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Background <p>Neonatal respiratory distress syndrome (NRDS) is a common and potentially life-threatening complication in preterm infants. Current diagnosis relies largely on imaging modalities such as chest X-ray and lung ultrasound, which may not be immediately available after birth. Therefore, accessible biomarkers for early risk stratification are clinically needed. This study investigated the association between the systemic immune-inflammation index (SII), derived from routine complete blood count within 1&#xa0;h after birth, and the risk of NRDS in preterm infants.</p> Methods <p>This retrospective study reviewed clinical data from 451 preterm infants admitted to a tertiary maternal and child health-care hospital in eastern China between January and December 2024. Infants were classified into NRDS and non-NRDS groups. Variables associated with NRDS were screened using univariate analysis and entered into multivariate logistic regression to identify independent predictors, with particular emphasis on SII as a predictive biomarker rather than a direct risk factor. Predictive models incorporating SII with established clinical predictors—gestational age (GA) and birth weight (BW)—were constructed, and their performance was evaluated using receiver operating characteristic (ROC) curve analysis. Gestational age-stratified analyses were further performed (28–32, 32–34, and 34–36&#xa0;weeks). In infants born at 28–32&#xa0;weeks, the modifying effect of infection-related factors was explored using premature rupture of membranes (PROM &gt; 18&#xa0;h).</p> Results <p>A total of 403 preterm infants met the inclusion criteria. Multivariate analysis identified GA, peripheral blood glucose, mild asphyxia, HDP, and SII as independent predictors of NRDS (<i>P</i> &lt; 0.05). The combined model including GA, BW, and SII demonstrated the best predictive performance (AUC = 0.809). Gestational age–stratified analysis showed that SII had the highest predictive value in infants born at 28–32&#xa0;weeks (AUC = 0.771), with declining performance at higher gestational ages. In this subgroup, SII levels and the incidence of premature rupture of membranes (PROM) differed significantly between NRDS and non-NRDS infants, indicating gestational age–specific effects.</p> Conclusion <p>SII is independently associated with NRDS in preterm infants and serves as a valuable predictive biomarker, with its predictive value predominantly observed in those born at 28–32&#xa0;weeks of gestation. Incorporating SII with gestational age and birth weight improves early risk stratification for NRDS.</p>

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Association between the systemic immune-inflammation index within 1 h after birth and the risk of neonatal respiratory distress syndrome in preterm infants

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Jian Li,
  • Liwei Fang,
  • Chao Tan

摘要

Background

Neonatal respiratory distress syndrome (NRDS) is a common and potentially life-threatening complication in preterm infants. Current diagnosis relies largely on imaging modalities such as chest X-ray and lung ultrasound, which may not be immediately available after birth. Therefore, accessible biomarkers for early risk stratification are clinically needed. This study investigated the association between the systemic immune-inflammation index (SII), derived from routine complete blood count within 1 h after birth, and the risk of NRDS in preterm infants.

Methods

This retrospective study reviewed clinical data from 451 preterm infants admitted to a tertiary maternal and child health-care hospital in eastern China between January and December 2024. Infants were classified into NRDS and non-NRDS groups. Variables associated with NRDS were screened using univariate analysis and entered into multivariate logistic regression to identify independent predictors, with particular emphasis on SII as a predictive biomarker rather than a direct risk factor. Predictive models incorporating SII with established clinical predictors—gestational age (GA) and birth weight (BW)—were constructed, and their performance was evaluated using receiver operating characteristic (ROC) curve analysis. Gestational age-stratified analyses were further performed (28–32, 32–34, and 34–36 weeks). In infants born at 28–32 weeks, the modifying effect of infection-related factors was explored using premature rupture of membranes (PROM > 18 h).

Results

A total of 403 preterm infants met the inclusion criteria. Multivariate analysis identified GA, peripheral blood glucose, mild asphyxia, HDP, and SII as independent predictors of NRDS (P < 0.05). The combined model including GA, BW, and SII demonstrated the best predictive performance (AUC = 0.809). Gestational age–stratified analysis showed that SII had the highest predictive value in infants born at 28–32 weeks (AUC = 0.771), with declining performance at higher gestational ages. In this subgroup, SII levels and the incidence of premature rupture of membranes (PROM) differed significantly between NRDS and non-NRDS infants, indicating gestational age–specific effects.

Conclusion

SII is independently associated with NRDS in preterm infants and serves as a valuable predictive biomarker, with its predictive value predominantly observed in those born at 28–32 weeks of gestation. Incorporating SII with gestational age and birth weight improves early risk stratification for NRDS.