Am J Perinatol
DOI: 10.1055/s-0043-1772747
Original Article

Respiratory Severity Score during the First 3 Hours of Life as a Predictor for Failure of Noninvasive Respiratory Support and Need for Late Rescue Surfactant Administration

1   Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Heather L. Becker
2   Department of Respiratory Therapy, UnityPoint-Meriter, Madison, Wisconsin
3   Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
Prem Fort
4   Department of Pediatrics, Division of Neonatology, Johns Hopkins All Children's Hospital, St. Peterburg, Florida
5   Department of Pediatrics, Division of Neonatology, Vanderbilt University School of Medicine, Nashville, Tennessee
1   Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
› Author Affiliations
Funding None.


Objective Preterm infants often develop failure of noninvasive respiratory support. These infants miss the advantages of early rescue surfactant therapy. In this study, we evaluate the utility of respiratory severity score (RSS) during the first 3 hours of life (HOL) as a predictor for failure of noninvasive respiratory support.

Study Design We conducted a post hoc analysis of infants between 23 and 40 weeks' gestational age who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression analysis were used to assess whether the RSS summary measures were associated with the odds of surfactant administration.

Results Study involved 146 infants. Sixty-four infants (45%) received surfactant within the first 72 hours. Administration of surfactant was associated with the mean RSS (p < 0.01) and the linear trend (p < 0.01).

Conclusion We demonstrated that RSS during the first 3 HOL can predict failure of noninvasive respiratory support and need for late rescue surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies.

Key Points

  • Early recognition of infants at risk of failure of noninvasive ventilation is important to prevent complications.

  • It is desirable to identify patients who would benefit from early rescue surfactant treatment.

  • RSS in first 3 hours can be used as a predictor of failure of noninvasive respiratory support.

Supplementary Material

Publication History

Received: 23 January 2023

Accepted: 18 July 2023

Article published online:
24 August 2023

© 2023. Thieme. All rights reserved.

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