Clinical Epidemiological Investigation Of NARDS In Some Areas Of Inner Mongolia: A Multi-center Retrospective Study

Objective Acute respiratory distress syndrome(ARDS)is a common respiratory emergency.Based on the special anatomical and physiological characteristics of neonates,In 2017,the Montreux definition of neonatal acute respiratory distress syndrome(NARDS)was published for the first time in the world.This standard plays an active role in the early diagnosis and treatment of NARDS,but it still provides limited information on the pathogenesis,clinical injury factors,applicable age,specific clinical characteristics and treatment strategies of NARDS.Therefore,this study will use the Montreux definition to understand the epidemiological characteristics of NARDS in some areas of Inner Mongolia and to investigate the risk factors for the severity and length of hospital stay in children with NARDS.Methods A retrospective clinical epidemiological approach was used to investigate and analyze the case data of 319 children with NARDS admitted to neonatal intensive care units(NICUs)in five tertiary care general hospitals in Inner Mongolia from 09/2017 to 09/2021according to the 2017 Montreux diagnostic criteria.The children were divided into mild(n=133),moderate(n=133)and severe(n=53)groups according to the oxygen index(OI),and the risk factors affecting the severity of NARDS were analyzed by comparing the basic information and laboratory test results of the children.In addition,Kaplan-Meier survival function curves were plotted for the length of hospitalization for the included children as a whole and for the predetermined subgroups,and the high-risk factors affecting the length of hospitalization for children with NARDS were analyzed by a multifactorial COX proportional risk regression model.Results From 09/2017 to 09/2021,a total of 22,071 neonates were admitted to five NICUs in Inner Mongolia,and children with NARDS accounted for 1.6% of hospitalized neonates,with a morbidity and mortality rate of 12.5%.The main primary diseases in this group of NARDS children included sepsis(48.9%),asphyxia(37.3%),pneumonia(28.5%),pulmonary hemorrhage(15.7%),meconium aspiration syndrome(12.5%),and neonatal necrotizing small intestinal colitis(2.8%).Major comorbidities included hypoalbuminemia(34.5%),jaundice(29.8%),persistent pulmonary hypertension(21.6%),and coagulation disorders(21.3%).A multifactorial logistic regression analysis revealed that mothers had infectious diseases in the third trimester(OR 0.045,95%CI 0.010～0.202,P=0.000),5min Apgar score≤7(OR 0.226,95%CI 0.082～0.628,P=0.004),invasive ventilatory support(OR 0.017,95%CI 0.003～0.102,P=0.000),use of high-frequency oscillatory ventilation after failure of conventional mechanical ventilation(OR 0.275,95%CI 0.089～0.849,P=0.025),use of multiple doses of PS(OR 0.319,95%CI 0.129～0.790,P=0.014),combined pulmonary hemorrhage(OR 0.085,95% CI 0.008～0.957,P=0.046),prolonged duration of assisted ventilation(OR 0.944,95%CI0.906～0.985,P=0.007),and positive pathogenic tests(OR 0.049,95%CI 0.010～0.247,P=0.000)were independent risk factors for increasing the severity of NARDS.In contrast,low birth weight infants(HR 0.140,95%CI 0.087～0.225,P=0.000),positive pathogenicity tests(HR 0.615,95%CI 0.414～0.915,P=0.016),invasive ventilation support(HR 0.578,95%CI 0.429～0.779,P=0.000),hypoalbumin blood(HR 0.686,95%CI 0.504～0.934,P=0.017)were independent risk factors for prolonged hospital days in children with NARDS.Conclusion The composition ratio and mortality rate of NARDS among hospitalized neonates in some regions of Inner Mongolia are similar to the latest epidemiological findings at home and abroad.The primary diseases causing NARDS in some parts of Inner Mongolia were mainly sepsis,asphyxia,and pneumonia,etc.Children with NARDS have high morbidity and mortality rates and many comorbidities,so it is necessary to strengthen maternal health care during pregnancy and neonatal resuscitation training,strictly control nosocomial infections,and develop the best clinical management strategies for different types of NARDS children as early as possible,in order to reduce the morbidity and mortality rates of NARDS children and shorten the length of hospitalization.