The Shenzhen Neonatal ARDS Cohort Study (SZ-NARDS): A Multi-Omics Approach to Elucidating Regional Epidemiology, Refined Phenotypes, and Long-Term Outcomes

Ruolin Zhang¹Jie Shen¹Linying Yang²Yanzhen Xu³Yanping Guo⁴Lichun Bai⁵Hanni Lin⁶Xianhong Chen⁷Yan Huang⁸Xin Guo⁹Zhangbin Yu³Jinxing Feng^10*Jun Chen^11*

• ¹Department of Neonatology, Nanshan Maternity and Child Health Care Hospital, Shenzhen, China
• ²Department of Neonatology, Shenzhen Children's Hospital, Shenzhen, China
• ³Department of Neonatology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
• ⁴Department of Neonatology, Peking University Shenzhen Hospital, Shenzhen, China
• ⁵Department of Neonatology, Shenzhen Guangming District People's Hospital, Shenzhen, China
• ⁶Department of Neonatology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, China
• ⁷Department of Neonatology, Longgang District Central Hospital of Shenzhen, Shenzhen, China
• ⁸Neonatology, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
• ⁹Department of Neonatology, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
• ¹⁰Department of Neonatology, Shenzhen Children's Hospital, Shenzhen, Shenzhen, China
• ¹¹Department of Neonatology, Shenzhen Nanshan Maternity and Child Healthcare Hospital, Shenzhen, China

Neonatal Acute Respiratory Distress Syndrome (NARDS) is a critical contributor to neonatal morbidity and mortality, with a global health burden that varies significantly by region. The Montreux definition provides a unified diagnostic framework; however, a significant clinical paradox exists. A prospective cohort in China reported a NARDS mortality rate of 12.6%, which is notably lower than the 17-24% reported in a large-scale international prospective study. The underlying reasons for this discrepancy remain to be elucidated, whether due to differences in etiology, clinical practice, or patient demographics. Methods: The Shenzhen Neonatal ARDS Cohort Study (SZ-NARDS) is a prospective, multicenter observational cohort study spanning from 2025 to 2028, designed to address this knowledge gap. We will enroll more than 1,000 neonates who meet the Montreux criteria across nine tertiary neonatal intensive care units (NICUs) in Shenzhen, China. Longitudinal data collection includes granular clinical parameters, respiratory support metrics, and multi-modal biospecimens for deep phenotyping and multi-omics profiling. Survivors will undergo rigorous follow-up until 36 months' corrected age, with standardized neurodevelopmental, pulmonary, and growth assessments. Results: The primary objective of this study is to characterize the epidemiology of NARDS in this regional population and to test the following hypotheses: (1) The true incidence, etiology, and mortality rates of NARDS in Shenzhen will differ from existing international and Chinese cohorts, and these differences can be systematically explained by specific clinical and demographic factors. A multimodal predictive model that integrates early clinical variables with multi-omics biomarkers has the potential to accurately identify neonates at high risk for severe NARDS (oxygenation index (OI) ≥ 16) and long-term adverse outcomes (Area Under the Receiver Operating Characteristic Curve (AUROC) > 0.85). Conclusions: The SZ-NARDS cohort is uniquely positioned to resolve a major clinical contradiction in NARDS epidemiology. By integrating deep phenotyping with a longitudinal biobank and advanced machine learning algorithms, this initiative will generate a comprehensive dataset. This dataset will serve to refine existing prognostic models, identify regional disparities in disease biology, and inform the development of precision medicine interventions for this vulnerable population. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2400093854.