Establishment and evaluation of nomogram for predicting acute respiratory distress syndrome in meconium-stained amniotic fluid neonates.

OBJECTIVE

To delineate risk factors and develop a predictive nomogram for acute respiratory distress syndrome (ARDS) in neonates exposed to meconium-stained amniotic fluid (MSAF).

METHODS

We conducted a comprehensive retrospective analysis of neonates with MSAF, classifying them into ARDS and non-ARDS groups based on the onset of ARDS within the first week after birth. Clinical and laboratory data are collected to screen the risk factors for ARDS in MSAF neonates, multivariate logistic regression was performed to identify independent predictors and establish a nomogram to predict the occurrence of neonatal ARDS.

RESULTS

We recognized five variables as independent risk factors for ARDS with MSAF neonates via logistic regression analysis, consisting of 1-min Apgar score (Apgar 1 min), white blood cell (WBC), platelet (PLT), red cell distribution width (RDW) and serum calcium (Ca). These predictors were integrated into a nomogram designed to estimate the individual risk of ARDS development in neonates. The predictive model achieved a C-index of 0.942 (95% CI: 0.915-0.970), indicating high predictive accuracy. Additionally, the nomogram was internally validated, demonstrating excellent calibration and practical utility for clinical decision-making.

CONCLUSIONS

The validated nomogram, based on five pivotal factors, provides clinicians with a reliable tool for early identification and management of ARDS in MSAF neonates, potentially improving outcomes by facilitating timely and appropriate therapeutic interventions.