TY - JOUR
T1 - Epidemiology of Neonatal Acute Respiratory Distress Syndrome
T2 - Prospective, Multicenter, International Cohort Study
AU - De Luca, Daniele
AU - Tingay, David G.
AU - Van Kaam, Anton H.
AU - Courtney, Sherry E.
AU - Kneyber, Martin C.J.
AU - Tissieres, Pierre
AU - Tridente, Ascanio
AU - Rimensberger, Peter C.
AU - Pillow, J. Jane
AU - Van Tuijl, Minke
AU - Carnielli, Virgilio P.
AU - Nobile, Stefano
AU - Shi, Yuan
AU - Long, Chen
AU - Barcos, Francisca
AU - Hochberg, Amit
AU - Crocker, Caroline E.
AU - Harrison, Allen
AU - Perkins, Elizabeth
AU - Mosca, Fabio
AU - Mercadante, Domenica
AU - Raimondi, Francesco
AU - Capasso, Letizia
AU - Kallio, Merja
AU - Raschetti, Roberto
AU - Cillis, Annagrazia
AU - Soreze, Yohan
AU - Black, Lachlan
AU - Khan, Nash
AU - Piastra, Marco
AU - Conti, Giorgio
AU - Danhaive, Olivier
AU - Gibelli, Maria Augusta Bento Cicaroni
AU - De Carvalho, Werther Brunow
AU - Mulder, Estelle
PY - 2022/7/1
Y1 - 2022/7/1
N2 - OBJECTIVES: Age-specific definitions for acute respiratory distress syndrome (ARDS) are available, including a specific definition for neonates (the "Montreux definition"). The epidemiology of neonatal ARDS is unknown. The objective of this study was to describe the epidemiology, clinical course, treatment, and outcomes of neonatal ARDS. DESIGN: Prospective, international, observational, cohort study. SETTING: Fifteen academic neonatal ICUs. PATIENTS: Consecutive sample of neonates of any gestational age admitted to participating sites who met the neonatal ARDS Montreux definition criteria. MEASUREMENTS AND MAIN RESULTS: Neonatal ARDS was classified as direct or indirect, infectious or noninfectious, and perinatal (≤ 72 hr after birth) or late in onset. Primary outcomes were: 1) survival at 30 days from diagnosis, 2) inhospital survival, and 3) extracorporeal membrane oxygenation (ECMO)-free survival at 30 days from diagnosis. Secondary outcomes included respiratory complications and common neonatal extrapulmonary morbidities. A total of 239 neonates met criteria for the diagnosis of neonatal ARDS. The median prevalence was 1.5% of neonatal ICU admissions with male/female ratio of 1.5. Respiratory treatments were similar across gestational ages. Direct neonatal ARDS (51.5% of neonates) was more common in term neonates and the perinatal period. Indirect neonatal ARDS was often triggered by an infection and was more common in preterm neonates. Thirty-day, inhospital, and 30-day ECMO-free survival were 83.3%, 76.2%, and 79.5%, respectively. Direct neonatal ARDS was associated with better survival outcomes than indirect neonatal ARDS. Direct and noninfectious neonatal ARDS were associated with the poorest respiratory outcomes at 36 and 40 weeks' postmenstrual age. Gestational age was not associated with any primary outcome on multivariate analyses. CONCLUSIONS: Prevalence and survival of neonatal ARDS are similar to those of pediatric ARDS. The neonatal ARDS subtypes used in the current definition may be associated with distinct clinical outcomes and a different distribution for term and preterm neonates.
AB - OBJECTIVES: Age-specific definitions for acute respiratory distress syndrome (ARDS) are available, including a specific definition for neonates (the "Montreux definition"). The epidemiology of neonatal ARDS is unknown. The objective of this study was to describe the epidemiology, clinical course, treatment, and outcomes of neonatal ARDS. DESIGN: Prospective, international, observational, cohort study. SETTING: Fifteen academic neonatal ICUs. PATIENTS: Consecutive sample of neonates of any gestational age admitted to participating sites who met the neonatal ARDS Montreux definition criteria. MEASUREMENTS AND MAIN RESULTS: Neonatal ARDS was classified as direct or indirect, infectious or noninfectious, and perinatal (≤ 72 hr after birth) or late in onset. Primary outcomes were: 1) survival at 30 days from diagnosis, 2) inhospital survival, and 3) extracorporeal membrane oxygenation (ECMO)-free survival at 30 days from diagnosis. Secondary outcomes included respiratory complications and common neonatal extrapulmonary morbidities. A total of 239 neonates met criteria for the diagnosis of neonatal ARDS. The median prevalence was 1.5% of neonatal ICU admissions with male/female ratio of 1.5. Respiratory treatments were similar across gestational ages. Direct neonatal ARDS (51.5% of neonates) was more common in term neonates and the perinatal period. Indirect neonatal ARDS was often triggered by an infection and was more common in preterm neonates. Thirty-day, inhospital, and 30-day ECMO-free survival were 83.3%, 76.2%, and 79.5%, respectively. Direct neonatal ARDS was associated with better survival outcomes than indirect neonatal ARDS. Direct and noninfectious neonatal ARDS were associated with the poorest respiratory outcomes at 36 and 40 weeks' postmenstrual age. Gestational age was not associated with any primary outcome on multivariate analyses. CONCLUSIONS: Prevalence and survival of neonatal ARDS are similar to those of pediatric ARDS. The neonatal ARDS subtypes used in the current definition may be associated with distinct clinical outcomes and a different distribution for term and preterm neonates.
KW - acute respiratory distress syndrome
KW - neonatal intensive care unit
KW - neonate
KW - outcome
KW - respiratory failure
UR - http://www.scopus.com/inward/record.url?scp=85134361077&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000002961
DO - 10.1097/PCC.0000000000002961
M3 - Article
C2 - 35543390
AN - SCOPUS:85134361077
SN - 1529-7535
VL - 23
SP - 524
EP - 534
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 7
ER -