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Predicting death or major neurodevelopmental disability in extremely preterm infants born in Australia
Rosemarie A Boland1, Peter G Davis, Jennifer A Dawson
1Newborn Research, 7th Floor, The Royal Women's Hospital, Locked Bag 300, Parkville, Victoria 3052, Australia. rose.boland@netsvic.org.au
Insights
The National Institute of Child Health and Human Development (NICHD) calculator accurately predicts mortality in Australian inborn infants born at 22-25 weeks gestation. However, it is less precise for outborn infants and overestimates combined death or disability outcomes.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- The National Institute of Child Health and Human Development (NICHD) developed a calculator to predict outcomes for premature infants.
- Assessing the validity of this calculator for contemporary Australian populations is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the accuracy of the NICHD calculator in predicting mortality and neurosensory disability in Australian infants born between 22 and 25 weeks' gestation.
- To compare the calculator's predictions with actual outcomes in a contemporary cohort.
Main Methods:
- Data from 114 infants born in Victoria, Australia, in 2005 (22-25 weeks gestation, 401-1000g birth weight, no lethal anomalies) were analyzed.
- Predicted outcomes from the NICHD online calculator were compared against actual outcomes at 2 years of age.
Main Results:
- The calculator showed good predictive accuracy for mortality in inborn infants (AUC 0.803), comparable to the original NICHD study.
- Predictive accuracy for mortality was lower for outborn infants (AUC 0.643).
- The calculator overestimated the combined outcome of death or major disability (predicted 72.0% vs. actual 60.5%).
Conclusions:
- The NICHD calculator is a useful tool for predicting mortality in inborn infants of 22-25 weeks gestation in Australia.
- Its precision is reduced for outborn infants.
- The calculator tends to overestimate the combined risk of death or major disability.
Background:
The aim of this study was to determine if the National Institute of Child Health and Human Development (NICHD) calculator, designed to predict mortality or neurosensory disability in infants 22-25 weeks' gestation, was valid for contemporary Australian infants.
Method:
Outcome data at 2 years of age for 114 infants who were liveborn in Victoria, Australia, in 2005, between 22 and 25 completed weeks' gestation, weighing 401-1000 g at birth, and free of lethal anomalies, were entered into the NICHD online calculator. Predicted outcomes were then compared with the actual outcomes.
Results:
Of the 114 infants, 99 (87%) were inborn and 15 (13%) were outborn. The overall prediction of death for inborn infants was 47.1% compared with the actual death rate to 2 years of age of 49.5%. The area under the curve (AUC) was 0.803 (95% CI 0.718 to 0.888; p<0.001) for mortality, comparable with the AUC for the NICHD study (AUC: 0.753; 95% CI 0.737 to 0.769; p<0.001). The accuracy for predicting death was not as precise for outborn infants (AUC: 0.643; 95% CI 0.337 to 0.949; p=0.36). The calculator overestimated the combined outcome of death or survival with major disability at 72.0%, compared with an actual rate of 60.5%.
Conclusions:
The NICHD outcome estimator was helpful in predicting mortality for inborn infants, 22-25 weeks' gestation, but was less precise for outborn infants. It overestimated the combined outcome of death or major disability in infants born in Victoria, Australia, in 2005.
