Abstract
This study aimed to assess the prognostic value of the lung ultrasound score (LUS) and serum miR-486-3p in neonatal acute respiratory distress syndrome (ARDS) and to explore the underlying mechanism. A total of 112 neonates with ARDS and 100 healthy infants born during the same period were enrolled in the study and healthy control groups, respectively. Each neonate underwent lung ultrasound within 6 h of admission to the intensive care unit and was evaluated for LUS. Real-time quantitative PCR was used to quantify gene expression, while receiver operating characteristic (ROC) curve and Pearson's correlation analyses were performed to evaluate prognostic performance and correlations. Furthermore, an in vitro ARDS model was established using HPMECs to investigate the underlying mechanism of miR-486-3p. A dual-luciferase reporter assay was performed to verify the target relationship between miR-486-3p and Delta-Like Canonical Notch Ligand 4 (DLL4). The results revealed that LUS and serum miR-486-3p were significantly upregulated in neonates with ARDS. ROC curve analysis showed that both miR-486-3p and LUS could predict the neonatal prognosis of ARDS (AUC = 0.883 and 0.873, sensitivity: 96.4% and 89.3%, specificity: 77.4% and 73.8%, respectively), and miR-486-3p combined with LUS had a better prediction effect (AUC = 0.929, sensitivity: 92.9%, specificity: 84.5%). Mechanistically, miR-486-3p targeted DLL4 to regulate the biological functions of ARDS model cells. Taken together, the combined assessment of LUS and serum miR-486-3p may serve as a promising approach for evaluating disease severity and predicting prognosis in neonates with ARDS. Further multi-center validation is still needed to confirm its general applicability.