Prognostic Utility of Serum Albumin in Neonates with Respiratory Distress Syndrome

Prognostic Utility of Serum Albumin in Neonates with Respiratory Distress Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prognostic Utility of Serum Albumin in Neonates with Respiratory Distress Syndrome Shaimaa M. Eldebsy, Nesrin M. Handoka, Abdel-moneim k. khashana, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8757733/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and objectives: A leading cause of morbidity and mortality among preterm newborns is respiratory distress syndrome (RDS), even though there have been breakthroughs in therapy such as surfactants, prenatal corticosteroids, and advanced neonatal respiratory care. The purpose of this study was to assess blood albumin levels in preterm infants with RDS and ascertain its role in detection of clinical outcome. Methods A prospective cross sectional case–control study was conducted at the NICU of Suez Canal University Hospital, Egypt, from March 2023 to March 2024. Sixty preterm neonates were enrolled: 30 with RDS and 30 healthy controls matched for gestational age and birth weight. All infants underwent clinical assessment, laboratory testing, and radiological evaluation. Serum albumin levels were measured, and correlations with disease severity, mechanical ventilation, clinical outcome and mortality were analyzed. Results Serum albumin levels were significantly lower in RDS cases and negatively correlated with oxygen duration and hospital stay. Albumin < 2.55 g/dL predicted poor outcome (sensitivity 96.7%). Conclusion Serum albumin is a biomarker for predicting clinical outcomes in preterm infants with RDS. Preterm infants respiratory distress syndrome serum albumin biomarkers Figures Figure 1 Introduction Respiratory distress syndrome (RDS), formerly known as hyaline membrane disease (HMD), usually causes respiratory distress, morbidity, and mortality in preterm newborns. The absence of pulmonary surfactant in a young lung is the main cause of this disease [ 1 ]. It is associated with both immediate and long-term adverse consequences and has a substantial impact on the survival rate and long-term quality of life of newborns [ 2 ]. RDS usually manifests as respiratory distress symptoms as tachypnea, grunting, nasal flaring, chest retractions, and cyanosis right after birth, and its severity is associated with prematurity. The most severe symptoms are seen in extremely preterm infants, and if the illness worsens, apnea, hypotonia, reduced breath sounds, and circulatory shock may result [ 3 ]. The incidence of RDS is negatively correlated with the infant's gestational age, with smaller and preterm newborns experiencing more severe illness [ 4 ]. Even with the development of new treatments including prenatal corticosteroids, surfactants, and advanced neonatal respiratory care, respiratory distress syndrome (RDS) is still the leading cause of death and disability among premature babies. [ 5 ]. The death rate was over 50% in the 1950s and 1960s, but it is now less than 2% thanks to the development of CPAP, surfactant therapy, prenatal steroids, and mechanical ventilation. This is an impressive development, however the 2% number might be overstated because RDS is sometimes misdiagnosed [ 6 ]. Albumin levels are a helpful indicator for the diagnosis and prognosis of preterm newborns with sepsis, since hypoalbuminemia may be associated with a worse clinical outcome, as demonstrated in Akram et al., study[ 22 ]. Compared to lactate, low serum albumin appears to be a more sensitive and specific indicator of mortality[ 24 ] .Given the vital roles albumin plays in sustaining oncotic pressure, transferring vital nutrients, and regulating immunological function, hypoalbuminemia in newborns can lead to a number of significant problems. One such risk is the development of edema, especially in the lungs, where low albumin levels cause fluid to seep from blood vessels into surrounding tissues, causing respiratory difficulty and other potentially fatal situations. Additionally, albumin is essential for wound healing and the immune response because it binds and transports hormones, enzymes, and nutrients. This suggests that hypoalbuminemia may increase the risk of infections and hinder newborns' recuperation[ 7 ]. Serum albumin levels and the incidence of respiratory distress in newborns with pneumonia have a linear dose-response relationship [ 7 ]. Aim: To investigate the role of serum albumin in detection of clinical outcome in neonatal RDS. Methods Study Design and Setting This prospective cross sectional case–control study was conducted in the Neonatal Intensive Care Unit (NICU) of Suez Canal University Hospital, Ismailia, Egypt, between March 2023 and March 2024. All the participating parents signed informed consent before enrollment. Institutional Review Board of the Faculty of Medicine, Port Said University (approval no. ]ERN: MED (4/12/2022) s.no (68) PED917-009[gave the ethical approval, and all procedures were in accordance with the declaration of Helsinki and ethical standards of the Egyptian Ministry of Health. Study Population Seventy-five preterm neonates were initially enrolled. Fifteen neonates were excluded due to congenital heart disease or patent ductus arteriosus (n = 5), inadequate sample collection (n = 7), or parental refusal to participate (n = 3). The final study population included 60 preterm neonates, divided equally into two groups: Case group : 30 preterm neonates diagnosed with respiratory distress syndrome (RDS) [ 29 ]. Control group : 30 gestational age-, sex-, and weight-matched preterm neonates admitted to the NICU primarily for low birth weight, with no clinical evidence of RDS. Inclusion and Exclusion Criteria Eligible participants were preterm neonates (< 37 weeks’ gestation) of either sex. Exclusion criteria included pneumothorax, meconium aspiration syndrome, major congenital malformations, perinatal asphyxia[ 9 ], neonatal sepsis[ 10 ], multiple gestations[ 11 ], and congenital heart disease confirmed clinically or by echocardiography. Clinical Evaluation All enrolled neonates underwent comprehensive clinical assessment, including detailed maternal, perinatal, and neonatal history, and complete physical examination. Maternal data included age, parity, medical comorbidities, antenatal corticosteroid use, and drug intake during pregnancy, obstetric complications, and mode of delivery. Neonatal assessment included gestational age determination using the Ballard score, birth weight, sex, and classification as small or large for gestational age. Signs of respiratory distress were evaluated, including tachypnea, expiratory grunting, chest retractions, cyanosis, nasal flaring, apnea, and hypothermia. Neonatal status was assessed using standardized scoring systems: Apgar scores at 1 and 5 minutes[ 12 ], Silverman–Anderson score for grading respiratory distress severity according to its grade (1–3 )is mild,(4–6 ) is moderate,(7–10 ) is severe RD.and (> 10 ) is a more severe respiratory distress) [ 13 ], and SNAPPE-II score to evaluate illness severity within the first 12 hours of NICU admission[ 14 ]. Radiological Assessment All neonates underwent chest radiography to assess the severity of RDS based on characteristic findings such as ground-glass opacity, air bronchograms, or diffuse lung opacification. Grades of RDS in chest X- ray according to Hansen,were classified to G I, II, III, IV [ 30 ].Echocardiography was performed selectively when clinically indicated to evaluate pulmonary hypertension or congenital heart disease, with pulmonary arterial pressure estimated using tricuspid regurgitation jet gradients. Laboratory Investigations Routine laboratory evaluations included complete blood count, serum albumin levels (Albumin concentration was measured by the Bromocresol green method. Bromocresolgreen (BCG) method using albumin kit (Ref AB 361) from Randox (U.K), C-reactive protein measurement, CRP levels may rise within six hours of an inflammatory stimulus [ 16 ] and blood culture analysis. In preterm (32–37 weeks), cutoff values of hypoalbuminemia is < 30 g/L [ 8 ].below 27.9 g/l [ 15 ]. Outcome assessed in this study was in NICU mortality, defined as death occurring at anytime during the NICU stay. Duration of mechanical ventilation and length of NICU stay served as surrogate endpoints. A favorable outcome was defined as full recovery without any complications. Unfavorable outcomes included death, occurrence of complications, extended mechanical ventilation, or prolonged NICU care[ 25 ]. Results Our studied groups are matched regarding sex distribution, gestational age and weight as no statistical difference between both cases and control Table 1 . Both the studied groups are matched regarding to maternal age, consanguinity, co morbidity, mode of delivery and administration of antenatal Steroids &its time, as no statistical difference between case and control. Table 1 show that there was a statistical significance decrease in Apgar score 1 & 5 and increase in frequency of Surfactant administration among cases compared to control group. Table 2 shows that SNAPPE II ranged from 5 to 49 with median 14.5. Chest X ray showed that 50% of the cases were G II, 33.3% were G III & 16.7% were G IV. According to Silverman score 20% of the cases were mild, 33.3% were moderate and 46.7% were sever. Table 3 shows that 53.3% of the cases were on Ventilator, 40% on CPAP and 6.7% on nasal Oxygen support. Support duration ranged from 1 to 31 days with median 4.5 days and Oxygen duration ranged from 4 to 45 days with median 8.5 days. Antibiotic was founded in 80% of the cases followed by caffeine 33.3%. Table 4 shows that there was a statistical significance increase in frequency of complications, hospital stay and death among cases compared to control group. In Table 5 an adverse result was noted in 20% of newborns, significantly correlated with reduced gestational age and birth weight. Infants with worse outcomes exhibited markedly lower Apgar scores at 1 and 5 minutes and presented with more severe respiratory distress, as evidenced by elevated Silverman–Anderson scores and more advanced radiological classifications. Disease severity was a critical factor influencing outcomes; all children with unfavourable outcomes exhibited severe RDS and markedly elevated SNAPPE-II scores. These newborns necessitated invasive mechanical ventilation more often and endured prolonged periods of respiratory support and oxygen treatment. Adverse outcomes were correlated with markedly reduced blood pH levels and extended hospitalizations. Serum albumin levels were dramatically diminished, with unfavourable outcomes, so affirming the robust prognostic significance of Albumin biomarker in forecasting severe clinical outcomes in preterm newborns with respiratory distress syndrome. Table 6 shows that accuracy of albumin at cut of level < 2.55 g/dl in prediction of unfavorable outcome cases was 96.7% (75%sensitivity and 100% specificity) with significant validity (P < 0.001**). Table 7 shows that there was a statistical significant positive correlation between Albumin and gestational age, weight and HCO 3 level. Also, there was a statistical significant negative correlation between Albumin and duration of oxygen and hospital stay. There was a statistical significance decrease in albumin level among cases with positive consanguinity, received Surfactant, had complications and received other treatment and dead cases compared to other cases. Figure 1 shows that accuracy of albumin was 96.7% with significant validity (P < 0.001**) in prediction of unfavorable outcome among the studied cases. Discussion We investigated the predictive usefulness of albumin in predicting hospital mortality and poor outcome among preterm hospitalized patients with RDS in order to develop a novel working hypothesis. Cases (30 preterm with RDS) and control (30 healthy preterm) were matched based on gestational age, sex and weight. The patients had a mean gestational age of 33.13 ± 2.36 and a mean birth weight of 2.33 ± 0.57 kg, whereas the control group had a mean gestational age of 33.7 ± 1.09 and a mean birth weight of 2.56 ± 0.35 kg. According to the group's chest X-ray, 50% of the cases were G II, 33.3% were G III, and 16.7% were G IV. The current investigation found that none of the maternal factors differed significantly between the cases and controls. Even though the RDS group had more cesarean sections and PROM, this difference was not statistically significant. Our results are consistent with those of Shahramian et al. [ 17 ], whose study group consisted of 65 premature newborns in the case group and 65 term infants in the control group. Of them, 53 were delivered via caesarean section and 77 were delivered vaginally (59.2%). The average birth weight and gestational age were 19.179 ± 19.741 pg/mL, 2.575 ± 0.791 kg, and 35.500 ± 2.213 weeks, respectively. He revealed that the results showed significant statistical differences between the two groups based on variables like gestational age, birth weight, and type of delivery (P ≤ 0.05). The highest frequency distributions of RDS in the patients were 38.5% for mild, 30.8% for moderate, and 13.8% for severe. He also agreed that there was no significant statistical difference (P > 0.05) when comparing the frequency of delivery among the patients based on RDS frequency. In contrast to Shahramian and colleagues' investigation, we were able to successfully match the study groups based on maternal age, consanguinity, co-morbidity, mode of birth, or administration of antenatal steroids or its timing. [ 17 ] Did not report comparable matching since he found a significant difference (P > 0.05) between the two groups in terms of pregnancy age, weight, and delivery type between the cases and control groups. Similar to Ying et al. [ 8 ], who showed that neonatal albumin level (g/dl) in the RDS group was significantly lower than that in the control group (32.70 ± 2.48 g/L vs. 35.66 ± 3.27 g/L, P < 0.05), the current study found a statistically significant decrease in albumin level among cases (mean ± Sd range is 2.93 ± 0.34 vs. 3.13 ± 0.34, P < 0.05). However, Barekatain et al. [ 18 ] found that there was no statistically significant difference in total blood protein and albumin levels between males and females, healthy preterm babies, and RDS neonates (P > 0.05). This discrepancy may be ascribed to the collection of samples immediately post-birth from cord blood, which may indicate maternal serum albumin levels and maternal clinical condition rather than solely neonatal status. Furthermore, the relatively small sample size of the study may have constrained the capacity to identify subtle differences. Throughout our research Birth weight, gestational age, APGAR scores at 1 and 5 minutes, severity of CXR findings, and Silverman scores were all substantially correlated with unfavourable outcomes, consistent with findings reported by other Authors [ 25 , 27 , 28 ]. The SNAPPE-II (Score for Neonatal Acute Physiology, Perinatal Extension II) is still the most widely used tool for assessing the severity of disease in newborns with respiratory failure. There was a high correlation between median SNAPPE-II scores and infant death caused by respiratory failure (r = 0.895, p < 0.001), as shown by Ding et al [ 26 ]. In our study, we found a comparable pattern among the newborns. The group of neonates that had unfavourable results had an average score of 43.0 ± 4.24, whereas the group that had favourable outcomes had an average score of 15.42 ± 8.97. This data emphasises the importance of SNAPPE II in predicting the severity of disease and unfavorable prognosis in RDS. Regarding the type of respiratory support employed, our study found a statistically significant difference (χ² = 6.563, p = 0.019). While most of the infants in the favourable group were handled with CPAP, all of the neonates in the adverse group required mechanical ventilation. The necessity for invasive ventilation appears to be associated with a more serious sickness and poorer results. This is in line with what Ivanove [ 25 ] found that long periods of mechanical ventilation were linked to unfavourable RD progression and complications. Prolonged mechanical ventilation is known to increase the likelihood of bronchopulmonary dysplasia and chronic nonspecific lung diseases. According to our research, the accuracy of albumin at the cutoff level of < 2.55 in the prediction of unfavorable outcome in RDS cases was 96.7% with significant validity (P < 0.001**). With an area under the curve (AUC) of 0.91 (95% CI: 0.76-1), albumin demonstrate an excellent diagnostic performance. With a sensitivity of 75% and a specificity of 100%, albumin at this threshold accurately identified unfavourable outcomes without yielding false-positive results. There was high dependability in ruling in favourable events and ruling out unfavourable ones, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 96.3%. There was a 96.7% total success rate in the diagnostics. The strength of albumin as a prognostic indicator in RDS was validated by the very statistically significant correlation (p < 0.001).Albumin shown relevance in predicting death within the case group on binary regression analysis. (95% confidence interval [CI] 0.001–0.375, odds ratio [OR] = 0.002, P < 0.021). However, according to Torer et al. [ 22 ], a logistic regression study with a sensitivity of 71% and a specificity of 86% indicated that serum albumin levels below 27.2 g/l were linked to death. Additionally, Cai et al. [ 23 ] evaluated the albumin levels of 364 preterm infants. According to their evaluations, the incidence of RDS was considerably higher in individuals with low albumin levels than in two other groups. Albumin concentration on the first day of life was an independent predictor of death, according to multiple logistic regressions. They even demonstrated that an albumin level of 22.8 g/l had 72% sensitivity and 85% specificity for predicting newborn mortality on the first day of birth. 382,190 albumin and bilirubin levels in 164,401 babies were analyzed by Watchko et al. [ 10 ]. The death rate was greater for newborns whose blood albumin levels were less than 2.5 g/dL. In contrast to Barekatain et al.'s [ 18 ] finding that there was a significant direct correlation between maternal age and albumin levels among healthy neonates, we found no statistical significance between maternal age and albumin levels among RDS neonates (P > 0.05). This could be because the samples were drawn from the cord blood as soon as the infant was delivered, and the mother's health or serum albumin level may have played a role. We found a statistically significant positive connection (P = 0.003&P < 0.001&P = 0.03, respectively) between albumin and gestational age, weight, and HCO3 level. Additionally, there was a statistically significant negative connection (P = 0.04 and P = 0.05, respectively) between albumin and hospital stay and oxygen duration. This is consistent with a study by Mohamed et al. [ 19 ] that discovered 41.3% of patients had low albumin levels. Low serum albumin levels are significantly correlated with both low birth weight and gestational age. These findings supported the findings of Akram et al. [ 20 ], who found that infants with hypoalbuminemia had longer median CPAP and total O2 durations (2.0 and 4.5 hours, respectively) than those with normal albumin levels. In contrast to our findings that there was a statistically significant negative correlation between albumin and the length of oxygen and hospital stay, he found that hypoalbuminemia had no significant correlation with the length of mechanical ventilation or the length of hospital stay, but it did show a significant correlation with the mortality of preterm babies. The mean albumin concentrations for respiratory distress syndrome did not significantly differ between the clinical and control groups, according to Jang et al. [ 21 ] [clinical group, 2.36 ± 0.42 g/dL, n = 54; control group, 2.64 ± 0.34 g/dL, n = 7]. According to Barekatain et al. [ 18 ], the albumin level in preterm RDS newborns was unaffected by birth weight. Despite this, he reported a direct correlation between measured albumin and gestational age in both the case and control groups, which is consistent with our findings. Study Limitations Initially, we looked at preterm infants who were 33 and 34 weeks old. Because the sample size in our study is modest, we must increase it in order to increase statistical significance. Additionally, the minimal or fluctuating pattern was not taken into account in our investigation; only the initial albumin level was. However, it is challenging to accurately determine when the lowest albumin level occurs during the course of a disease, which reduces the usefulness of comparison. In clinical practice, the albumin level on the first day is more significant. Changes in albumin during the first three days can be used as a reliable indicator in subsequent tests. Conclusions This study provides evidence that low serum albumin levels are significantly associated with increased disease severity and poor outcome in preterm neonates with RDS. The evaluation of serum albumin can improve prognosis prediction in neonatal RDS, assisting clinicians in optimizing monitoring and management strategies for preterm infants at higher risk of complications and mortality. Declarations Conflicts of interest: None. Source of funding: None. Author Contribution S.E. contributed to the study conception and design, data collection, data analysis, and writing of the manuscript.M.E. supervised the study, guided the research process, and critically revised the manuscript.N.H. contributed to data interpretation and manuscript revision.A.M. contributed to manuscript review and scientific revision.S.F. contributed to laboratory investigations and analysis of results.All authors reviewed and approved the final manuscripفز Data Availability The datasets generated and analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author upon reasonable request. References Jeenakeri R, Drayton MJP (2009) c. health, Management of respiratory distress syndrome. 19(4):158–164 Ma YJ, Sun Y, Zhang CH (2025) Adverse perinatal outcomes associated with respiratory distress syndrome in preterm infants: a retrospective analysis. 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Medicina 60(2):193. 10.3390/medicina60020193 Lin M, Zhang X, Wang YY, Zhu XB, Xue J (2023) Interpretation of the key updates in the 2022 European guideline on the management of neonatal respiratory distress syndrome. Zhongguo Dang dai er ke za zhi=. Chin J Contemp Pediatr 25(8):779–784 Hansen T (1991) Disorders of the transition. Dis newborn, 504–514 Tables Table (1): Basic characteristic data of the studied groups: Cases (n = 30) Control (n = 30) Test of Sig. p No. % No. % Sex Male 14 46.7 14 46.7 c 2 = 0.000 1.000 Female 16 53.3 16 53.3 Gestational age (week) 1.20 0.24 NS Mean ± SD. 33.13±2.36 33.7±1.09 Range 27-36 31-35 Weight (kg) 1.86 0.07 NS Mean ± SD. 2.33±0.57 2.56±0.35 Range 1.35-3.35 1.7-3.2 Consanguinity Negative 17 56.7 20 66.7 c 2 = 0.64 0.43 Positive 13 43.3 10 33.3 Maternal age (years) 0.73 0.47 NS Mean ± Sd 28.5±6.4 27.37±5.61 Range 19-41 19-40 Maternal disease No 18 60 22 73.3 26.7 1.2 0.27 NS Yes 12 40 8 Mode of delivery C/S 28 93.3 23 76.7 3.27 0.07 NS VD 2 6.7 7 23.3 Antental steroid use No 15 50.0 22 73.3 3.46 2.58 0.06 NS 0.27 NS 1D 11 36.7 8 26.7 2D 3 10.0 0 0.0 3D 1 3.3 0 0.0 APGAR (1min) 8.56 <0.001** Mean ± Sd 6.03±1.16 8.43±1.01 Range 4-8 6-10 APGAR (5min) 7.53 <0.001 * Mean ± Sd 7.3±1.06 9±0.64 Range 5-9 8-10 Surfactant use: No Yes 10(33.3%) 20(66.7%) 30(100%) 0(0) c 2 =30 0.05) **: Highly significant (P<0.001) Table (2): Clinical and radiological data of the studied cases groups: Variable Cases (n=30) SNAPPE II: Mean ± Sd Median (Range) 20.93±13.89 14.5 (5-49) Variable No % Chest X ray: G II G III G IV 15 10 5 50 33.3 16.7 Silverman score: Mild Moderate Sever 6 10 14 20 33.3 46.7 SD: Standard deviation , SNAPPE II :Score for Neonatal Acute Physiology II. Table (3): Management data of the studied groups: Variable Cases (n=30) No % Type of resp support: CPAP M.Vent 14 16 46 53.3 Support duration: (day) Mean ± Sd Range 7.03±7.07 4.5(1-31) Total Oxygen duration: (day) Mean ± Sd Range 13.43±11.54 8.5(4-45) Other treatment: Antibiotic Caffeine Inotrops 24 10 2 80 33.3 6.7 SD: Standard deviation , M.Vent: mechanical ventilator Table (4): clinical outcome data of the studied groups: Variable Cases (n=30) Control (n=30) χ 2 P No % No % Complications: No Yes 18 12 60 40 30 0 100 0 10.59 0.001* Type: Apnea NEC pneumothorax Sepsis 2 1 2 7 6.7 3.3 6.7 23.3 ---- ---- ---- ---- Hospital stay: (day) Mean ± Sd Median (Range) 15.27±12.16 11(5-48) 1.47±1.07 2 (0-3) MW 6.7 <0.001** Outcome: favorable unfavorable 24 6 80 20 30 0 100 0 4.29 0.04* SD: Standard deviation , χ 2 :Chi square test, MW: Mann Whitney test, *: Significant (P<0.05), **: Highly significant (P<0.001) Table (5) : Comparison between favorable and unfavorable outcome neonates among RDS cases (n = 30) Parameter Unfavorable (n = 6) No. (%) Favorable (n = 24) No. (%) Test of significance p value Sex χ² = 0.033 1.000 Male 3 (50.0) 11 (45.8) Female 3 (50.0) 13 (54.2) Gestational age (weeks) t = 2.00 <0.001* Mean ± SD 29.30 ± 1.64 34.04 ± 1.46 Median (Min–Max) 29.50 (27.0–32.0) 34.50 (31.0–36.0) Weight (kg) t = 3.590 0.001* Mean ± SD 1.176 ± 0.45 2.51 ± 0.46 Median (Min–Max) 1.58 (1.35–2.40) 2.44 (1.84–3.35) Consanguinity χ² = 4.887 0.061 Negative 1 (16.7) 16 (66.7) Positive 5 (83.3) 8 (33.3) Maternal age (years) t = 0.422 0.677 Mean ± SD 27.50 ± 5.34 28.75 ± 6.69 Median (Min–Max) 30.0 (20.0–33.0) 28.0 (19.0–41.0) Maternal disease χ² = 1.205 0.378 Yes 2 (33.3) 14 (58.3) No 4 (66.7) 10 (41.7) Mode of delivery χ² = 1.205 0.366 C/S 1 (16.7) 1 (4.2) NVD 5 (83.3) 23 (95.8) Antenatal steroid use χ² = 4.249 0.302 Yes 4 (66.7) 11 (45.8) APGAR (1 min) U = 19.00 0.004* Mean ± SD 4.83 ± 0.75 6.33 ± 1.00 Median (Min–Max) 5.0 (4.0–6.0) 6.0 (4.0–8.0) APGAR (5 min) U = 3.00 0.001* Mean ± SD 5.75 ± 0.50 7.70 ± 0.73 Median (Min–Max) 6.0 (5.0–6.0) 8.0 (6.0–9.0) Surfactant use χ² = 0.938 0.633 Yes 5 (83.3) 15 (62.5) CXR χ² = 9.179 0.005* Grade II 0 (0.0) 15 (62.5) Grade III 3 (50.0) 7 (29.2) Grade IV 3 (50.0) 2 (8.3) Silverman score Mild Moderate Severe 0 (0.0) 0 (0.0) 6 (100.0) 6 (25.0) 10 (41.7) 8 (33.3) χ² = 9.179 0.005* SNAPPE II 10 (41.7) U = 2.00 <0.001* Mean ± SD 43.0 ± 4.24 8 (33.3) Median (Min–Max) 42.50 (37.0–49.0) 11.0 (5.0–41.0) Mean ± SD pH PO₂ HCO₃ Mean ± SD 7.20 ± 0.02 74.67 ± 9.20 18.43 ± 2.43 Mean ± SD 7.31 ± 0.05 75.92 ± 6.98 20.50 ± 2.64 t = 9.061 t = 0.409 t = 1.760 <0.001* 0.686 0.089 Hospital stay (days) Mean ± SD 33.33 ± 15.17 10.75 ± 5.48 U = 12.00 0.001* Median (Min–Max) 36.0 (6.0–48.0) 9.50 (2.0–25.0) Albumin Mean ± SD Median (Min–Max) 2.60 ± 0.13 2.55 (2.50–2.80) 3.02 ± 0.33 3.0 (2.60–3.80) U = 12.00 0.001* SD: Standard deviation t: Student t-test U: Mann Whitney test c 2 : Chi square test FE: Fisher Exact test MC: Monte Carlo test p: p value for comparison between the studied categories *: Statistically significant at p ≤ 0.05 Table (6): Validity of Albumin in prediction of unfavorable outcome of RDS among the studied groups: Albumin Cut off AUC (CI 95%) Sensitivity Specificity PPV NPV Accuracy p outcome <2.55 0.91 (0.76-1) 75% 100% 100% 96.3% 96.7% <0.001** AUC: Area under curve, CI: Confidence interval, PPV:+ve predicted value, NPV:-ve predicted value, *: significant (P<0.05), **:Highly Significant (P<0.001), Table (7): Correlation between Albumin and different parameters among the studied cases group: Variable Albumin (n=30) r P Gestational age (week) 0.52 0.003* Weight (Kg) 0.62 <0.001** Maternal age (years) 0.02 0.94 NS Apgar score 1 -0.12 0.52 NS Apgar score 5 0.03 0.88 NS SNAPPE II -0.16 0.39 NS Support duration (day) -0.30 0.11 NS Total oxygen duration (d) -0.37 0.04* pH 0.28 0.13 NS HCO 3 (%) 0.40 0.03* PO 2 (%) -0.22 0.23 NS PCO 2 (%) -0.05 0.78 NS Hospital stay (Day) -0.35 0.05* r: Spearman’s or Pearson’s correlation coefficient, NS: Non significant (P>0.05), *: Significant (P<0.05), **: Highly significant (P<0.001) SNAPPE II :Score for Neonatal Acute Physiology II, Additional Declarations No competing interests reported. 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Handoka","email":"","orcid":"","institution":"Port Saied University","correspondingAuthor":false,"prefix":"","firstName":"Nesrin","middleName":"M.","lastName":"Handoka","suffix":""},{"id":584472574,"identity":"1b1a8fb0-d3ae-4a36-a1d2-62bf0cba3bdb","order_by":2,"name":"Abdel-moneim k. khashana","email":"","orcid":"","institution":"Port Saied University","correspondingAuthor":false,"prefix":"","firstName":"Abdel-moneim","middleName":"k.","lastName":"khashana","suffix":""},{"id":584472575,"identity":"3ebbf134-f55b-45ef-a29e-a64b4caa8547","order_by":3,"name":"Safinaz H. EL-Khoulany","email":"","orcid":"","institution":"Port Saied University","correspondingAuthor":false,"prefix":"","firstName":"Safinaz","middleName":"H.","lastName":"EL-Khoulany","suffix":""},{"id":584472576,"identity":"d8ddb89f-191b-4b51-8bb3-78330e0427cc","order_by":4,"name":"Mona M Ismail","email":"","orcid":"","institution":"Port Saied University","correspondingAuthor":false,"prefix":"","firstName":"Mona","middleName":"M","lastName":"Ismail","suffix":""}],"badges":[],"createdAt":"2026-02-01 16:38:35","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8757733/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8757733/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101935790,"identity":"cad0ee71-6ac1-4b87-a955-4a5a193b8216","added_by":"auto","created_at":"2026-02-05 08:28:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10548,"visible":true,"origin":"","legend":"\u003cp\u003eRoc curve for validity of Albumin in prediction of unfavorable outcome among the studied cases group cases (sensitivity 75%- specificity 100%).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8757733/v1/cbc6ceab95d3a551ee4fb3b8.png"},{"id":104400215,"identity":"e87eb304-e7ac-4f8c-869b-a706c47c5a55","added_by":"auto","created_at":"2026-03-11 12:09:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1327623,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8757733/v1/bce9e3c1-98fe-4af8-9009-86687ec88095.pdf"},{"id":101935781,"identity":"230a26b8-5e02-4f1d-bf1f-63430497100b","added_by":"auto","created_at":"2026-02-05 08:28:33","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":6963110,"visible":true,"origin":"","legend":"","description":"","filename":"protocolsigned.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8757733/v1/fd1313f7971d406e515d5949.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prognostic Utility of Serum Albumin in Neonates with Respiratory Distress Syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRespiratory distress syndrome (RDS), formerly known as hyaline membrane disease (HMD), usually causes respiratory distress, morbidity, and mortality in preterm newborns. The absence of pulmonary surfactant in a young lung is the main cause of this disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is associated with both immediate and long-term adverse consequences and has a substantial impact on the survival rate and long-term quality of life of newborns [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRDS usually manifests as respiratory distress symptoms as tachypnea, grunting, nasal flaring, chest retractions, and cyanosis right after birth, and its severity is associated with prematurity. The most severe symptoms are seen in extremely preterm infants, and if the illness worsens, apnea, hypotonia, reduced breath sounds, and circulatory shock may result [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe incidence of RDS is negatively correlated with the infant's gestational age, with smaller and preterm newborns experiencing more severe illness [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEven with the development of new treatments including prenatal corticosteroids, surfactants, and advanced neonatal respiratory care, respiratory distress syndrome (RDS) is still the leading cause of death and disability among premature babies. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe death rate was over 50% in the 1950s and 1960s, but it is now less than 2% thanks to the development of CPAP, surfactant therapy, prenatal steroids, and mechanical ventilation. This is an impressive development, however the 2% number might be overstated because RDS is sometimes misdiagnosed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlbumin levels are a helpful indicator for the diagnosis and prognosis of preterm newborns with sepsis, since hypoalbuminemia may be associated with a worse clinical outcome, as demonstrated in Akram et al., study[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Compared to lactate, low serum albumin appears to be a more sensitive and specific indicator of mortality[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] .Given the vital roles albumin plays in sustaining oncotic pressure, transferring vital nutrients, and regulating immunological function, hypoalbuminemia in newborns can lead to a number of significant problems. One such risk is the development of edema, especially in the lungs, where low albumin levels cause fluid to seep from blood vessels into surrounding tissues, causing respiratory difficulty and other potentially fatal situations. Additionally, albumin is essential for wound healing and the immune response because it binds and transports hormones, enzymes, and nutrients. This suggests that hypoalbuminemia may increase the risk of infections and hinder newborns' recuperation[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Serum albumin levels and the incidence of respiratory distress in newborns with pneumonia have a linear dose-response relationship [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eAim:\u003c/h3\u003e\n\u003cp\u003eTo investigate the role of serum albumin in detection of clinical outcome in neonatal RDS.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003e This prospective cross sectional case–control study was conducted in the Neonatal Intensive Care Unit (NICU) of Suez Canal University Hospital, Ismailia, Egypt, between March 2023 and March 2024. All the participating parents signed informed consent before enrollment. Institutional Review Board of the Faculty of Medicine, Port Said University (approval no. ]ERN: MED (4/12/2022) s.no (68) PED917-009[gave the ethical approval, and all procedures were in accordance with the declaration of Helsinki and ethical standards of the Egyptian Ministry of Health.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eSeventy-five preterm neonates were initially enrolled. Fifteen neonates were excluded due to congenital heart disease or patent ductus arteriosus (n\u0026thinsp;=\u0026thinsp;5), inadequate sample collection (n\u0026thinsp;=\u0026thinsp;7), or parental refusal to participate (n\u0026thinsp;=\u0026thinsp;3). The final study population included 60 preterm neonates, divided equally into two groups:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCase group\u003c/b\u003e: 30 preterm neonates diagnosed with respiratory distress syndrome (RDS) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eControl group\u003c/b\u003e: 30 gestational age-, sex-, and weight-matched preterm neonates admitted to the NICU primarily for low birth weight, with no clinical evidence of RDS.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eEligible participants were preterm neonates (\u0026lt;\u0026thinsp;37 weeks\u0026rsquo; gestation) of either sex. Exclusion criteria included pneumothorax, meconium aspiration syndrome, major congenital malformations, perinatal asphyxia[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], neonatal sepsis[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], multiple gestations[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and congenital heart disease confirmed clinically or by echocardiography.\u003c/p\u003e\n\u003ch3\u003eClinical Evaluation\u003c/h3\u003e\n\u003cp\u003eAll enrolled neonates underwent comprehensive clinical assessment, including detailed maternal, perinatal, and neonatal history, and complete physical examination. Maternal data included age, parity, medical comorbidities, antenatal corticosteroid use, and drug intake during pregnancy, obstetric complications, and mode of delivery. Neonatal assessment included gestational age determination using the Ballard score, birth weight, sex, and classification as small or large for gestational age.\u003c/p\u003e \u003cp\u003eSigns of respiratory distress were evaluated, including tachypnea, expiratory grunting, chest retractions, cyanosis, nasal flaring, apnea, and hypothermia. Neonatal status was assessed using standardized scoring systems: Apgar scores at 1 and 5 minutes[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Silverman\u0026ndash;Anderson score for grading respiratory distress severity according to its grade (1\u0026ndash;3 )is mild,(4\u0026ndash;6 ) is moderate,(7\u0026ndash;10 ) is severe RD.and (\u0026gt;\u0026thinsp;10 ) is a more severe respiratory distress) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and SNAPPE-II score to evaluate illness severity within the first 12 hours of NICU admission[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRadiological Assessment\u003c/h2\u003e \u003cp\u003eAll neonates underwent chest radiography to assess the severity of RDS based on characteristic findings such as ground-glass opacity, air bronchograms, or diffuse lung opacification. Grades of RDS in chest X- ray according to Hansen,were classified to G I, II, III, IV [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].Echocardiography was performed selectively when clinically indicated to evaluate pulmonary hypertension or congenital heart disease, with pulmonary arterial pressure estimated using tricuspid regurgitation jet gradients.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLaboratory Investigations\u003c/h3\u003e\n\u003cp\u003eRoutine laboratory evaluations included complete blood count, serum albumin levels (Albumin concentration was measured by the Bromocresol green method. Bromocresolgreen (BCG) method using albumin kit (Ref AB 361) from Randox (U.K), C-reactive protein measurement, CRP levels may rise within six hours of an inflammatory stimulus [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and blood culture analysis. In preterm (32\u0026ndash;37 weeks), cutoff values of hypoalbuminemia is \u0026lt;\u0026thinsp;30 g/L [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].below 27.9 g/l [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOutcome assessed in this study was in NICU mortality, defined as death occurring at anytime during the NICU stay. Duration of mechanical ventilation and length of NICU stay served as surrogate endpoints. A favorable outcome was defined as full recovery without any complications. Unfavorable outcomes included death, occurrence of complications, extended mechanical ventilation, or prolonged NICU care[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eOur studied groups are matched regarding sex distribution, gestational age and weight as no statistical difference between both cases and control \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e. Both the studied groups are matched regarding to maternal age, consanguinity, co morbidity, mode of delivery and administration of antenatal Steroids \u0026amp;its time, as no statistical difference between case and control. \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e show that there was a statistical significance decrease in Apgar score 1 \u0026amp; 5 and increase in frequency of Surfactant administration among cases compared to control group. \u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e shows that SNAPPE II ranged from 5 to 49 with median 14.5. Chest X ray showed that 50% of the cases were G II, 33.3% were G III \u0026amp; 16.7% were G IV. According to Silverman score 20% of the cases were mild, 33.3% were moderate and 46.7% were sever. \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e shows that 53.3% of the cases were on Ventilator, 40% on CPAP and 6.7% on nasal Oxygen support. Support duration ranged from 1 to 31 days with median 4.5 days and Oxygen duration ranged from 4 to 45 days with median 8.5 days. Antibiotic was founded in 80% of the cases followed by caffeine 33.3%.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;4\u003c/b\u003e shows that there was a statistical significance increase in frequency of complications, hospital stay and death among cases compared to control group. In \u003cb\u003eTable\u0026nbsp;5\u003c/b\u003e an adverse result was noted in 20% of newborns, significantly correlated with reduced gestational age and birth weight. Infants with worse outcomes exhibited markedly lower Apgar scores at 1 and 5 minutes and presented with more severe respiratory distress, as evidenced by elevated Silverman\u0026ndash;Anderson scores and more advanced radiological classifications.\u003c/p\u003e \u003cp\u003eDisease severity was a critical factor influencing outcomes; all children with unfavourable outcomes exhibited severe RDS and markedly elevated SNAPPE-II scores. These newborns necessitated invasive mechanical ventilation more often and endured prolonged periods of respiratory support and oxygen treatment. Adverse outcomes were correlated with markedly reduced blood pH levels and extended hospitalizations.\u003c/p\u003e \u003cp\u003eSerum albumin levels were dramatically diminished, with unfavourable outcomes, so affirming the robust prognostic significance of Albumin biomarker in forecasting severe clinical outcomes in preterm newborns with respiratory distress syndrome. \u003cb\u003eTable\u0026nbsp;6\u003c/b\u003e shows that accuracy of albumin at cut of level\u0026thinsp;\u0026lt;\u0026thinsp;2.55 g/dl in prediction of unfavorable outcome cases was 96.7% (75%sensitivity and 100% specificity) with significant validity (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001**). \u003cb\u003eTable\u0026nbsp;7\u003c/b\u003e shows that there was a statistical significant positive correlation between Albumin and gestational age, weight and HCO\u003csub\u003e3\u003c/sub\u003e level. Also, there was a statistical significant negative correlation between Albumin and duration of oxygen and hospital stay. There was a statistical significance decrease in albumin level among cases with positive consanguinity, received Surfactant, had complications and received other treatment and dead cases compared to other cases. Figure\u0026nbsp;1 shows that accuracy of albumin was 96.7% with significant validity (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001**) in prediction of unfavorable outcome among the studied cases.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe investigated the predictive usefulness of albumin in predicting hospital mortality and poor outcome among preterm hospitalized patients with RDS in order to develop a novel working hypothesis.\u003c/p\u003e \u003cp\u003eCases (30 preterm with RDS) and control (30 healthy preterm) were matched based on gestational age, sex and weight.\u003c/p\u003e \u003cp\u003eThe patients had a mean gestational age of 33.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36 and a mean birth weight of 2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57 kg, whereas the control group had a mean gestational age of 33.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09 and a mean birth weight of 2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35 kg. According to the group's chest X-ray, 50% of the cases were G II, 33.3% were G III, and 16.7% were G IV. The current investigation found that none of the maternal factors differed significantly between the cases and controls. Even though the RDS group had more cesarean sections and PROM, this difference was not statistically significant.\u003c/p\u003e \u003cp\u003eOur results are consistent with those of Shahramian et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], whose study group consisted of 65 premature newborns in the case group and 65 term infants in the control group. Of them, 53 were delivered via caesarean section and 77 were delivered vaginally (59.2%). The average birth weight and gestational age were 19.179\u0026thinsp;\u0026plusmn;\u0026thinsp;19.741 pg/mL, 2.575\u0026thinsp;\u0026plusmn;\u0026thinsp;0.791 kg, and 35.500\u0026thinsp;\u0026plusmn;\u0026thinsp;2.213 weeks, respectively. He revealed that the results showed significant statistical differences between the two groups based on variables like gestational age, birth weight, and type of delivery (P\u0026thinsp;\u0026le;\u0026thinsp;0.05). The highest frequency distributions of RDS in the patients were 38.5% for mild, 30.8% for moderate, and 13.8% for severe. He also agreed that there was no significant statistical difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) when comparing the frequency of delivery among the patients based on RDS frequency.\u003c/p\u003e \u003cp\u003eIn contrast to Shahramian and colleagues' investigation, we were able to successfully match the study groups based on maternal age, consanguinity, co-morbidity, mode of birth, or administration of antenatal steroids or its timing. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Did not report comparable matching since he found a significant difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between the two groups in terms of pregnancy age, weight, and delivery type between the cases and control groups.\u003c/p\u003e \u003cp\u003eSimilar to Ying et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], who showed that neonatal albumin level (g/dl) in the RDS group was significantly lower than that in the control group (32.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48 g/L vs. 35.66\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27 g/L, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the current study found a statistically significant decrease in albumin level among cases (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Sd range is 2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34 vs. 3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, Barekatain et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] found that there was no statistically significant difference in total blood protein and albumin levels between males and females, healthy preterm babies, and RDS neonates (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This discrepancy may be ascribed to the collection of samples immediately post-birth from cord blood, which may indicate maternal serum albumin levels and maternal clinical condition rather than solely neonatal status. Furthermore, the relatively small sample size of the study may have constrained the capacity to identify subtle differences.\u003c/p\u003e \u003cp\u003eThroughout our research Birth weight, gestational age, APGAR scores at 1 and 5 minutes, severity of CXR findings, and Silverman scores were all substantially correlated with unfavourable outcomes, consistent with findings reported by other\u003c/p\u003e \u003cp\u003eAuthors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe SNAPPE-II (Score for Neonatal Acute Physiology, Perinatal Extension II) is still the most widely used tool for assessing the severity of disease in newborns with respiratory failure. There was a high correlation between median SNAPPE-II scores and infant death caused by respiratory failure (r\u0026thinsp;=\u0026thinsp;0.895, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as shown by Ding et al [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In our study, we found a comparable pattern among the newborns. The group of neonates that had unfavourable results had an average score of 43.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.24, whereas the group that had favourable outcomes had an average score of 15.42\u0026thinsp;\u0026plusmn;\u0026thinsp;8.97. This data emphasises the importance of SNAPPE II in predicting the severity of disease and unfavorable prognosis in RDS.\u003c/p\u003e \u003cp\u003eRegarding the type of respiratory support employed, our study found a statistically significant difference (χ\u0026sup2; = 6.563, p\u0026thinsp;=\u0026thinsp;0.019). While most of the infants in the favourable group were handled with CPAP, all of the neonates in the adverse group required mechanical ventilation. The necessity for invasive ventilation appears to be associated with a more serious sickness and poorer results. This is in line with what Ivanove [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] found that long periods of mechanical ventilation were linked to unfavourable RD progression and complications. Prolonged mechanical ventilation is known to increase the likelihood of bronchopulmonary dysplasia and chronic nonspecific lung diseases.\u003c/p\u003e \u003cp\u003eAccording to our research, the accuracy of albumin at the cutoff level of \u0026lt;\u0026thinsp;2.55 in the prediction of unfavorable outcome in RDS cases was 96.7% with significant validity (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001**). With an area under the curve (AUC) of 0.91 (95% CI: 0.76-1), albumin demonstrate an excellent diagnostic performance.\u003c/p\u003e \u003cp\u003eWith a sensitivity of 75% and a specificity of 100%, albumin at this threshold accurately identified unfavourable outcomes without yielding false-positive results. There was high dependability in ruling in favourable events and ruling out unfavourable ones, with a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 96.3%. There was a 96.7% total success rate in the diagnostics.\u003c/p\u003e \u003cp\u003eThe strength of albumin as a prognostic indicator in RDS was validated by the very statistically significant correlation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).Albumin shown relevance in predicting death within the case group on binary regression analysis. (95% confidence interval [CI] 0.001\u0026ndash;0.375, odds ratio [OR]\u0026thinsp;=\u0026thinsp;0.002, P\u0026thinsp;\u0026lt;\u0026thinsp;0.021).\u003c/p\u003e \u003cp\u003eHowever, according to Torer et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], a logistic regression study with a sensitivity of 71% and a specificity of 86% indicated that serum albumin levels below 27.2 g/l were linked to death. Additionally, Cai et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] evaluated the albumin levels of 364 preterm infants. According to their evaluations, the incidence of RDS was considerably higher in individuals with low albumin levels than in two other groups. Albumin concentration on the first day of life was an independent predictor of death, according to multiple logistic regressions.\u003c/p\u003e \u003cp\u003eThey even demonstrated that an albumin level of 22.8 g/l had 72% sensitivity and 85% specificity for predicting newborn mortality on the first day of birth. 382,190 albumin and bilirubin levels in 164,401 babies were analyzed by Watchko et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The death rate was greater for newborns whose blood albumin levels were less than 2.5 g/dL.\u003c/p\u003e \u003cp\u003eIn contrast to Barekatain et al.'s [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] finding that there was a significant direct correlation between maternal age and albumin levels among healthy neonates, we found no statistical significance between maternal age and albumin levels among RDS neonates (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This could be because the samples were drawn from the cord blood as soon as the infant was delivered, and the mother's health or serum albumin level may have played a role.\u003c/p\u003e \u003cp\u003eWe found a statistically significant positive connection (P\u0026thinsp;=\u0026thinsp;0.003\u0026amp;P\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u0026amp;P\u0026thinsp;=\u0026thinsp;0.03, respectively) between albumin and gestational age, weight, and HCO3 level. Additionally, there was a statistically significant negative connection (P\u0026thinsp;=\u0026thinsp;0.04 and P\u0026thinsp;=\u0026thinsp;0.05, respectively) between albumin and hospital stay and oxygen duration. This is consistent with a study by Mohamed et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] that discovered 41.3% of patients had low albumin levels. Low serum albumin levels are significantly correlated with both low birth weight and gestational age.\u003c/p\u003e \u003cp\u003eThese findings supported the findings of Akram et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], who found that infants with hypoalbuminemia had longer median CPAP and total O2 durations (2.0 and 4.5 hours, respectively) than those with normal albumin levels. In contrast to our findings that there was a statistically significant negative correlation between albumin and the length of oxygen and hospital stay, he found that hypoalbuminemia had no significant correlation with the length of mechanical ventilation or the length of hospital stay, but it did show a significant correlation with the mortality of preterm babies. The mean albumin concentrations for respiratory distress syndrome did not significantly differ between the clinical and control groups, according to Jang et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] [clinical group, 2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42 g/dL, n\u0026thinsp;=\u0026thinsp;54; control group, 2.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34 g/dL, n\u0026thinsp;=\u0026thinsp;7].\u003c/p\u003e \u003cp\u003eAccording to Barekatain et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], the albumin level in preterm RDS newborns was unaffected by birth weight. Despite this, he reported a direct correlation between measured albumin and gestational age in both the case and control groups, which is consistent with our findings.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy Limitations\u003c/strong\u003e \u003cp\u003eInitially, we looked at preterm infants who were 33 and 34 weeks old. Because the sample size in our study is modest, we must increase it in order to increase statistical significance. Additionally, the minimal or fluctuating pattern was not taken into account in our investigation; only the initial albumin level was. However, it is challenging to accurately determine when the lowest albumin level occurs during the course of a disease, which reduces the usefulness of comparison. In clinical practice, the albumin level on the first day is more significant. Changes in albumin during the first three days can be used as a reliable indicator in subsequent tests.\u003c/p\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThis study provides evidence that low serum albumin levels are significantly associated with increased disease severity and poor outcome in preterm neonates with RDS.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe evaluation of serum albumin can improve prognosis prediction in neonatal RDS, assisting clinicians in optimizing monitoring and management strategies for preterm infants at higher risk of complications and mortality.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e None.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of funding:\u003c/strong\u003e None.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.E. contributed to the study conception and design, data collection, data analysis, and writing of the manuscript.M.E. supervised the study, guided the research process, and critically revised the manuscript.N.H. contributed to data interpretation and manuscript revision.A.M. contributed to manuscript review and scientific revision.S.F. contributed to laboratory investigations and analysis of results.All authors reviewed and approved the final manuscripفز\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJeenakeri R, Drayton MJP (2009) c. health, Management of respiratory distress syndrome. 19(4):158\u0026ndash;164\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa YJ, Sun Y, Zhang CH (2025) Adverse perinatal outcomes associated with respiratory distress syndrome in preterm infants: a retrospective analysis. 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Clark, Prevalence of hypoalbuminemia and elevated bilirubin/albumin ratios in a large cohort of infants in the neonatal intensive care unit. 188:280\u0026ndash;286e4\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorres X et al (2020) Uncomplicated monochorionic twins: two normal hearts sharing one placenta. 9(11):3602\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimon NT et al (2024) Changes in metabolic acidosis following birth in intensive care unit neonates. 297:161\u0026ndash;168\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldsmith JP, Karotkin EH (2011) Introduction to assisted ventilation. Assisted ventilation of the neonate. 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Dis newborn, 504\u0026ndash;514\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable (1):\u0026nbsp;\u003c/strong\u003eBasic characteristic data of the studied groups:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCases\u003cbr\u003e\u0026nbsp;(n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003cbr\u003e\u0026nbsp;(n = 30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of Sig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e\u0026nbsp;0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age (week)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e33.13\u0026plusmn;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e33.7\u0026plusmn;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e27-36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e31-35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2.33\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e2.56\u0026plusmn;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1.35-3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1.7-3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsanguinity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e=\u003cbr\u003e\u0026nbsp;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; Sd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e28.5\u0026plusmn;6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e27.37\u0026plusmn;5.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19-41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e19-40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e93.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntental steroid use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3.46\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e1D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e2D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e3D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPGAR (1min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; Sd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e6.03\u0026plusmn;1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e8.43\u0026plusmn;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e4-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e6-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAPGAR (5min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 17px;\"\u003e\n \u003cp\u003e7.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; Sd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e7.3\u0026plusmn;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e9\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e8-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurfactant use:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10(33.3%)\u003c/p\u003e\n \u003cp\u003e20(66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30(100%)\u003c/p\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u003c/sup\u003e=30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026lt;0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: Standard deviation\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003et: Independent t test, \u003cstrong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e:Chi square test, NS: Non significant (P\u0026gt;0.05) **: Highly significant (P\u0026lt;0.001) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2):\u0026nbsp;\u003c/strong\u003eClinical and radiological data of the studied cases groups:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 322px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eCases\u003c/p\u003e\n \u003cp\u003e(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eSNAPPE II:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; Sd\u003c/p\u003e\n \u003cp\u003eMedian (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e20.93\u0026plusmn;13.89\u003c/p\u003e\n \u003cp\u003e14.5 (5-49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 322px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eChest X ray:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eG II\u003c/p\u003e\n \u003cp\u003eG III\u003c/p\u003e\n \u003cp\u003eG IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eSilverman score:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003eSever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: Standard deviation\u003cstrong\u003e\u0026nbsp;,\u0026nbsp;\u003c/strong\u003eSNAPPE II :Score for Neonatal Acute Physiology II.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3):\u0026nbsp;\u003c/strong\u003eManagement data of the studied groups:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"580\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 389px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eCases\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eType of resp support:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCPAP\u003c/p\u003e\n \u003cp\u003eM.Vent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eSupport duration: (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; Sd\u003c/p\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e7.03\u0026plusmn;7.07\u003c/p\u003e\n \u003cp\u003e4.5(1-31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eTotal Oxygen duration: (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; Sd\u003c/p\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e13.43\u0026plusmn;11.54\u003c/p\u003e\n \u003cp\u003e8.5(4-45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOther treatment:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eAntibiotic\u003c/p\u003e\n \u003cp\u003eCaffeine\u003c/p\u003e\n \u003cp\u003eInotrops\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: Standard deviation\u003cstrong\u003e\u0026nbsp; \u0026nbsp;,\u003c/strong\u003e M.Vent: mechanical ventilator\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (4):\u0026nbsp;\u003c/strong\u003eclinical outcome data of the studied groups:\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 278px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003eCases\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(n=30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eComplications:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10.59\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eType:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eApnea\u003c/p\u003e\n \u003cp\u003eNEC\u003c/p\u003e\n \u003cp\u003epneumothorax\u003c/p\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003cp\u003e23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eHospital stay: (day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; Sd\u003c/p\u003e\n \u003cp\u003eMedian (Range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e15.27\u0026plusmn;12.16\u003c/p\u003e\n \u003cp\u003e11(5-48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.47\u0026plusmn;1.07\u003c/p\u003e\n \u003cp\u003e2 (0-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMW\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e6.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eOutcome:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003efavorable\u003c/p\u003e\n \u003cp\u003eunfavorable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSD: Standard deviation\u003cstrong\u003e, \u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e:Chi square test, MW: Mann Whitney test, *: Significant (P\u0026lt;0.05), **: Highly significant (P\u0026lt;0.001) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5)\u003c/strong\u003e: Comparison between favorable and unfavorable outcome neonates among RDS cases (n = 30)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUnfavorable\u003cstrong\u003e\u0026nbsp;(n = 6) No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFavorable\u003cstrong\u003e\u0026nbsp;(n = 24) No. (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age (weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.30 \u0026plusmn; 1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.04 \u0026plusmn; 1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.50 (27.0\u0026ndash;32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34.50 (31.0\u0026ndash;36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 3.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.176 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.51 \u0026plusmn; 0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.58 (1.35\u0026ndash;2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.44 (1.84\u0026ndash;3.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eConsanguinity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 4.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.50 \u0026plusmn; 5.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.75 \u0026plusmn; 6.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.0 (20.0\u0026ndash;33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.0 (19.0\u0026ndash;41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 1.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMode of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 1.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (95.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAntenatal steroid use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 4.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAPGAR (1 min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eU = 19.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.83 \u0026plusmn; 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.33 \u0026plusmn; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.0 (4.0\u0026ndash;6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.0 (4.0\u0026ndash;8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAPGAR (5 min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eU = 3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.75 \u0026plusmn; 0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.70 \u0026plusmn; 0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6.0 (5.0\u0026ndash;6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.0 (6.0\u0026ndash;9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSurfactant use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCXR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 9.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGrade II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGrade III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGrade IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSilverman score\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e6 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (25.0)\u003c/p\u003e\n \u003cp\u003e10 (41.7)\u003c/p\u003e\n \u003cp\u003e8 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026chi;\u0026sup2; = 9.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSNAPPE II\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eU = 2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43.0 \u0026plusmn; 4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42.50 (37.0\u0026ndash;49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.0 (5.0\u0026ndash;41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u0026nbsp;\u003c/p\u003e\n \u003cp\u003epH\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePO₂\u003c/p\u003e\n \u003cp\u003eHCO₃\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.20 \u0026plusmn; 0.02\u003c/p\u003e\n \u003cp\u003e74.67 \u0026plusmn; 9.20\u003c/p\u003e\n \u003cp\u003e18.43 \u0026plusmn; 2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003e7.31 \u0026plusmn; 0.05\u003c/p\u003e\n \u003cp\u003e75.92 \u0026plusmn; 6.98\u003c/p\u003e\n \u003cp\u003e20.50 \u0026plusmn; 2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003et = 9.061\u003c/p\u003e\n \u003cp\u003et = 0.409\u003c/p\u003e\n \u003cp\u003et = 1.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\n \u003cp\u003e0.686\u003c/p\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.33 \u0026plusmn; 15.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.75 \u0026plusmn; 5.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eU = 12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.0 (6.0\u0026ndash;48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.50 (2.0\u0026ndash;25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAlbumin\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003cp\u003eMedian (Min\u0026ndash;Max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.60 \u0026plusmn; 0.13\u003c/p\u003e\n \u003cp\u003e2.55 (2.50\u0026ndash;2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.02 \u0026plusmn; 0.33\u003c/p\u003e\n \u003cp\u003e3.0 (2.60\u0026ndash;3.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eU = 12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: \u003cstrong\u003eStandard deviation\u003c/strong\u003e \u003cstrong\u003et: Student t-test \u0026nbsp; \u0026nbsp;U: Mann Whitney test \u0026nbsp;\u003c/strong\u003ec\u003csup\u003e2\u003c/sup\u003e:\u003cstrong\u003e\u0026nbsp;Chi square test FE: Fisher Exact test MC: Monte Carlo\u003csup\u003e\u0026nbsp;\u003c/sup\u003etest\u0026nbsp;\u003c/strong\u003ep: p value for comparison between the studied categories \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e*: Statistically significant at p \u0026le; 0.05 \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (6):\u0026nbsp;\u003c/strong\u003eValidity of Albumin in prediction of unfavorable outcome of RDS among the studied groups:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"703\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eAlbumin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eCut off\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 93px;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003cp\u003e(CI 95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003ePPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eNPV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eAccuracy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eoutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003cp\u003e(0.76-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e96.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e96.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAUC: Area under curve, CI: Confidence interval, PPV:+ve predicted value, NPV:-ve predicted value, *: significant (P\u0026lt;0.05), **:Highly Significant (P\u0026lt;0.001),\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (7):\u0026nbsp;\u003c/strong\u003eCorrelation between Albumin and different parameters among the studied cases group:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"585\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 238px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlbumin (n=30)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age (week)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.52\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (Kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.62\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.94 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApgar score 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.52 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApgar score 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.88 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSNAPPE II\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.39 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupport duration (day)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e-0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.11 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Total oxygen duration (d)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.37\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003epH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.13 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCO\u003csub\u003e3\u003c/sub\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.40\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePO\u003csub\u003e2\u003c/sub\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.23 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePCO\u003csub\u003e2\u003c/sub\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.78 NS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 347px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay (Day)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.05*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003er: Spearman\u0026rsquo;s or Pearson\u0026rsquo;s correlation coefficient, NS: Non significant (P\u0026gt;0.05), *: Significant (P\u0026lt;0.05), **: Highly significant (P\u0026lt;0.001) \u0026nbsp;SNAPPE II :Score for Neonatal Acute Physiology II,\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Preterm infants, respiratory distress syndrome, serum albumin, biomarkers","lastPublishedDoi":"10.21203/rs.3.rs-8757733/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8757733/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground and objectives:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA leading cause of morbidity and mortality among preterm newborns is respiratory distress syndrome (RDS), even though there have been breakthroughs in therapy such as surfactants, prenatal corticosteroids, and advanced neonatal respiratory care. The purpose of this study was to assess blood albumin levels in preterm infants with RDS and ascertain its role in detection of clinical outcome.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA prospective cross sectional case\u0026ndash;control study was conducted at the NICU of Suez Canal University Hospital, Egypt, from March 2023 to March 2024. Sixty preterm neonates were enrolled: 30 with RDS and 30 healthy controls matched for gestational age and birth weight. All infants underwent clinical assessment, laboratory testing, and radiological evaluation. Serum albumin levels were measured, and correlations with disease severity, mechanical ventilation, clinical outcome and mortality were analyzed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSerum albumin levels were significantly lower in RDS cases and negatively correlated with oxygen duration and hospital stay. Albumin\u0026thinsp;\u0026lt;\u0026thinsp;2.55 g/dL predicted poor outcome (sensitivity 96.7%).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSerum albumin is a biomarker for predicting clinical outcomes in preterm infants with RDS.\u003c/p\u003e","manuscriptTitle":"Prognostic Utility of Serum Albumin in Neonates with Respiratory Distress Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-05 08:27:08","doi":"10.21203/rs.3.rs-8757733/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"918c91d5-4914-4494-b410-15fe6c7c0045","owner":[],"postedDate":"February 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-03T06:10:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-05 08:27:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8757733","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8757733","identity":"rs-8757733","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}