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Multicenter Study
. 2022 Jul 1;23(7):524-534.
doi: 10.1097/PCC.0000000000002961. Epub 2022 May 9.

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

Daniele De Luca  1   2 , David G Tingay  1   2   3   4   5   6   7   8   9   10   11   12   13   14   15   16 , Anton H van Kaam  6 , Sherry E Courtney  7 , Martin C J Kneyber  8   9 , Pierre Tissieres  10   11 , Ascanio Tridente  12   13 , Peter C Rimensberger  13 , J Jane Pillow  15   16 ; Neonatal ARDS Project Collaboration Group
Collaborators, Affiliations
Multicenter Study

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

Daniele De Luca et al. Pediatr Crit Care Med. .

Abstract

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.

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Conflict of interest statement

Dr. De Luca received funding from Chiesi Farmaceutici S.p.A., Abbvie, Vyaire, Getinge, Medtronic, Masimo, Natus, Airway Therapeutics, and Ophirex; he disclosed that he served as a lecturer for Airway Therapeutics, Chiesi Farmaceutici S.p.A., Abbvie, Getinge, and Vyaire; he received nonfinancial research support from Chiesi Farmaceutici S.p.A. and Getinge; and he is a member of the advisory boards for Chiesi Farmaceutici S.p.A. and Ophirex. Dr. Tingay is supported by the Victorian Government Infrastructure Support Program. Drs. Tingay and Pillow received support for article research from the National Health and Medical Research Council (NHMRC) (Australia) Fellowships GNT1053889 and GNT1077691, respectively. Dr. van Kaam’s intuition received funding from Vyaire, Mallinckrodt, and Chiesi Farmaceutici S.p.A. Dr. Kneyber disclosed that he received nonfinancial research support from Vyaire and Applied Biosignals; he received funding from the National Heart, Lung, and Blood Institute, ZonMW, Stichting Vrienden Beatrix Kinderziekenhuis, and University Medical Center Groningen. Dr. Tissieres received funding from Sanofi, Inotrem, and Sedana. Dr. Pillow’s institution received funding from the NHMRC Centre of Research Excellence, the NHMRC Senior Research Fellowship, Chiesi Farmaceutici S.p.A., and Draeger Medical; she served as a consultant for Chiesi Farmaceutici S.p.A. and a lecturer for Draeger Medical; and she received product from Pari GmBH and Draeger Medical. All these relevant activities were outside the present work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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    1. De Luca D, van Kaam AH, Tingay DG, et al.: The Montreux definition of neonatal ARDS: Biological and clinical background behind the description of a new entity. Lancet Respir Med. 2017; 5:657–666

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