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Comparison of the Montreux definition with the Berlin definition for neonatal acute respiratory distress syndrome

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Abstract

To compare the similarities and differences between the Montreux definition and the Berlin definition in terms of the prevalence, mortality, and complications of neonatal acute respiratory distress syndrome (ARDS). We retrospectively analyzed the data of neonates with respiratory failure treated in a neonatal intensive care unit (NICU) between 1 November 2019 and 31 December 2021. In total, 554 infants had neonatal ARDS (524 infants, Montreux definition; 549 infants, Berlin definition). The prevalence (3.1% vs. 3.3%, p = 0.438) and mortality (18.9% vs.18.0%, p = 0.716) of neonatal ARDS did not differ between the definitions. Among the 519 infants meeting both definitions, key clinical outcomes did not differ between the definitions such as ventilation duration, NICU stay, complication rates, and antibiotic use, except for nitric oxide inhalation. The Montreux and Berlin definitions identified an additional 5 and 30 patients, respectively, not captured by the other definition. The rate of inhaled nitric oxide treatment (20.0% vs. 0%, p = 0.013), air leaks (20.0% vs. 0%, p = 0.013), and invasive ventilation duration (110.00 vs.0.00 h, p = 0.002) significantly differed between the above two groups. Sixty-two patients had moderate and severe ARDS according to the Montreux and Berlin definitions, respectively. The rates of adverse outcomes (e.g., mortality, invasive ventilation time) among these patients were similar to the rates among patients with moderate ARDS according to both definitions than among patients with severe ARDS according to both definitions.

  Conclusion: The prevalence, mortality, and most complications of neonatal ARDS were similar between the Montreux and Berlin definitions, which mainly differed in terms of the severity of neonatal ARDS.

What is Known:

• The Montreux definition was first proposed for the diagnosis of neonatal acute respiratory distress syndrome and was established in 2017. To date, the Montreux definition has not been compared with other diagnostic definitions of ARDS.

What is New:

• The study suggests that perinatal lung disease need not be excluded in the diagnosis of neonatal ARDS, and that the Montreux definition is more applicable to neonates, taking into account their specific physiological characteristics.

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Data availability

Data generated or used in this study are available from the corresponding authors upon reasonable request.

Abbreviations

ARDS:

Acute respiratory distress syndrome

BPD:

Bronchopulmonary dysplasia

FiO2 :

Fraction of inspired oxygen

IVH:

Intraventricular hemorrhage

IQR:

Interquartile range

MAS:

Meconium aspiration syndrome

NICU:

Neonatal intensive care unit

NEC:

Neonatal necrotizing enterocolitis

OI:

Oxygenation index

PPHN:

Persistent pulmonary hypertension of the newborn

PEEP:

Positive end-expiratory pressure

PROM:

Premature rupture of membranes

ROP:

Retinopathy of prematurity

SD:

Standard deviation

SNAPPE-II:

Score for Neonatal Acute Physiology with Perinatal Extension-II

References

  1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2(7511):319–323. https://doi.org/10.1016/s0140-6736(67)90168-7

    Article  CAS  PubMed  Google Scholar 

  2. Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD (2009) Incidence and outcomes of pediatric acute lung injury. Pediatrics 124(1):87–95. https://doi.org/10.1542/peds.2007-2462

    Article  PubMed  Google Scholar 

  3. López-Fernández Y, Azagra AM, de la Oliva P, Modesto V, Sánchez JI, Parrilla J, Arroyo MJ, Reyes SB, Pons-Ódena M, López-Herce J, Fernández RL, Kacmarek RM, Villar J, Epidemiology PALI, History N, (PED-ALIEN) Network (2012) Pediatric acute lung injury epidemiology and natural history study: incidence and outcome of the acute respiratory distress syndrome in children. Crit Care Med 40(12):3238–3245. https://doi.org/10.1097/CCM.0b013e318260caa3

    Article  PubMed  Google Scholar 

  4. Lee SH, Choi CW, Oh YK, Kim BI (2016) Atypical acute respiratory disorder in late preterm and term newborn infants. J Matern Fetal Neonatal Med 29(9):1430–1434. https://doi.org/10.3109/14767058.2015.1050663

    Article  PubMed  Google Scholar 

  5. De Luca D, Tingay DG, van Kaam AH, Courtney SE, Kneyber MCJ, Tissieres P, Tridente A, Rimensberger PC, Pillow JJ; Neonatal ARDS Project Collaboration Group (2022) Epidemiology of neonatal acute respiratory distress syndrome: prospective, multicenter, international cohort study. Pediatr Crit Care Med 23(7):524–534. https://doi.org/10.1097/PCC.0000000000002961

    Article  Google Scholar 

  6. Khemani RG, Smith L, Lopez-Fernandez YM, Kwok J, Morzov R, Klein MJ, Yehya N, Willson D, Kneyber MCJ, Lillie J, Fernandez A, Newth CJL, Jouvet P, Thomas NJ (2019) Distress PAR, syndrome Incidence and Epidemiology (PARDIE) Investigators; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study. Lancet Respir Med 7(2):115–128. https://doi.org/10.1016/S2213-2600(18)30344-8

    Article  PubMed  Google Scholar 

  7. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149(3 Pt 1):818–824. https://doi.org/10.1164/ajrccm.149.3.7509706

  8. Fan E, Brodie D, Slutsky AS (2018) Acute respiratory distress syndrome: advances in diagnosis and treatment. JAMA 319(7):698–710. https://doi.org/10.1001/jama.2017.21907

    Article  PubMed  Google Scholar 

  9. Definition Task Force ARDS, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307(23):2526–2533. https://doi.org/10.1001/jama.2012.5669

    Article  CAS  Google Scholar 

  10. Cheifetz IM (2011) Pediatric acute respiratory distress syndrome. Respir Care 56(10):1589–1599. https://doi.org/10.4187/respcare.01515

    Article  PubMed  Google Scholar 

  11. Pediatric Acute Lung Injury Consensus Conference Group (2015) Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 16(5):428–439. https://doi.org/10.1097/PCC.0000000000000350

    Article  Google Scholar 

  12. Faix RG, Viscardi RM, DiPietro MA, Nicks JJ (1989) Adult respiratory distress syndrome in full-term newborns. Pediatrics 83(6):971–976. PMID: 2657626

    Article  CAS  PubMed  Google Scholar 

  13. De Luca D, van Kaam AH, Tingay DG, Courtney SE, Danhaive O, Carnielli VP, Zimmermann LJ, Kneyber MCJ, Tissieres P, Brierley J, Conti G, Pillow JJ, Rimensberger PC (2017) The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity. Lancet Respir Med 5(8):657–666. https://doi.org/10.1016/S2213-2600(17)30214-X

    Article  PubMed  Google Scholar 

  14. Dargaville PA, Copnell B, Australian and New Zealand Neonatal Network (2006) The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 117(5):1712–1721. https://doi.org/10.1542/peds.2005-2215

    Article  PubMed  Google Scholar 

  15. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N (2018) The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med 6(3):223–230. https://doi.org/10.1016/S2213-2600(18)30063-8

    Article  PubMed  Google Scholar 

  16. Sharma R, Hudak ML (2013) A clinical perspective of necrotizing enterocolitis: past, present, and future. Clin Perinatol 40(1):27–51. https://doi.org/10.1016/j.clp.2012.12.012

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jobe AH, Bancalari EH (2017) Controversies about the definition of bronchopulmonary dysplasia at 50 years. Acta Paediatr 106(5):692–693. https://doi.org/10.1111/apa.13775

    Article  PubMed  Google Scholar 

  18. Vander JF, McNamara JA, Tasman W, Brown GC (2005) Revised indications for early treatment of retinopathy of prematurity. Arch Ophthalmol 123(3):406–410. https://doi.org/10.1001/archopht.123.3.406-b

    Article  PubMed  Google Scholar 

  19. Fuloria M, Aschner JL (2017) Persistent pulmonary hypertension of the newborn. Semin Fetal Neonatal Med 22(4):220–226. https://doi.org/10.1016/j.siny.2017.03.004

    Article  PubMed  Google Scholar 

  20. Radic JA, Vincer M, McNeely PD (2015) Outcomes of intraventricular hemorrhage and posthemorrhagic hydrocephalus in a population-based cohort of very preterm infants born to residents of Nova Scotia from 1993 to 2010. J Neurosurg Pediatr 15(6):580–588. https://doi.org/10.3171/2014.11.PEDS14364

    Article  PubMed  Google Scholar 

  21. McNicholas BA, Rooney GM, Laffey JG (2018) Lessons to learn from epidemiologic studies in ARDS. Curr Opin Crit Care 24(1):41–48. https://doi.org/10.1097/MCC.0000000000000473

    Article  PubMed  Google Scholar 

  22. Wong JJ, Loh TF, Testoni D, Yeo JG, Mok YH, Lee JH (2014) Epidemiology of pediatric acute respiratory distress syndrome in singapore: risk factors and predictive respiratory indices for mortality. Front Pediatr 2:78. https://doi.org/10.3389/fped.2014.00078

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wong JJ, Jit M, Sultana R, Mok YH, Yeo JG, Koh JWJC, Loh TF, Lee JH (2019) Mortality in pediatric acute respiratory distress syndrome: a systematic review and meta-analysis. J Intensive Care Med 34(7):563–571. https://doi.org/10.1177/0885066617705109

    Article  PubMed  Google Scholar 

  24. Bard H (1975) The postnatal decline of hemoglobin F synthesis in normal full-term infants. J Clin Invest 55(2):395–398. https://doi.org/10.1172/JCI107943

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Guillén U, Cummings JJ, Bell EF, Hosono S, Frantz AR, Maier RF, Whyte RK, Boyle E, Vento M, Widness JA, Kirpalani H (2012) International survey of transfusion practices for extremely premature infants. Semin Perinatol 36(4):244–247. https://doi.org/10.1053/j.semperi.2012.04.004

    Article  PubMed  PubMed Central  Google Scholar 

  26. Saugstad OD, Aune D (2014) Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies. Neonatology 105(1):55–63. https://doi.org/10.1159/000356561

    Article  CAS  PubMed  Google Scholar 

  27. Shein SL, Maddux AB, Klein MJ, Bhalla A, Briassoulis G, Dahmer MK, Emeriaud G, Flori HR, Gedeit R, Ilia S, Kneyber MCJ, Napolitano N, Ohshimo S, Pons-Òdena M, Rubin S, White BR, Yehya N, Khemani R, Smith L (2022) V4 PARDIE Investigators and the PALISI Network Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study. Crit Care Med 50(3):363–374. https://doi.org/10.1097/CCM.0000000000005287

    Article  PubMed  Google Scholar 

  28. Liu K, Chen L, Xiong J, Xie S, Hu Y, Shi Y (2021) HFOV vs CMV for neonates with moderate-to-severe perinatal onset acute respiratory distress syndrome (NARDS): a propensity score analysis. Eur J Pediatr 180(7):2155–2164. https://doi.org/10.1007/s00431-021-03953-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Randolph AG (2009) Management of acute lung injury and acute respiratory distress syndrome in children. Crit Care Med 37(8):2448–2454. https://doi.org/10.1097/CCM.0b013e3181aee5dd

    Article  PubMed  Google Scholar 

  30. Dahlem P, van Aalderen WM, Bos AP (2007) Pediatric acute lung injury. Paediatr Respir Rev 8(4):348–362. https://doi.org/10.1016/j.prrv.2007.03.001

    Article  CAS  PubMed  Google Scholar 

  31. Cabello B, Thille AW (2012) Are we able to optimize the definition and diagnosis of severe acute respiratory distress syndrome? Med Intensiva 36(5):322–323. https://doi.org/10.1016/j.medin.2012.02.006

    Article  CAS  PubMed  Google Scholar 

  32. Gupta S, Sankar J, Lodha R, Kabra SK (2018) Comparison of prevalence and outcomes of pediatric acute respiratory distress syndrome using pediatric acute lung injury consensus conference criteria and Berlin definition. Front Pediatr 6:93. https://doi.org/10.3389/fped.2018.00093

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lodha R, Kabra SK, Pandey RM (2001) Acute respiratory distress syndrome: experience at a tertiary care hospital. Indian Pediatr 38(10):1154–1159. PMID: 11677305

    CAS  PubMed  Google Scholar 

  34. Seeley E, McAuley DF, Eisner M, Miletin M, Matthay MA, Kallet RH (2008) Predictors of mortality in acute lung injury during the era of lung protective ventilation. Thorax 63(11):994–998. https://doi.org/10.1136/thx.2007.093658

    Article  CAS  PubMed  Google Scholar 

  35. Trachsel D, McCrindle BW, Nakagawa S, Bohn D (2005) Oxygenation index predicts outcome in children with acute hypoxemic respiratory failure. Am J Respir Crit Care Med 172(2):206–211. https://doi.org/10.1164/rccm.200405-625OC

    Article  PubMed  Google Scholar 

  36. Heart N, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354(24):2564–2575. https://doi.org/10.1056/NEJMoa062200

    Article  Google Scholar 

  37. Wirbelauer J, Speer CP (2009) The role of surfactant treatment in preterm infants and term newborns with acute respiratory distress syndrome. J Perinatol 29(Suppl 2):S18-22. https://doi.org/10.1038/jp.2009.30

    Article  CAS  PubMed  Google Scholar 

  38. Günther A, Ruppert C, Schmidt R, Markart P, Grimminger F, Walmrath D, Seeger W (2001) Surfactant alteration and replacement in acute respiratory distress syndrome. Respir Res 2(6):353–364. https://doi.org/10.1186/rr86

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This work was supported by the National Key Research and Development Program of China (2022YFC2704803), the National Natural Science Foundation of China (81401236, 82001602), the Science and health project of Chongqing Health Commission (NNO.2020FYYX21), and Natural Science Foundation of Chongqing (cstc2021jcyj-msxmX0257).

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Author notes

  1. Liting Liu and Yiran Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China

    Liting Liu, Yiran Wang, Yihan Zhang, Yu He, Long Chen & Yuan Shi

  2. Department of Pediatrics, Chongqing Health Center for Women and Children (Women and Children’s Hospital of Chongqing Medical University), Chongqing, China

    Fang Li

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  1. Liting Liu
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Contributions

Yuan Shi conceived the idea for this study. Liting Liu, Yiran Wang, and Long Chen designed the study protocol. Liting Liu, Yiran Wang, and Yihan Zhang collected the data. Yiran Wang, Yihan Zhang, and Fang Li were responsible for data management. Yiran Wang, Yihan Zhang, and Yu He analyzed the data. Liting Liu and Yiran Wang wrote the first draft. All authors contributed to the report. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. All authors have read and approved the content, and agree to submit it for consideration for publication in your journal.

Corresponding author

Correspondence to Yuan Shi.

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This study was approved by the Institutional Review Board, Children’s Hospital of Chongqing Medical University of China (No 2022–378).

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The authors declare no competing interests.

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Communicated by Daniele De Luca.

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Liu, L., Wang, Y., Zhang, Y. et al. Comparison of the Montreux definition with the Berlin definition for neonatal acute respiratory distress syndrome. Eur J Pediatr 182, 1673–1684 (2023). https://doi.org/10.1007/s00431-023-04848-x

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