Epidemiology of Neonatal Acute Respiratory Distress Syndrome: Prospective, Multicenter, International Cohort Study

Daniele De Luca, David G. Tingay, Anton H. Van Kaam, Sherry E. Courtney, Martin C.J. Kneyber, Pierre Tissieres, Ascanio Tridente, Peter C. Rimensberger, J. Jane Pillow, Minke Van Tuijl, Virgilio P. Carnielli, Stefano Nobile, Yuan Shi, Chen Long, Francisca Barcos, Amit Hochberg, Caroline E. Crocker, Allen Harrison, Elizabeth Perkins, Fabio MoscaDomenica Mercadante, Francesco Raimondi, Letizia Capasso, Merja Kallio, Roberto Raschetti, Annagrazia Cillis, Yohan Soreze, Lachlan Black, Nash Khan, Marco Piastra, Giorgio Conti, Olivier Danhaive, Maria Augusta Bento Cicaroni Gibelli, Werther Brunow De Carvalho, Estelle Mulder

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


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.
Original languageEnglish
Pages (from-to)524-534
Number of pages11
JournalPediatric Critical Care Medicine
Issue number7
Publication statusPublished - 1 Jul 2022


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