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How to improve CPAP failure prediction in preterm infants with RDS: a pilot study

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Abstract

We aimed to test the diagnostic accuracy in predicting continuous positive airway pressure (CPAP) failure in premature infants with respiratory distress syndrome (RDS) by integrating oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio) with the measurement of peak velocity of the right diaphragmatic excursions (RD-PV), during the inspiration (I-Peak) and expiratory (E-Peak) phases, performed by pulsed-wave Tissue Doppler imaging. This is a prospective, observational pilot study conducted over a 2-year period. Neonates at ≤ 32 weeks gestation supported by early CPAP were eligible. Natural surfactant was delivered via a minimally invasive technique. We performed serial measurements of SF ratio and RD-PV during the early post-natal hours to test the accuracy in predicting surfactant administration as well as invasive ventilation support within 72 h from birth because of the RDS worsening. Of 56 preterm infants enrolled, 34 (61%) failed CPAP support. SF ratio showed a significant inverse relationship with both Silverman-Andersen score at birth (rho = − 0.417; P = .001) and RD-PV [E-Peak] (rho = − 0.361; P = .007). We achieved a high accuracy in predicting CPAP failure (AUC = 95%; 95% CI, 89–100%) by integrating gender, SF ratio, and RD-PV [E-Peak] at the restricted, multivariate analysis.

Conclusions: SF ratio and RD-PV, as measured by pulsed-wave Tissue Doppler, may help physicians to improve their confidence in optimizing therapeutic options in preterm infants with RDS.

What is Known:

• Continuous positive airway pressure is the recommended first-line treatment for respiratory distress syndrome in preterm infants, but failure rates remain unacceptably high.

• Choosing the optimal treatment in terms of non-invasive ventilation effectiveness and timeliness of surfactant administration for these patients is often challenging, also due to our inability to identify a worsening respiratory failure.

What is New:

• The integration of oxygen saturation, as measured by SpO2/FiO2, with right diaphragm peak motion velocities, as measured by pulsed-wave tissue Doppler, allows for high prediction accuracy of non-invasive ventilation support failure in premature infants at risk of respiratory distress syndrome.

• These measurements may help physicians in providing optimal supportive therapy for these patients.

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Abbreviations

AUC:

area under the curve

CI:

confidence interval

CPAP:

continuous positive airway pressure

DR:

delivery room

FiO2 :

fraction of inspired oxygen

IQR:

interquartile ratio

OR:

odds ratio

PaO2 :

partial pressure of oxygen

PW-TDI:

pulsed-wave tissue Doppler imaging

RD-PV:

right diaphragm excursion peak velocity

RDS:

respiratory distress syndrome

ROC:

receiver operating characteristic

SF:

SpO2/FiO2

SpO2 :

pulse oximetric oxygen saturation

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Acknowledgments

We thank Dr. Stefania Troiani and the neonatal intensive care unit staff for their valuable contribution.

Author information

Authors and Affiliations

  1. Department of Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria della Misericordia Hospital of Perugia, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy

    Maurizio Radicioni & Pier Giorgio Camerini

  2. Pediatric Clinic, University of Perugia, Perugia, Italy

    Alberto Leonardi & Lucia Lanciotti

  3. Pediatric Division, Hospital San Giovanni Battista, Foligno, Italy

    Victoria Elisa Rinaldi

  4. Department of Medicine, University of Perugia, Perugia, Italy

    Vittorio Bini

Authors
  1. Maurizio Radicioni
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  2. Alberto Leonardi
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  3. Lucia Lanciotti
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  4. Victoria Elisa Rinaldi
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  5. Vittorio Bini
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  6. Pier Giorgio Camerini
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Contributions

All authors made a substantial contribution to the concept and design of the work. AL and LL drafted the manuscript, designed the data collection instruments, performed exams, collected as well as interpreted data, and critically revised the manuscript for important intellectual content. VR helped in the collection and interpretation of data, gave administrative, technical, and material support, and critically revised the manuscript for important intellectual content. MR, PC, and VB conceptualized, designed, coordinated, and supervised the study, performed the data analysis and interpretation, and critically reviewed. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Maurizio Radicioni.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local Ethics Committee approved the study protocol (Ethics Committee of the Health Authorities of the Umbria Region number 3095/17)

Additional information

Communicated by Daniele De Luca

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Radicioni, M., Leonardi, A., Lanciotti, L. et al. How to improve CPAP failure prediction in preterm infants with RDS: a pilot study. Eur J Pediatr 180, 709–716 (2021). https://doi.org/10.1007/s00431-020-03700-w

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  • DOI: https://doi.org/10.1007/s00431-020-03700-w

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