Trends in epidemiology and outcomes of respiratory distress syndrome in the United States

Abstract

Background: The management practices of Respiratory Distress Syndrome (RDS) in the newborn have changed over time. We examine the trends in the epidemiology, resource utilization, and outcomes (mortality and bronchopulmonary dysplasia [BPD]) of RDS in preterm neonates ≤34 weeks gestational age (GA) in the United States.Methods: In this retrospective serial cross-sectional study, we used ICD-9 codes to classify preterm infants GA ≤34 weeks between 2003 and 2014 from the National Inpatient Sample as having RDS or not. Trends in the prevalence of infants defined as RDS by ICD-9 code (ICD9-RDS), length of stay, BPD, and mortality were analyzed using Cochran-Armitage and Jonckheere-Terpstra tests and multivariable logistic regression.Results: Of 1 526 186 preterm live births with GA ≤34 weeks, 554 409 had ICD9-RDS (260 cases per 1000 live births) with the prevalence increasing from 170 to 361 (P trend < 0.001) and associated decrease in all-cause mortality (7.6% to 6.1%; P trend < 0.001) from 2003 to 2014. Increased utilization of non-invasive mechanical ventilation (NIMV) (69.5% to 74.3%; P trend < 0.001) was associated with decreased invasive mechanical ventilation (IMV) use >96 h (60.4 to 56.6%; P trend < 0.001). Exclusive NIMV use increased from 16.8% to 29.1% (P trend < 0.0001). BPD incidence decreased from 14% to 12.5% (P trend < 0.001). LOS increased from 32 days to 38 days (P trend < 0.001) and cost increased from $49,521 to $55,394 (P trend < 0.001).Conclusion: From 2003 to 2014, the assigned ICD9-RDS diagnosis, and utilization of NIMV increased and mortality among infants assigned the ICD9-RDS diagnosis decreased. With higher survival, hospital cost increased incrementally, indicating the importance of ongoing analysis of appropriate reimbursement for the care provided at tertiary centers for preterm infants. K E Y W O R D S bronchopulmonary dysplasia, epidemiology, invasive mechanical ventilation, national inpatient sample, non-invasive mechanical ventilation, respiratory distress syndrome Abbreviation: AHRQ, agency for healthcare research and quality; BPD, bronchopulmonary dysplasia; CI, confidence interval; HCUP, healthcare cost and utilization project; ICD-9-CM, International Classification of Diseases, Ninth edition, clinical modification; IMV, invasive positive pressure ventilation; NIMV, non-invasive mechanical ventilation; NIS, national inpatient sample; PN, preterm neonates; RDS, respiratory distress syndrome; TTN, transient tachypnea of the newborn.This study was presented in part as a poster abstract at the

National Trends in the Epidemiology and Resource Use for Henoch-Schönlein Purpura (IgA Vasculitis) Hospitalizations in the United States From 2006 to 2014

“…The NIS has been used to estimate population-level trends in numerous conditions. [15][16][17][18][19] Researchers and policymakers use the NIS to make national estimates of health care use, access, charges, quality, and outcomes. The NIS is released annually, which makes it an excellent database for longitudinal analysis.…”

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

“…Studies indicate that the incidence of BPD has remained constant over the last few decades [6,7]. However, a recent study analyzing a large database of premature infants showed that the incidence of BPD has decreased over the last few years, with an increase in the use of non-invasive ventilation during the same period [8]. Mechanical ventilation with subsequent ventilator-induced lung injury (VILI) contributes to BPD.…”

Porcine versus bovine surfactant therapy for RDS in preterm neonates: pragmatic meta-analysis and review of physiopathological plausibility of the effects on extra-pulmonary outcomes

“…Respiratory distress syndrome (RDS) represents the main cause of respiratory failure in preterm neonates and is associated with an increasing burden of care [1]. Since RDS is caused by primary surfactant deficiency, the availability of exogenous surfactants allows an effective replacement therapy, which is recommended by current international guidelines, in neonates failing continuous positive airway pressure (CPAP) [2,3].…”