Abstract 1519
BACKGROUND. Mortality associated to Respiratory Distress Syndrome (RDS) is high in the neonatal intensive care unit (NICU) at the Hospital Infantil de Mexico, which is a level III, reference pediatric hospital in Mexico City. OBJECTIVE. Identify factors associated to adverse outcome in patients with RDS in our NICU. METHODS. Retrospective chart review of all preterm (PT) infants admitted from January 1993 to December 1997, and diagnosed with RDS. Previously suggested risk factors associated to mortality in RDS were analyzed in this population. A comparison between survivors and non-survivors was performed; odds ratio with 95% confidence interval was calculated for each factor. A multiple regression analysis was undertaken to adjust the odds ratio for each significant risk factor (as detected by univariate analysis). RESULTS. During the study period 973 patients were admitted to the NICU and RDS was diagnosed in 98 PT infants. The median age at admission was 17.5 hours (range 2-96 hours) and the median gestational age was 32 weeks (range 24-35.3 weeks). The median SNAP at admission was 13, however, 30 patients had a SNAP>19.77 PT (78%) received surfactant. The general mortality in this group of patients was 49% (48/98). 48% of the deaths occurred within 72 hours of admission. Only 8 infants received prenatal steroids. The following risk factors were significantly associated to mortality: SNAP >13, leukopenia, birthweight (BW) <1500g, air leak, gestational age <30 weeks, pulmonary hemorrhage and grade IV intraventricular hemorrhage. However, after multiple logistic regression analysis, only SNAP>13 (OR 23, 95% CI 1.6-319; p 0.019) and BW <1500g (OR 67, 95% CI 2.3-1969; p 0.014) were identified as risk factors associated to mortality. CONCLUSIONS. Mortality associated to RDS is extremely high in our NICU. Most of the deaths occurred within 72 hs of admission and are associated to a high SNAP and VLBW. More than a third of the RDS patients have a SNAP>19 at admission. These data suggest that an effort must be directed to: 1)regionalize the perinatal systems in our country, 2)assure an adequate prenatal management, 3)improve treatment in early life and 4)implement a good neonatal transport system.
