Risk Factors for Refractory Respiratory Distress Syndrome among Very-Low-Birth- Weight Infants

Abstract The objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs). The data of VLBWIs born from January 2013–December 2020 and registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis. Multivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] =1.26), male sex (aOR = 1.17), cesarean section (aOR = 1.58), maternal hypertensive disorder (aOR = 1.54), and low 5-minute Apgar scores (aOR = 1.24) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81) and maternal chorioamnionitis (aOR = 0.79) were significantly inversely associated with refractory RDS. Compared with nonrefractory RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days. Refractory RDS was associated with unfavorable neonatal outcomes. Maternal hypertensive disorder is a significant risk factor for refractory RDS.