for predicting extubation failure in very-low-birth-weight premature infants. Methods: Demographic characteristics, clinical course, and neonatal morbidities were retrospectively analyzed. Data were obtained from the files of infants who were admitted to our unit between February 2016 and September 2020, were born before 30 weeks’ gestation, and had a birth weight <1250 g. Extubation success was defined as no need for reintubation for 72 h after extubation. RSS and RSS/kg values before each patient’s first planned extubation were calculated. RSS values before extubation and risk factors for extubation failure were compared between infants in the successful and failed extubation groups. Results: Our study enrolled 142 infants who met the inclusion criteria. The extubation failure rate was 30.2% (43/142). Early gestation, low birth weight, male sex, high RSS, grade ≥3 intraventricular hemorrhage, late-onset sepsis, low weight at the time of extubation, and postmenstrual age at the time of extubation were identified as risk factors for extubation failure. In the logistic regression analysis including these risk factors, RSS/kg remained a significant risk factor, along with late-onset sepsis (OR 25.7 [95% CI: 5.70–115.76]; p <0.001). In the receiver operating characteristic analysis of RSS values, at a cutoff value of 2.13 (area under the curve: 82.5%), RSS/kg had 77% sensitivity and 78% specificity ( p <0.001). The duration of mechanical ventilation and hospital stay were prolonged in infants with extubation failure. The incidence rates of stage ≥3 retinopathy of prematurity and stage ≥2 necrotizing enterocolitis were also higher. Conclusions: High RSS and RSS/kg values were closely associated with extubation failure and can be used as a non-invasive assessment tool to support clinical decision-making, and thus reduce the rate of extubation failure.

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“…Most studies exploring the predictive role of RSS involved patients who required invasive MV. In Shah et al's study (17), NCPAP pressure was considered equal to MAP in infants requiring nasal continuous positive airway pressure (NCPAP) in the birth room with no need for subse-quent MV. These authors found that a RSS of ≥ 2 on the first postnatal day was associated with increased morbidity and mortality in infants weighing ≤ 1250 g. On the other hand, in infants undergoing NCPAP or nasal positive pressure ventilation (NIPPV) therapy, the ventilator settings for PEEP/MAP are not equal to the achieved MAP (33,34).…”

Section: Discussionmentioning

confidence: 99%

“…RSS has been shown to closely correlate with OI in newborns receiving mechanical ventilation (12) and has been utilized as a measure of disease severity in several large-scale, multi-center studies (13,14). Further areas of previous research include the role of RSS in preparation for extubation as well as in the prediction of BPD, mortality, and short-term complications (15)(16)(17). Also, it has been found that RSS/kg is correlated more closely with pulmonary hypertension than RSS alone (18).…”

Section: Introductionmentioning

confidence: 99%

Respiratory Severity Score and Its Association with Adverse Outcomes in Extremely Low Birth Weight Infants Undergoing Invasive Mechanical Ventilation

Dursun

Zübarioğlu

2021

Iran J Pediatr

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Background: Respiratory severity score (RSS) is a simple, non-invasive respiratory failure assessment tool that its appropriateness for lung disease severity is well-established. Objectives: This study aimed to investigate the potential value of early-life RSS values in predicting mortality or severe bronchopulmonary dysplasia (BPD) in infants with extremely low birth weight (ELBW) undergoing invasive mechanical ventilation. Methods: Following a retrospective approach, the current multi-center study intended to estimate the RSS and RSS/kg values in the first three days of life and time-weighted means of these values in ELBW babies who received invasive mechanical ventilation. Participants were categorized into two groups of survival without severe BPD and those with severe BPD or death. All RSS values and other risk factors were compared between groups. A multivariate logistic regression analysis was used to identify factors affecting severe BPD or death. The sensitivity and specificity of RSS values in predicting severe BPD or death were estimated using receiver operating characteristic (ROC) curves. Results: A total of 101 infants met the inclusion criteria. All RSS and RSS/kg values in the first three days of life were found to be significantly higher in the severe BPD or death group. The maximum area under the curve (AUC) in the ROC curves created for the respiratory severity score values was determined as RSS/kg mean with a cut-off value of 3.62 (85.3%), (P = 0.001). According to the multivariate logistic regression analysis, which included risk factors that may affect the development of severe BPD or mortality, both the mean RSS/kg score and the duration of invasive mechanical ventilation maintained statistically significant. [RSS/kg mean; OR = 2.28 (1.37 – 3.78), P = 0.001], [invasive MV duration; OR = 1.08 (95% CI, 1.03 – 1.14), P = 0.003]. Conclusions: This study demonstrated that high RSS/kg mean values in the early periods of life are valuable in predicting severe BPD or death in ELBW babies undergoing invasive mechanical ventilation. Furthermore, mean RSS had more predictive power than single RSS determinations, and incorporating body weight was associated with improved sensitivity of the score.

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Respiratory Severity Score greater than or equal to 2 at birth is associated with an increased risk of mortality in infants with birth weights less than or equal to 1250 g

Cited by 9 publications

References 44 publications

Oxygenation index in the first 21 days of life is a predictor for bronchopulmonary dysplasia grade in very preterm infants

Oxygenation index in the first 21 days of life is a predictor for bronchopulmonary dysplasia grade in very preterm infants

Relationship Between the Respiratory Severity Score and Extubation Failure in Very-low-birth-weight Premature Infants

Respiratory Severity Score and Its Association with Adverse Outcomes in Extremely Low Birth Weight Infants Undergoing Invasive Mechanical Ventilation

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