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Opportunities and Challenges of Prognostic Models for Extremely Preterm Infants
Angret de Boer1,2, Pauline E van Beek1,3, Peter Andriessen3
1Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 32, 6525 GA Nijmegen, The Netherlands.
Insights
Predicting outcomes for extremely preterm infants is difficult. Prognostic models can help clinicians, parents, and policymakers by providing accurate estimates for both population-level decisions and individual prenatal counseling.
Area of Science:
- Neonatal Medicine
- Medical Informatics
- Public Health Policy
Background:
- Accurate prediction of short- and long-term outcomes for extremely preterm infants is a significant clinical challenge.
- Multivariable prognostic models offer potential solutions for improving outcome estimations.
Purpose of the Study:
- To discuss the opportunities and challenges of utilizing prognostic models for extremely preterm infants.
- To explore the application of these models at both population and individual levels.
- To provide recommendations for the development and implementation of prognostic models.
Main Methods:
- Perspective-based discussion of prognostic model development and application.
- Consideration of predictor and outcome measure selection.
- Assessment of clinical impact and generalizability.
Main Results:
- Prognostic models can aid population-level decisions regarding treatment limits, benchmarking, and resource allocation.
- At the individual level, models can enhance prenatal counseling, improve transparency, and ensure consistent outcome projections for parents.
Conclusions:
- Clearly defining the purpose of prognostic models is crucial.
- Thoughtful integration into prenatal counseling is necessary for effective use.
- Further development and recommendations for prognostic models are suggested to improve care for extremely preterm infants.
Abstract:
Predicting the short- and long-term outcomes of extremely preterm infants remains a challenge. Multivariable prognostic models might be valuable tools for clinicians, parents, and policymakers for providing accurate outcome estimates. In this perspective, we discuss the opportunities and challenges of using prognostic models in extremely preterm infants at population and individual levels. At a population level, these models could support the development of guidelines for decisions about treatment limits and may support policy processes such as benchmarking and resource allocation. At an individual level, these models may enhance prenatal counselling conversations by considering multiple variables and improving transparency about expected outcomes. Furthermore, they may improve consistency in projections shared with parents. For the development of prognostic models, we discuss important considerations such as predictor and outcome measure selection, clinical impact assessment, and generalizability. Lastly, future recommendations for developing and using prognostic models are suggested. Importantly, the purpose of a prognostic model should be clearly defined, and integrating these models into prenatal counselling requires thoughtful consideration.
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