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Five-year outcomes for extremely preterm babies with active perinatal management: A clinical prediction model
Caroline Diguisto1,2, Andrei Scott Morgan1,3, Laurence Foix L'Hélias1,4
1Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France.
Insights
A new clinical prediction model helps forecast outcomes for extremely preterm infants receiving active perinatal care. The model uses gestational age, small-for-gestational-age status, and sex to predict survival without neurodevelopmental disability at five years.
Area of Science:
- Neonatal Medicine
- Perinatal Outcomes
- Clinical Prediction Modeling
Background:
- Extremely preterm infants (born 24-26 weeks gestation) receiving active perinatal management face significant risks.
- Accurate prediction of long-term outcomes is crucial for clinical decision-making and family counseling.
Purpose of the Study:
- To develop and validate a clinical prediction model for survival without moderate or severe neurodevelopmental disability (NDD) at 5 years of age.
- To identify key factors influencing outcomes in this vulnerable population.
Main Methods:
- The EPIPAGE-2 national prospective cohort study included live-born neonates (24-26 weeks gestation) receiving active perinatal management in France, 2011.
- A logistic regression model was developed using gestational age, small-for-gestational-age (SGA) status, and sex.
- Model performance was assessed via calibration and discrimination with internal validation using bootstrap methods.
Main Results:
- Of 557 neonates, 72% survived to 5 years, with 59% surviving without NDD.
- Predicted survival without NDD varied by gestational age (45-64%) and SGA status (47% for SGA, 62% for non-SGA).
- The model demonstrated good calibration but modest discrimination (C-index 0.59).
Conclusions:
- A simple prediction model incorporating easily ascertainable antenatal factors can aid clinical decision-making.
- This tool supports healthcare providers and families in managing extremely preterm neonates under active perinatal care.
Objective:
To develop and validate a clinical prediction model for outcomes at 5 years of age for children born extremely preterm and receiving active perinatal management.
Design:
The EPIPAGE-2 national prospective cohort.
Setting:
France, 2011.
Population:
Live-born neonates between 24+0 and 26+6 weeks of gestation who received active perinatal management (i.e. birth in a tertiary-level hospital, with antenatal steroids and resuscitation at birth).
Methods:
A prediction model using logistic modelling, including gestational age, small-for gestational-age (SGA) status and sex, was developed. Model performance was assessed through calibration and discrimination, with bootstrap internal validation.
Main Outcome Measures:
Survival without moderate or severe neurodevelopmental disability (NDD) at 5 years.
Results:
Among the 557 neonates included, 401 (72%) survived to 5 years, of which 59% survived without NDD (95% CI 54% to 63%). Predicted rates of survival without NDD ranged from 45% (95% CI 33% to 57%), to 56% (95% CI 49% to 64%) to 64% (95% CI 57% to 70%) for neonates born at 24, 25 and 26 weeks of gestation, respectively. Predicted rates of survival without NDD were 47% (95% CI 18% to 76%) and 62% (95% CI 49% to 76%) for SGA and non-SGA children, respectively. The model showed good calibration (calibration slope 0.85, 95% CI 0.54 to 1.16; calibration-in-the-large -0.0123, 95% CI -0.25 to 0.23) and modest discrimination (C-index 0.59, 95% CI 0.53 to 0.65).
Conclusions:
A simple prediction model using three factors easily known antenatally may help doctors and families in their decision-making for extremely preterm neonates receiving active perinatal management.
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