{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:53:46Z","timestamp":1791262426298,"version":"4.1.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017949","name":"Health Commission of Shanxi Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017949","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and internally evaluate a model that uses maternal blood markers obtained before delivery to differentiate neonatal acute respiratory distress syndrome (ARDS) from other causes of respiratory distress in late-preterm and term neonates requiring mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study enrolled 227 mother-infant pairs from two tertiary hospitals between June 2024 and January 2026. Neonates born at 34\u201340 weeks\u2019 gestation with ventilation-dependent respiratory distress were divided into a training cohort and an internal test cohort. Predictors were screened using elastic-net regression with 1,000 bootstrap resamples. Four feature sets and six algorithms were then compared by 20 repeats of stratified five-fold cross-validation, and a six-predictor random forest (RF) was ultimately selected. Discrimination, calibration and net benefit were assessed, with 500-resample bootstrap optimism correction and Shapley additive explanation (SHAP) interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Maternal systemic immune-inflammation index (SII) and related inflammatory ratios were higher, and antenatal infection was more frequent, in the ARDS group, whereas recorded antenatal corticosteroid (ACS) use was less frequent (P &amp;lt; 0.001). Six predictors were retained in the final model: SII, antenatal infection, maternal age, gestational hypothyroidism, gestational diabetes mellitus and ACS use. The principal internal performance estimate, the mean training-set cross-validated area under the curve (AUC) was 0.729 \u00b1 0.080, the fixed-pipeline optimism-corrected AUC was 0.793 and the internal test-set AUC was 0.827 (95% CI, 0.712\u20130.923), with an average precision of 0.828 and a Brier score of 0.175. These three values are not interchangeable and are reported as one principal and two secondary estimates, and none represents fully independent performance. At the training-derived threshold of 0.424, sensitivity was 78.8% and specificity 77.8%. SHAP identified SII as the largest contributor, without implying a causal effect for any predictor. Logistic regression using the same six predictors reached a numerically higher internal test-set AUC (0.838 versus 0.827, \u0394AUC = \u22120.011, P\u00a0=\u00a00.744) and a cross-validated AUC of 0.706 \u00b1 0.082 versus 0.729 \u00b1 0.080, the RF therefore conferred no discriminative advantage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In mechanical ventilation needed neonates born at 34\u201340 weeks' gestation with respiratory distress, the six-predictor RF showed moderate discrimination, whereas evidence of adequate calibration was limited. The model remains preliminary and requires external validation, recalibration and prospective clinical-impact evaluation before clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1889452","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:24:58Z","timestamp":1791260698000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A predictive model based on maternal immune-inflammatory markers for ARDS identification in mechanically ventilated late-preterm and term neonates"],"prefix":"10.3389","volume":"17","author":[{"given":"Chao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pediatric, Peking University Third Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Jing","sequence":"additional","affiliation":[{"name":"First Clinical Medical College of Shanxi 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China"]},{"name":"Department of Neonatal Intensive Care, First Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinmiao","family":"Yang","sequence":"additional","affiliation":[{"name":"First Clinical Medical College of Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Department of Neonatal Intensive Care, First Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Neonatal Intensive Care, Shanxi Children's Hospital (Maternal and Child Health Hospital & Obstetrics and Gynecology Hospital)","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaiqing","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Neonatal Intensive Care, First Hospital of Shanxi Medical 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