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Development and Validation of a Risk Scoring Tool for Bronchopulmonary Dysplasia in Preterm Infants Based on a
Zhumei Yu1,2, Lili Wang1, Yang Wang1
1Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
Insights
A new scoring tool helps identify preterm infants at high risk for bronchopulmonary dysplasia (BPD). This simple clinical tool aids early screening and intervention for BPD in premature infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Clinical Prediction Modeling
Background:
- Bronchopulmonary dysplasia (BPD) is a leading cause of mortality and disability in preterm infants.
- Early identification and intervention are crucial for managing BPD.
- Existing risk assessment methods may lack precision for early BPD detection.
Purpose of the Study:
- To develop and validate a novel risk scoring tool for early identification of preterm infants at high risk of developing BPD.
- To create a simple, clinically applicable tool for risk stratification.
- To improve early management strategies for BPD.
Main Methods:
- A systematic review and meta-analysis identified significant risk factors for BPD.
- A logistic regression model was constructed using odds ratios of identified risk factors.
- A clinical scoring tool was developed and externally validated using a Chinese cohort.
- Risk stratification included low, low-intermediate, high-intermediate, and high-risk groups.
Main Results:
- The study analyzed 83,034 preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g), with a BPD incidence of 30.37%.
- Nine key predictors were identified: Chorioamnionitis, gestational age, birth weight, sex, small for gestational age, 5-min Apgar score, delivery room intubation, and surfactant/respiratory distress syndrome.
- The validated tool demonstrated good discrimination (AUC=0.907) and calibration, with optimal cut-off (25.5) yielding sensitivity of 0.897 and specificity of 0.873.
Conclusions:
- An effective and validated risk scoring tool for predicting BPD in preterm infants has been developed.
- This simple scoring tool can aid in establishing screening strategies for BPD.
- The tool has the potential to guide timely early interventions for high-risk preterm infants.
Abstract:
Background: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in preterm infants with high disability and mortality rates. Early identification and treatment of BPD is critical. Objective: This study aimed to develop and validate a risk scoring tool for early identification of preterm infants that are at high-risk for developing BPD. Methods: The derivation cohort was derived from a systematic review and meta-analysis of risk factors for BPD. The statistically significant risk factors with their corresponding odds ratios were utilized to construct a logistic regression risk prediction model. By scoring the weights of each risk factor, a risk scoring tool was established and the risk stratification was divided. External verification was carried out by a validation cohort from China. Results: Approximately 83,034 preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g were screened in this meta-analysis, and the cumulative incidence of BPD was about 30.37%. The nine predictors of this model were Chorioamnionitis, Gestational age, Birth weight, Sex, Small for gestational age, 5 min Apgar score, Delivery room intubation, and Surfactant and Respiratory distress syndrome. Based on the weight of each risk factor, we translated it into a simple clinical scoring tool with a total score ranging from 0 to 64. External validation showed that the tool had good discrimination, the area under the curve was 0.907, and that the Hosmer-Lemeshow test showed a good fit (p = 0.3572). In addition, the results of the calibration curve and decision curve analysis suggested that the tool showed significant conformity and net benefit. When the optimal cut-off value was 25.5, the sensitivity and specificity were 0.897 and 0.873, respectively. The resulting risk scoring tool classified the population of preterm infants into low-risk, low-intermediate, high-intermediate, and high-risk groups. This BPD risk scoring tool is suitable for preterm infants with gestational age < 32 weeks and/or birth weight < 1500 g. Conclusions: An effective risk prediction scoring tool based on a systematic review and meta-analysis was developed and validated. This simple tool may play an important role in establishing a screening strategy for BPD in preterm infants and potentially guide early intervention.
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