{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:24:16Z","timestamp":1789691056270,"version":"4.0.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Method<\/jats:title>\n                <jats:p>The data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Multivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR]\u2009=\u20091.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR\u2009=\u20091.17, 95% CI [1.06, 1.29]), cesarean section (aOR\u2009=\u20091.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR\u2009=\u20091.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR\u2009=\u20091.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR\u2009=\u20090.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR\u2009=\u20090.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Maternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12887-024-05138-7","type":"journal-article","created":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T09:02:34Z","timestamp":1729760554000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Risk factors for refractory respiratory distress syndrome among very-low-birth-weight infants"],"prefix":"10.1186","volume":"24","author":[{"given":"Jeongmin","family":"Shin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Won","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Kook","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,24]]},"reference":[{"issue":"6","key":"5138_CR1","first-page":"463","volume":"31","author":"Z Eras","year":"2014","unstructured":"Eras Z, Zeybek C, Akansel R, Yildirim S, Simsek DG, Turkyilmaz C, et al. 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