title: Clinical prediction score for nasal CPAP failure in pre-term VLBW neonates with early onset respiratory distress.
abstract: We prospectively observed 62 pre-term very low birth weight neonates initiated on nasal continuous positive airway pressure (CPAP) for respiratory distress in the first 24 h of life to devise a clinical score for predicting its failure. CPAP was administered using short binasal prongs with conventional ventilators. On multivariate analysis, we found three variables-gestation <28 weeks [adjusted odds ratio (OR) 6.5; 95% confidence interval (CI) 1.5-28.3], pre-term premature rupture of membranes [adjusted OR 5.3; CI 1.2-24.5], and product of CPAP pressure and fraction of inspired oxygen ≥1.28 at initiation to maintain saturation between 88% and 93% [adjusted OR 3.9; CI 1.0-15.5] to be independently predictive of failure. A prediction model was devised using weighted scores of these three variables and lack of exposure to antenatal steroids. The clinical scoring system thus developed had 75% sensitivity and 70% specificity for prediction of CPAP failure (area under curve: 0.83; 95% CI 0.71-0.94).
authors.affiliation: Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mrinal S
authors.initials: MS
authors.lastname: Pillai
authors.forename: Mari J
authors.initials: MJ
authors.lastname: Sankar
authors.forename: Kalaivani
authors.initials: K
authors.lastname: Mani
authors.forename: Ramesh
authors.initials: R
authors.lastname: Agarwal
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Paul
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Deorari
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007362:Intensive Care Units; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure