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. 2023 Sep 28:11:1216073.
doi: 10.3389/fped.2023.1216073. eCollection 2023.

The perinatal period should be considered in neonatal acute respiratory distress syndrome: comparison of the Montreux definition vs. the second pediatric acute lung injury consensus conference definition

Liting Liu #  1 , Yihan Zhang #  1 , Yiran Wang  1 , Yu He  1 , Xionghui Ding  2 , Long Chen  1 , Yuan Shi  1
Affiliations

The perinatal period should be considered in neonatal acute respiratory distress syndrome: comparison of the Montreux definition vs. the second pediatric acute lung injury consensus conference definition

Liting Liu et al. Front Pediatr. .

Abstract

Background: The recently developed Montreux definition for neonatal acute respiratory distress syndrome (ARDS) partially differs from the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) definition. Here, we compare the Montreux and PALICC-2 definitions regarding morbidity, mortality, and prognosis of neonatal cases of ARDS in order to evaluate which definition is more appropriate for newborns.

Methods: Neonates admitted to our neonatal intensive care unit between 1 January 2018 and 30 September 2019 who met the Montreux or PALICC-2 definition of neonatal ARDS were retrospectively analyzed (n = 472). One comparison was made between application of the Montreux and PALICC-2 definitions to neonates outside the perinatal period (> 7 d after birth). A second comparison was made between a diagnosis of neonatal ARDS within (≤ 7 d of birth) and outside (> 7 d after birth) the perinatal period using the Montreux definition.

Results: No significant differences in morbidity, mortality, severity, therapies, or prognosis were observed between neonates in the extra perinatal group according to the Montreux and PALICC-2 definitions. However, epidemiology, clinical course, and prognosis of neonatal ARDS within the perinatal period did differ from those outside the perinatal period according to the Montreux definition.

Conclusion: Neonates with ARDS within the perinatal period have unique triggers, epidemiology, clinical course, and prognosis, yet a similar pathobiology pattern, to neonates at other ages. Therefore, it may be essential to consider the perinatal period when defining neonatal ARDS.

Keywords: PALICC-2 definition; montreux definition; neonatal ARDS; newborns; perinatal period.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study population selected.
Figure 2
Figure 2
The distribution of patients who met the definition of neonatal ARDS according to the montreux and PALICC-2 definitions. The blue areas represent the 355 neonates who only met the Montreux definition, the dark orange area represents the 99 neonates who met the Montreux and PALICC-2 definitions, and the orange area represents the 18 neonates who only met the PALICC-2 definition.
Figure 3
Figure 3
Severity of neonatal ARDS in the montreux extra perinatal group and the PALICC-2 group.
Figure 4
Figure 4
Severity of neonatal ARDS in the montreux extra perinatal group and the montreux intra perinatal group.
See this image and copyright information in PMC

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