Newborns with ARDS originating from sepsis of extrapulmonary origin exhibit worse prognoses: findings from a multicenter study in China.

Research on the infection-related etiologies of neonatal acute respiratory distress syndrome (NARDS) remains limited. This study aimed to investigate mortality risk differences in NARDS attributed to distinct infection origins (sepsis of extrapulmonary origin or pulmonary infection origin). Subjects were derived from a multicenter retrospective study organized by the Jiangsu Provincial Neonatal Respiratory Failure Collaboration Network. It included neonates with NARDS who initiated invasive mechanical ventilation (IMV) within 72 h of birth. A total of 268 from 1275 NARDS cases with infectious etiologies were enrolled. Multivariate Cox regression found a significant difference in the survival prognosis (sepsis of extrapulmonary origin, adjusted hazard ratio (HR): 3.93, 95% CI 1.79-8.62, log-rank test: P < 0.001]. Further multi-model and sensitivity analysis confirmed the robustness. Between early-onset and late-onset NARDS, the subgroup analysis showed no significant differences in the mortality risk, whether it was pulmonary infection origin (HR 1.69, 95% CI 0.61-4.64) or sepsis of extrapulmonary origin (HR 0.50, 95% CI 0.17-1.51). Restricted cubic spline also exhibited that the onset time of NARDS was not related to the mortality risk.

conclusionThis study suggests that for sepsis of extrapulmonary origin, we should be more vigilant about the mortality risk it brings and deal with the risk factors more actively and prudently. WHAT IS KNOWN: • Limited research has systematically investigated the association between infection origin and mortality risk in neonatal acute respiratory distress syndrome (NARDS). WHAT IS NEW: • Our study found that sepsis of extrapulmonary origin was associated with an increased mortality risk in neonates with gestational age > 34 weeks, with robust results from multivariate Cox modeling and sensitivity analyses. • It highlights the need for heightened vigilance and proactive management of extrapulmonary sepsis-related NARDS to mitigate mortality risk in neonates.