Background: Respiratory distress syndrome (RDS) is a common clinical condition in preterm infants, complicated by pulmonary inflammation and edema. Early identification remains challenging due to limitations in conventional diagnostics. This study aims to explore the clinical significance of pulse oximetry monitoring in predicting RDS in low birth weight (LBW) neonates.

Methods: This retrospective analysis included 140 LBW neonates admitted to Zhongshan Hospital of Xiamen University between February 2022 and March 2023. The patients were divided into an RDS group (n = 51) and a non-RDS group (n = 89) based on the RDS diagnostic criteria. Furthermore, based on the severity of RDS, they were categorized into mild, moderate, and severe RDS subgroups. Additionally, based on surfactant therapy, patients in the RDS group were divided into the surfactant and non-surfactant subgroups. Baseline clinical characteristics were compared between the two groups. Similarly, pulse oximetry, heart rate, and respiratory rate were analyzed among the patients. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for RDS diagnosis. The clinical significance of combined heart rate, respiratory rate, 1-minute Apgar score, and the ratio of peripheral oxygen saturation to fraction of inspired oxygen (SpO₂/FiO₂) in predicting RDS was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Compared to the non-RDS group, the RDS group had significantly higher heart rate and respiratory rate at 6 h (p < 0.001) and lower SpO₂ and SpO₂/FiO₂ (p = 0.017, p < 0.001). Additionally, the surfactant group showed a significantly higher SpO₂/FiO₂ ratio at 6 h, 12 h, and 24 h, compared to the non-surfactant group (p < 0.05). Multivariate logistic regression analysis identified heart rate (p = 0.042) and respiratory rate (p = 0.009), as independent risk factors, while 1-minute Apgar score (p = 0.037) and SpO₂/FiO₂ (6 h) (p = 0.005) were identified as independent protective factors for predicting RDS in LBW neonates. The ROC curve analysis revealed that the combined prediction model had an area under the curve of 0.995.

Conclusion: In conclusion, heart rate and respiratory rate were identified as independent risk factors, whereas 1-minute Apgar score and SpO₂/FiO₂ were independent protective factors for RDS in LBW neonates. The combined predictive model shows reliable diagnostic performance, underscoring the clinical significance of pulse oximetry monitoring in early RDS identification.