title: Prediction of respiratory failure in late-preterm infants with respiratory distress at birth.
abstract: The aim of this study was to evaluate indices of respiratory failure in terms of their ability to predict respiratory impairment and need for ventilatory support in late-preterm neonates with respiratory distress. Arterial blood gas data during the first 12 postnatal hours or until intubation were recorded in 155 neonates with gestational age 34(0/7)-36(6/7) weeks admitted in the NICU with respiratory distress between January 2006 and June 2008. Alveolar-arterial oxygen tension difference (A-aDO(2)), arterial to alveolar oxygen tension ratio (a/A ratio), and partial arterial oxygen tension to inspired oxygen fraction ratio (PaO(2)/FiO(2)) were calculated. Considering the worst single value of each parameter, receiver operating characteristic curve analyses and area under the curve (AUC) comparisons were used to evaluate their predictive performance. Fifty-five neonates (35.5%) required mechanical ventilation. The predictive performances of the maximum A-aDO(2) (AUC 0.97), minimum a/A ratio (AUC 0.95), and minimum PaO(2)/FiO(2) (AUC 0.95) were similar. The A-aDO(2) at a threshold of >200 mmHg proved to be more effective than the other parameters, having excellent positive and negative likelihood ratios of 24.5 and 0.02, respectively. This threshold was achieved by 98.25% of the neonates who developed respiratory failure at a median of 3 h before the ventilatory support to be definitely decided. Composite indices, such as A-aDO(2), a/A ratio, and PaO(2)/FiO(2), can reasonably predict respiratory failure in late-preterm neonates with respiratory distress, allowing for closer monitoring, early medical intervention, or transfer to a level III neonatal unit.
authors.affiliation: Neonatal Intensive Care Unit, Department of Pediatrics, University of Patras Medical School, Rio, Patras, Greece. gdimitriou@med.upatras.gr
authors.forename: Gabriel
authors.initials: G
authors.lastname: Dimitriou
authors.forename: Sotirios
authors.initials: S
authors.lastname: Fouzas
authors.forename: Ioannis
authors.initials: I
authors.lastname: Giannakopoulos
authors.forename: Vassilis G
authors.initials: VG
authors.lastname: Papadopoulos
authors.forename: George
authors.initials: G
authors.lastname: Decavalas
authors.forename: Stefanos
authors.initials: S
authors.lastname: Mantagos
mesh_terms: D001784:Blood Gas Analysis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010100:Oxygen / Q000097:blood*; D010102:Oxygen Inhalation Therapy; D011237:Predictive Value of Tests; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011650:Pulmonary Alveoli / Q000098:blood supply / Q000378:metabolism*; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood* / Q000150:complications / Q000628:therapy; D012131:Respiratory Insufficiency / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control
chemical_list: D010100:Oxygen