Prediction of respiratory failure in late-preterm infants with respiratory distress at birth
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Gabriel Dimitriou & Sotirios Fouzas & Ioannis Giannakopoulos & Vassilis G. Papadopoulos & George Decavalas & Stefanos Mantagos
- چاپ و سال / کشور: 2011
Description
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 340/7–366/7 weeks admitted in the NICU with respiratory distress between January 2006 and June 2008. Alveolar-arterial oxygen tension difference (A-aDO2), arterial to alveolar oxygen tension ratio (a/A ratio), and partial arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2) 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-aDO2 (AUC 0.97), minimum a/A ratio (AUC 0.95), and minimum PaO2/FiO2 (AUC 0.95) were similar. The A-aDO2 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-aDO2, a/A ratio, and PaO2/FiO2, 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.
Eur J Pediatr (2011) 170:45–50 Received: 19 January 2010 / Accepted: 14 July 2010 / Published online: 29 July 2010
