A scoring system to predict chronic oxygen dependency
Caroline May1, Valia Kavvadia, Gabriel Dimitriou
1Division of Asthma, Allergy and Lung Biology, King's College London School of Medicine, Guy's, King's College and St Thomas' Hospitals, London, UK.
Insights
A new scoring system accurately predicts chronic oxygen dependency in premature infants. This simple test aids in targeting interventions to prevent long-term respiratory issues in newborns.
Area of Science:
- Neonatology
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Chronic oxygen dependency (COD) is a frequent complication in extremely premature infants.
- Early identification of infants at risk for COD is crucial for timely interventions.
- Current predictive methods may lack simplicity or accuracy.
Purpose of the Study:
- To develop and validate a simple predictive score for chronic oxygen dependency (COD).
- To assess the score's efficacy in predicting COD at different post-menstrual ages.
Main Methods:
- A combined retrospective (136 infants) and prospective (75 infants) study design.
- A novel scoring system based on inspired oxygen concentration and respiratory support level was developed.
- Predictive accuracy was compared to inspired oxygen levels and lung volume measurements.
Main Results:
- Infants who developed COD had significantly higher scores on days 2 and 7 (p<0.0001).
- The developed score demonstrated superior predictive performance compared to inspired oxygen levels and lung volumes.
- A day 7 score >0.323 showed high specificity (95%) and sensitivity (78%) for predicting COD at 28 days.
Conclusions:
- A straightforward scoring system effectively predicts chronic oxygen dependency in premature infants.
- This tool can aid clinicians in identifying at-risk neonates for targeted interventions.
- The score offers a simple yet accurate method for predicting long-term respiratory outcomes.
Introduction:
Chronic oxygen dependency (COD) is a common adverse outcome of very premature birth. It is, therefore, important to develop an accurate and simple predictive test to facilitate targeting of interventions to prevent COD. Our aim was to determine if a simple score based on respiratory support requirements predicted COD development.
Methods:
A retrospective study of 136 infants, median gestation age (GA) 28 weeks (range: 23-33 weeks) and a prospective study of 75 infants, median GA 30 weeks (range: 23-32 weeks), were performed. The score was calculated by multiplying the inspired oxygen concentration by the level of respiratory support (mechanical ventilation: 2.5; continuous positive airway pressure: 1.5; nasal cannula or head box oxygen or air: 1.0). Scores were calculated on data from days 2 and 7, and their predictive ability compared to that of the maximum inspired oxygen concentration at those ages and (retrospective study) the results of lung volume measurement.
Results:
Infants that were oxygen dependent at 28 days and 36 weeks post-menstrual age (PMA) had higher scores on days 2 (p<0.0001, p<0.0001, respectively) and 7 (p<0.0001, p<0.0001, respectively) than the non-oxygen dependent infants in both the retrospective and prospective cohorts. Construction of receiver operator characteristic curves demonstrated the score performed better than the inspired oxygen level and lung volume measurement results. A score on day 7 >0.323 had 95% specificity and 78% sensitivity in predicting COD at 28 days, and 80% specificity and 73% sensitivity in predicting COD at 36 weeks PMA.
Conclusion:
Chronic oxygen dependency can be predicted using a simple scoring system.
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