Respiratory Severity Score during the first three hours of life as a predictor for CPAP failure and need for late surfactant administration

Abstract Background Preterm infants often develop CPAP failure. 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 three hours of life (HOL) as a predictor for CPAP failure. Methods We conducted a post-hoc analysis of patients who received usual care in the AERO-02 clinical trial. Univariate and multivariable logistic regression 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 three HOL can predict CPAP failure and need for surfactant administration. Optimal RSS cutoffs for early rescue surfactant therapy need to be determined in large cohort studies.