Survival of Respiratory Failure within the First 72 Hours in Preterm Infants with Respiratory Distress Based on the Downes Score Assessment

Respiratory distress in neonates is the most common condition of preterm infants receiving treatment in the neonatal intensive care unit. As a clinical assessment of respiratory distress, the Downes score can predict the risk of respiratory failure. The present study aimed to determine the survival of respiratory failure in the first 72 h in preterm infants with respiratory distress based on the Downes score assessment. A prospective cohort survival analysis was performed at three hospitals in Indonesia (Al-Islam Hospital, Bandung, Al-Ihsan Hospital, Bandung, and Cibabat Hospital, Cimahi) from April to July 2021. Subjects were infants aged 28-36 weeks, with respiratory distress based on the Downes score within the first 2, 6, 12, 24, 48, and 72 h after delivery. The analyzed variables included birth weight ([BW], <1500 vs. 1500-2500 g), gestational age ([GA], 28-32 vs. 32-37 weeks), and 5-min APGAR score (<7 vs. >7). Bivariate and multivariate analyses were conducted with Cox regression proportional hazard and the Kaplan-Meier estimate of survival rate was also performed. In addition, the adjusted hazard ratio (aHR) was calculated, and a P-value of less than 0.05 was considered statistically significant. Of the 89 subjects who met the criteria, 20 (22.47%) experienced respiratory failure. The multivariate analysis including BW (aHR: 1.846, 95%CI: 0.570-5.979, P> 0.05), GA (aHR: 2.273, 95 %CI: 0.697-7.416, P>0.05), and the 5-min APGAR score (aHR: 2.049, 95%CI: 0.811-5.179, P>0.05) estimated the survival rate for respiratory failure at the age of 72 h at 74.7% (standard error: 0.05%). A GA of <32 weeks, a BW of <1500 g, and the condition of asphyxia simultaneously increased the aHR of respiratory failure, with an estimated survival rate of 74.7%.