87: Management and Evolution of Respiratory Distress Syndrome in Late Preterm Infants: A Descriptive Study
Bibliographic record
Abstract
To date, no recommendation guides the management of respiratory distress syndrome (RDS) in late preterm infants (34 0/7 to 36 6/7 weeks postmenstrual age (PMA)). The objective of this study was to describe a late preterms population affected by RDS and their respiratory management during neonatal intensive care unit (NICU) hospitalization in order to identify potential prognostic factors. A descriptive and retrospective study including late preterms with RDS diagnosis, admitted in a tertiary NICU, from January 2009 to December 2011 was conducted. RDS prevalence in late preterms was 13.6% during the studied period and 85 late preterms were included in the study. Median length of hospitalization was 8.9 (IQR 7.2 to 12.7) days and was significantly longer in late preterms with caffeine treatment for apnea of prematurity (13.8 vs. 9.7, days; P=0.047). Oxygen requirements lasted a median time of 2.2 (IQR 0.5 to 3.2) days. Median duration of respiratory support was 4.5 (IQR 2.9 to 6.1) days and was significantly longer when associated with younger PMA (P=0.023), female sex (P=0.003) and caffeine treatment (P=0.027). Five different modes of non invasive ventilation (NIV) were used. At some moment, 96% of the 85 patients were supported with nasal continuous positive airway pressure. Intubation was considered as NIV failure and occurred in 25% of patients who subsequently received surfactant. Intubated patients were younger at oxygen introduction (1.1 h vs 2.3 h; P=0.029) and had higher PCO2 at NIV initiation (66.0 mmHg vs 59.5 mmHg; P=0.049). Pneumothorax occurred on NIV support for 10 of 11 patients. Six patients had their pneumothorax drained and there was a trend for longer duration of oxygen requirements (P=0.142), ventilatory support (P=0.039) and hospitalization (P=0.059) in those patients. Nasal sigh intermittent positive pressure ventilation (NSIPPV) was more frequently used in patients who presented a pneumothorax (P=0.013). In this study, NIV management of RDS failed in 25% of patients. Early oxygen introduction seems to be a predictive factor of NIV failure. Due to great variability in respiratory management, no specific conduct arises to show advantages. However, almost all pneumothorax occurred while on NIV support and NSIPPV was more frequently used in those patients. Nonetheless, more studies addressing prognostic factors are needed to make recommandations regarding surfactant administration in RDS management in late preterms to prevent complications and avoid prolonged mechanical ventilation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".