Risk factors for mortality in neonatal ARDS: a multicenter retrospective cohort study in China

As a life-threatening respiratory syndrome, epidemiological data from China has shown that the mortality rate of neonatal acute respiratory distress syndrome (ARDS) is as high as 12.5%. Nevertheless, studies on the influencing factors of this mortality remain limited. This research enrolled newborns with ARDS who initiated invasive mechanical ventilation (IMV) within 72 hours after birth. A Cox regression model with hazard ratio (HR) was constructed using the least absolute shrinkage and selection operator analysis with the lambda.1se screening criterion. Four characteristic variables were identified: inhaled nitric oxide (iNO), high frequency ventilation (HFV), gestational age (GA), and IMV duration. The Kaplan-Meier curve indicated that infants with a higher GA, receiving iNO, or undergoing HFV had a higher risk of death. Restricted cubic spline analysis further revealed that GA ⩾ 38.785 weeks and IMV duration < 117 hours were associated with a significant mortality risk. A linear trend test confirmed a significant linear relationship between GA and mortality risk. Significant interaction effects were observed between "iNO" and "IMV" as well as between "HFV" and "GA". This study underscores that neonates with advanced GA who require concomitant HFV and iNO therapy are associated with a significantly heightened mortality risk.