Prognostic Models for Stillbirth and Neonatal Death in Very Preterm Birth: A Validation Study (original) (raw)

Prognostic model for predicting survival in very preterm infants: an external validation study

Bjog: An International Journal Of Obstetrics And Gynaecology, 2021

Objective To perform a temporal and geographical validation of a prognostic model, considered of highest methodological quality in a recently published systematic review, for predicting survival in very preterm infants admitted to the neonatal intensive care unit. The original model was developed in the UK and included gestational age, birthweight and gender. Design External validation study in a population-based cohort. Setting Dutch neonatal wards. Population or sample All admitted white, singleton infants born between 23 +0 and 32 +6 weeks of gestation between 1 January 2015 and 31 December 2019. Additionally, the model's performance was assessed in four populations of admitted infants born between 24 +0 and 31 +6 weeks of gestation: white singletons, non-white singletons, all singletons and all multiples. Methods The original model was applied in all five validation sets. Model performance was assessed in terms of calibration and discrimination and, if indicated, it was updated. Main outcome measures Calibration (calibration-in-the-large and calibration slope) and discrimination (c statistic). Results Out of 6092 infants, 5659 (92.9%) survived. The model showed good external validity as indicated by good discrimination (c statistic 0.82, 95% CI 0.79-0.84) and calibration (calibration-inthe-large 0.003, calibration slope 0.92, 95% CI 0.84-1.00). The model also showed good external validity in the other singleton populations, but required a small intercept update in the multiples population. Conclusions A high-quality prognostic model predicting survival in very preterm infants had good external validity in an independent, nationwide cohort. The accurate performance of the model indicates that after impact assessment, implementation of the model in clinical practice in the neonatal intensive care unit could be considered.

Prediction of Mortality in Very Premature Infants: A Systematic Review of Prediction Models

PLoS ONE, 2011

Context: Being born very preterm is associated with elevated risk for neonatal mortality. The aim of this review is to give an overview of prediction models for mortality in very premature infants, assess their quality, identify important predictor variables, and provide recommendations for development of future models. Methods: Studies were included which reported the predictive performance of a model for mortality in a very preterm or very low birth weight population, and classified as development, validation, or impact studies. For each development study, we recorded the population, variables, aim, predictive performance of the model, and the number of times each model had been validated. Reporting quality criteria and minimum methodological criteria were established and assessed for development studies. Results: We identified 41 development studies and 18 validation studies. In addition to gestational age and birth weight, eight variables frequently predicted survival: being of average size for gestational age, female gender, non-white ethnicity, absence of serious congenital malformations, use of antenatal steroids, higher 5-minute Apgar score, normal temperature on admission, and better respiratory status. Twelve studies met our methodological criteria, three of which have been externally validated. Low reporting scores were seen in reporting of performance measures, internal and external validation, and handling of missing data. Conclusions: Multivariate models can predict mortality better than birth weight or gestational age alone in very preterm infants. There are validated prediction models for classification and case-mix adjustment. Additional research is needed in validation and impact studies of existing models, and in prediction of mortality in the clinically important subgroup of infants where age and weight alone give only an equivocal prognosis.

Antenatal prediction of neonatal mortality in very premature infants

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2014

Preterm birth is the leading cause of neonatal morbidity and mortality in high income countries [1], and is estimated to be responsible for a million neonatal deaths worldwide each year [2]. The consequences of preterm birth arise from the fact that the immature organ systems of the neonate are not yet prepared to support extrauterine life. This is expressed in respiratory insufficiency, intracranial hemorrhage and infections. The impact of very preterm birth, defined as birth before 32 completed weeks of gestation, on neonatal morbidity and mortality risk is dependent on the actual length of gestation, as the risk decreases when pregnancy progresses [3-5]. The risk of neonatal complications in very preterm birth influences antenatal clinical decision-making concerning the administration of tocolytics/corticosteroids and/or referral to a 3rd level perinatal centre [6,7]. Prediction models can be a helpful tool for clinicians working in perinatal care [8-10]. To assess the risk of neonatal mortality in infants born very preterm there are around 40 prediction models available to clinicians [11]. Medlock et al. systematically reviewed all these prediction models and found that besides gestational age and birth weight, several other variables were recurrently found to be independent predictors for neonatal mortality after very preterm birth. These predictors were: being small for gestational age (SGA), male gender, white ethnicity, congenital anomalies, no use of antenatal corticosteroids, lower Apgar score, neonatal hypoor hyper-thermia at time of admission and clinical or biochemical signs of respiratory insufficiency [11]. The majority of these prediction models were only applicable after birth as they included predictors that are not known antenatally, like birth weight, SGA

Survival Predictors of Preterm Neonates - Single Center Experience

Albanian Journal of Trauma and Emergency Surgery

Introduction: Adequate prenatal and postnatal care for preterm neonates not only affects the survival rate, but also the occurrence of chronic diseases, and in the future also affects the quality of life of that children. Aim: To examine the influence of independent predictors (weeks of gestation, body weight, sex) on the outcome of the disease and to analyze the influence of the applied ventilatory mode on the final outcome of treatment. Material and methods: The study included neonates (n = 248) born prematurely who were treated in the neonatal intensive care unit for a period of one year due to immaturity-related difficulties. Results: The mean age of male neonates (n = 119) at birth was 31.13 ± 3.3 weeks of gestation (WG), and females (n = 129) 31.59 ± 3.2 WG. Weeks of gestation have a statistically significant effect on survival (p = 0.0001), for each more week of gestation, the chances of survival increase by 21%. There was no significant difference between birth weight and s...

External validation of inpatient neonatal mortality prediction models in high-mortality settings

Objectives: To evaluate the predictive accuracy of two neonatal prediction models in predicting all cause in-hospital mortality following patient admission. These models (The Neonatal Essential Treatment Score (NETS) which used treatments prescribed at admission, and the Score for Essential Neonatal Symptoms and Signs (SENSS) which used basic clinical signs), were derived in high-mortality, low-resource settings and are reflective of low-income countries’ clinical settings. Study design and settings: We used retrospectively collected routine clinical data recorded by duty clinicians at admission from 15 hospitals to externally validate and update the SENSS and NETS models to predict in-hospital mortality. Model performance was evaluated by assessing discrimination and calibration. Results: At initial external validation, the calibration intercept for NETS and SENSS was -1.109 (95% CI: -1.148 to -1.069) and -0.703 (95% CI: -0.738 to -0.669) respectively; The calibration slope for NET...

Model that predicted death or disabilities in premature infants was valid at seven years of age

Acta Paediatrica, 2018

Validated a model that used bronchopulmonary dysplasia (BPD), brain injuries measured using ultrasound and retinopathy of prematurity (ROP) to predict late death or disability in premature infants at seven years of age. Methods A retrospective study was performed at the 12 de Octubre Hospital neonatal unit in Madrid. A logistic model was applied to estimate the independent prognostic contribution of each morbidity and the effect that the combination of morbidities had on the seven-year outcomes. The analysis was performed on the total cohort from

Outcome Trajectories in Extremely Preterm Infants

PEDIATRICS, 2012

Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas that of respiratory illness severity increases with advancing postnatal age. abstract OBJECTIVE: Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization. METHODS: Data on infants with birth weight #1.0 kg admitted to 18 large academic tertiary NICUs during 1998-2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months. RESULTS: Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30. CONCLUSIONS: Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual "outcome trajectories" and evaluate impact of possible morbidities on outcome. Pediatrics 2012;130:e115-e125

What we have learned about antenatal prediction of neonatal morbidity and mortality

Seminars in Perinatology, 2003

When extremely preterm birth is anticipated, a reliable estimate of neonatal outcome is essential for the parents and health care providers who face difficult management decisions. Estimates of birth weight and gestational age are most commonly used for this purpose. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (NICHD MFMU) Network performed an observational study of data available before delivery of infants with birth weights <1000 g. Ultrasonographic variables (estimated fetal weight, obstetrically estimated gestational age, femur length, and biparietal diameter) and clinical variables (maternal race, antenatal care, substance abuse, medical treatment, reason for delivery, fetal gender, and presentation) were studied as predictors of intrapartum stillbirth, neonatal death, survival to 120 days after birth or to discharge, and with markers of "serious" morbidity (high-grade intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, oxygen dependence at discharge or 120 days, and seizures). Survival without serious morbidity was considered "intact." Logistic regression was used to evaluate the influence of the obstetrician's opinion of viability and willingness to perform cesarean delivery for fetal distress, birth weight, growth, gender, presentation, and ethnicity on outcomes. Fetal femur length and estimated gestational age predicted survival better than did biparietal diameter or estimated fetal weight. Antenatal ultrasound and clinical data did not distinguish those infants who would suffer serious morbidity or be considered intact. Willingness to perform cesarean delivery was associated with increased likelihood of both survival and intact survival by virtually eliminating intrapartum stillbirth and reducing neonatal mortality. However, such practice was associated with an increased chance of serious morbidity among survivors below 800 g or 26 weeks'. Although obstetricians were willing to intervene for fetal indications in most cases by 24 weeks', willingness to perform cesarean delivery was associated with twice the risk for serious morbidity in survivors at that gestational age.