NEONATAL RESPIRATORY DISTRESS
Description
INTRODUCTION: Respiratory distress (RD) is the most common cause of the development of critical neonatal conditions, requiring treatment in the intensive care unit, while the identification of early predictors of an unfavorable outcome of RD is one of the most important tasks of modern neonatology, the solution of which will reduce the development of severe complications and deaths. The aim is to identify predictors of adverse outcome of respiratory distress in newborns requiring ICU treatment. MATERIALS AND METHODS. Design - retrospective observational study. 180 newborns were examined, among which there were 109 (61%) boys and 71 (39%) girls. The average weight of children was 1620 (1075-2197.5) g, and the gestational age was 31.8 (29-34.5) weeks. The Apgar score in the first minute was 5 (4-7), in the fifth - 7 (6-7) points. The duration of mechanical ventilation was 52 (12.5-242) hours, the duration of treatment in the ICU was 10 (6-19) days. Deaths occurred in 6 (3%) cases, nine (5%) children were transferred for further treatment to other hospitals. RESULTS. The adverse outcome of RD most often occurred in children with low birth weight 1160 (890-1750) g, gestational age 30 (27-32) weeks and low Apgar scores at 1 and 5 minutes (5 and 6, respectively), which was statistically significant. The maximum prognostic significance with respect to outcome was birth weight and gestational age (AUC ROC = 0.80); Apgar score at 1 minute (AUC ROC = 0.71) Silverman-Andersen scores (AUC ROC = 0.73) and nSOFA scores (AUC ROC = 0.74). A mathematical model was developed to assess the probability of an unfavorable outcome of respiratory distress in newborns, including birth weight, Apgar scores at 1 minutes and nSOFA organ dysfunction on the first day of life. The model has high predictive power (AUC ROC was 0.865 (p = 0.0001); sensitivity = 84.5%, specificity = 82%, accuracy 86%). CONCLUSION. Independent predictors of an unfavorable outcome of respiratory distress in newborns are birth weight less than 1475 g, Apgar score at 1 minutes less than 5 points and nSOFA organ dysfunction on the first day of life more than three points.