Neonatal World Conference 2026

Abstract

Introduction Neonatal respiratory distress necessitates varied degrees of respiratory support, with noninvasive ventilation (NIV) being a common modality. Predicting NIV failure in neonates remains challenging. ROX Index is defined as the ratio of SpO2/FIO2 to respiratory rate .The ROX index, proven effective in adults, is explored in this research as a potential predictor for neonatal NIV outcomes. The data on the Neonatal population is still lacking. the recent generation of ventilators includes an integrated system to calculate the ROX index. Methods: A retrospective cohort study at King Faisal Specialist Hospital & Research Centre (KFSH&RC) from January 2021 to December 2022 included neonates receiving NIV. Data, including ROX index, were collected from medical records. Inclusion criteria covered neonates on NIV as initial support or post-extubation. Exclusions involved major congenital anomalies, brain insult, airway malformation, and elective intubation. The primary outcome was treatment failure within 72 hours, defined by oxygen requirement increase, urgent intubation, or escalation to non-invasive high-frequency mode. Statistical analysis employed STATA version 17 Results: The study involved 197 neonates with median gestational age 34 weeks (IQR: 32, 35.4) and birth weight 2120 grams (IQR: 1680, 2580). The highest ROX index median (9.9) occurred 30 minutes before downgrading primary NIV support. Treatment failure within 72 hours was observed in 5.6%, with a median ROX index of 5.1, while successful treatment had a median ROX index of 9.3. A negative association existed between treatment failure and ROX index (P= 0.024). Conclusion: This study reveals the ROX index’s potential as a prognostic tool for neonatal NIV outcomes. The negative association with treatment failure suggests its utility in guiding respiratory support strategies. Despite promising findings, caution is warranted due to single-center, retrospective design, lack of a control group, potential confounders, and the limited follow- up duration. Further multicenter, prospective studies are crucial to validate and enhance the generalizability of these findings.