Respiratory Severity Score (RSS): A Predictive Tool for Successful Extubation in Preterm Neonates

Introduction The coexistence of immature lungs, poor respiratory drive, overly compliant chest wall, and surfactant deficiency in preterm neonates, leads to dependency on mechanical ventilation during the first days of life. Respiratory Severity Score (RSS) is a readily available, simple and non-invasive extubation failure prediction tool. Objective This study aims to evaluate the utility of pre-extubation RSS as a tool for predicting successful extubation among preterms. Methods and Analysis This was a retrospective study with a duration of two years started after obtaining clearance from the Institutional Ethics Committee. All preterm neonates ventilated in NICU were included in the study. The hospital unit number was noted and the respective patient records were procured from the hospital records department. Demographic data were recorded from the files. Pre-extubation RSS was calculated. Other findings related to clinical review such as duration of invasive and non-invasive ventilation, surfactant requirement, intraventricular hemorrhage (IVH), early and late-onset sepsis, length of hospital stay (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) mortality data etc. were also recorded. The age, time of extubation and weight of those babies who underwent planned extubation were also recorded. Results The RSS and RSS/kg were significantly higher among the neonates who failed extubation ( P < .001). The Area under curve (AUC) for RSS and RSS/kg was 0.921 and 0.85, respectively. There was a significantly higher proportion of morbidities such as late-onset sepsis ( P = .046), grade ≥3 IVH ( P = .004) and ROP ( P = .043) observed among the neonates with extubation failure. The prevalence of in-hospital mortality was observed only among neonates with extubation failure which was statistically significant ( P < .001). Conclusion This study shows that pre-extubation RSS is an excellent tool for predicting successful extubation and is more accurate than RSS/kg. RSS could be a useful tool for clinicians to assess readiness of extubation. However, more prospective, multicentric studies are necessary to validate the generalizability of RSS.