351 - Pilot Study of Preterm Infant Behavioral Signs of Respiratory Instability Scores

Poster Number: 351
Publication Number: 351.346

Raga S. Kilaru, Phoenix Children's Hospital, Phoenix, AZ, United States; Ava Smesik, Creighton University School of Medicine, Phoenix, AZ, United States; Sarah Shepperson Ward, Phoenix Children's Hospital, Phoenix, AZ, United States; Pamela Griffiths, Phoenix Children's Hospital, Phoenix, AZ, United States; Sophia Williams, Phoenix Children's Hospital, Phoenix, AZ, United States; Mohammed Elkhwad, Phoenix Children's Hospital, Scottsdale, AZ, United States; Hemananda K. Muniraman, Phoenix Children's Hospital, PHOENIX, AZ, United States

Background: The behavioral signs of respiratory instability (BSRI) assessment tool has been developed at Nationwide Children’s Hospital for evaluation of tolerance to developmentally appropriate activities of infants at term corrected gestational age and has been shown to correlate with respiratory severity. However, a similar tool has not been developed for preterm infants. At St. Joseph’s Neonatal Intensive Care Unit (NICU), a modified behavioral signs of respiratory instability (PiBSRI) scoring protocol was developed that evaluates for the ability to participate in developmental activities as well as signs of respiratory distress during developmental handling.

Objective: Our objective with this pilot study was to describe the trajectory of BSRI scores in preterm infants requiring respiratory support, and evaluate for correlation between BSRI scoring and pulmonary severity scores and weaning of respiratory support.

Design/Methods: We retrospectively reviewed the PiBSRI scores and collected data on infants' characteristics and respiratory support at time of assessment. The trajectory of PiBSRI scores during NICU stay were described. Correlation with post menstrual age (PMA), weight, pulmonary severity scores (PSS), neonatal pain, agitation, and sedation scores (NPASS), weaning of respiratory support and predictive values for PiBSRI scores associated with weaning were analyzed.

Results: 211 PiBSRI scores were evaluated on 26 infants with a median of 7 PiBSRI evaluations (5,12) per infant. The median birth gestation of included infants was 25 weeks (IQR, 24.2, 27.3) and birth weight was 730 grams (IQR, 620, 1025). PiBSRI correlated positively with advancing gestational age (r=0.36, p <0.01 ) with median PiBSRI score of 5 (IQR 4,6) at 32 weeks PMA increasing to 7 (IQR, 6,9) by 40 weeks PMA (Figure 1). PiBSRI scores correlated negatively with PSS with increase in PiBSRI seen with decreasing PSS scores, (r=-0.15, p 0.01) and NPASS score (r=-0.32, p 0.04) (Table 2). PIBSRI correlated with weaning of respiratory support (r=0.60, p< 0.01). PiBSRI cut offs associated with weaning of respiratory support was highest for a cut off of 6 (AUC: 0.78), followed by 7 (AUC 0.75) and 5 (AUC: 0.71).

Conclusion(s): PiBSRI scores are associated negatively with pulmonary severity scores and are seen to increase with improvement in respiratory status and advancing gestational age. A PiBSRI score of 6 is associated with weaning of respiratory support with an AUC of 0.78. Further large multicenter studies are required to validate PiBSRI scores for the assessment and management of preterm infants at risk for BPD.