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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Development and validation of a model to predict mortality risk among extremely preterm infants during the early
Wen-Wen Zhang1, Shaofeng Wang2, Yuxin Li3
1Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University, Jinan, China.
Insights
A new model predicts mortality risk for extremely preterm infants (EPIs) using factors available shortly after birth. This tool aids in guiding parental decisions for life-saving interventions in neonates.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Predictive Analytics in Healthcare
Background:
- Survival rates for extremely preterm infants (EPIs) have improved due to advancements in perinatal care.
- Despite improvements, treatment outcomes for EPIs remain suboptimal, posing challenges for medical practitioners.
- Withdrawing care is a critical and urgent consideration in managing EPIs.
Purpose of the Study:
- To develop and validate a practical model for assessing mortality risk and survival chances in EPIs shortly after birth.
- To utilize regression analysis for creating a predictive tool for EPI outcomes.
- To provide timely risk assessment for informed clinical and parental decision-making.
Main Methods:
- A multicentre prospective cohort study involving 46 neonatal intensive care units (NICUs) in China.
- Data collection included maternal and neonatal variables within one hour post-childbirth.
- A total of 1363 neonates were included, with data split into training (41 NICUs) and validation (5 NICUs) sets.
Main Results:
- Key influencing factors for EPI mortality include gestational age, birth weight, blood gas analysis (pH, lactic acid), hypothermia, and antenatal corticosteroids.
- The developed prediction model demonstrated strong predictive accuracy with an area under the curve (AUC) of 0.81 (internal) and 0.80 (external validation).
- The model showed good calibration, outperforming the Clinical Risk Index for Babies-II in external validation (0.80 vs. 0.51).
Conclusions:
- The study established a highly accurate prediction model for EPI mortality using prenatal and early postnatal factors.
- Early prediction of mortality risk can empower parents to make proactive decisions regarding life-saving treatments for EPIs.
- The model offers a valuable tool for perinatal medical practitioners to guide care strategies for extremely preterm infants.
Background:
Recently, with the rapid development of the perinatal medical system and related life-saving techniques, both the short-term and long-term prognoses of extremely preterm infants (EPIs) have improved significantly. In rapidly industrialising countries like China, the survival rates of EPIs have notably increased due to the swift socioeconomic development. However, there is still a reasonably lower positive response towards the treatment of EPIs than we expected, and the current situation of withdrawing care is an urgent task for perinatal medical practitioners.
Objective:
To develop and validate a model that is practicable for EPIs as soon as possible after birth by regression analysis, to assess the risk of mortality and chance of survival.
Methods:
This multicentre prospective cohort study used datasets from the Sino-Northern Neonatal Network, including 46 neonatal intensive care units (NICUs). Risk factors including maternal and neonatal variables were collected within 1 hour post-childbirth. The training set consisted of data from 41 NICUs located within the Shandong Province of China, while the validation set included data from 5 NICUs outside Shandong Province. A total of 1363 neonates were included in the study.
Results:
Gestational age, birth weight, pH and lactic acid in blood gas analysis within the first hour of birth, moderate-to-severe hypothermia on admission and adequate antenatal corticosteroids were influencing factors for EPIs' mortality with important predictive ability. The area under the curve values for internal validation of our prediction model and Clinical Risk Index for Babies-II scores were 0.81 and 0.76, and for external validation, 0.80 and 0.51, respectively. Moreover, the Hosmer-Lemeshow test showed that our model has a constant degree of calibration.
Conclusions:
There was good predictive accuracy for mortality of EPIs based on influencing factors prenatally and within 1 hour after delivery. Predicting the risk of mortality of EPIs as soon as possible after birth can effectively guide parents to be proactive in treating more EPIs with life-saving value.
Trial Registration Number:
ChiCTR1900025234.
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