Factors associated with the development of neonatal acute respiratory distress syndrome in preterm infants: a retrospective cohort study

Neonatal acute respiratory distress syndrome (NARDS) carries high morbidity and mortality. Preterm infants at risk need to be identified early so that treatment is not delayed. We aimed to identify factors associated with NARDS in preterm infants. Clinical data of 548 preterm infants admitted to the NICU between 2019 and 2023 were retrospectively analyzed. Preterm infants were categorized into the NARDS group ( n = 275) and the control group ( n = 273) according to the Montreux definition. Univariate analysis and multivariable logistic regression were used to identify factors independently associated with NARDS; the results are shown in a forest plot. The study was reported in accordance with the STROBE guidelines. Six factors were independently associated with NARDS in preterm infants: male sex (OR = 1.895, 95% CI 1.051–3.420), premature rupture of membranes (PROM) (OR = 6.784, 95% CI 3.415–13.478), chorioamnionitis (OR = 11.143, 95% CI 5.460–22.742), cesarean delivery (OR = 2.104, 95% CI 1.125–3.935), higher PaCO2 (OR = 1.188 per mmHg, 95% CI 1.143–1.234), and lower gestational age (OR = 0.715 per week, 95% CI 0.587–0.871). Conclusion: Male sex, lower gestational age, PROM, chorioamnionitis, cesarean delivery, and elevated early postnatal PaCO2 were independently associated with NARDS in preterm infants. All six are available in routine practice and could help clinicians flag preterm infants who need closer monitoring. What is Known: • NARDS is a severe, recently defined form of acute respiratory failure in neonates, and evidence on its risk factors in preterm infants remains limited. What is New: • Male sex, lower gestational age, premature rupture of membranes, chorioamnionitis, cesarean delivery, and elevated PaCO2 within 15 min of birth were independently associated with NARDS in preterm infants.