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Personalized lung care: Bronchopulmonary dysplasia risk prediction tool tailored for neonates born in
Flávia Maria de Medeiros Cavalcante Meneghetti1, Davi Casale Aragon1, Cristina Calixto1
1Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil.
Insights
A new tool accurately predicts bronchopulmonary dysplasia (BPD) risk in neonates by day 14. This method shows higher accuracy than the NICHD instrument, especially for small-for-gestational-age infants.
Area of Science:
- Neonatal Medicine
- Respiratory Medicine
- Pediatric Critical Care
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants.
- Accurate BPD prediction is crucial for optimizing therapeutic interventions and minimizing medication side effects.
- Current prediction tools may lack sufficient accuracy for specific infant populations.
Purpose of the Study:
- To develop and validate a novel instrument for predicting BPD in preterm neonates.
- To compare the performance of the new instrument against the existing National Institute of Child Health and Human Development (NICHD) instrument.
- To assess the utility of the new tool for risk stratification in Brazilian neonates.
Main Methods:
- Retrospective cohort study of neonates with gestational age 23-30 weeks (2016-2020).
- Development of predictive equations using variables assessed on day 14 of life.
- Random split of data (70% training, 30% validation) for equation construction and testing.
- Comparison of the new instrument's sensitivity, specificity, and predictive values against the NICHD calculator.
Main Results:
- The developed equation demonstrated high specificity (98%) and positive predictive value (93%) for BPD.
- The new tool proved effective for predicting BPD in small-for-gestational-age (SGA) infants.
- The NICHD calculator showed lower specificity (93%) and positive predictive value (75%) in this cohort, with limitations for extremely SGA infants.
Conclusions:
- The novel prediction tool accurately identifies BPD risk by day 14 in preterm neonates.
- The developed instrument offers superior specificity and positive predictive value compared to the NICHD tool for the studied population.
- The tool shows promise for application in SGA infants, warranting further validation in diverse populations.
Purpose:
Predicting bronchopulmonary dysplasia (BPD) to assess the risk-benefit of therapy is necessary considering the side effects of medications. We developed and validated an instrument for predicting BPD and compared it with an instrument currently used for neonates born in a Brazilian hospital.
Methods:
This was a retrospective cohort study of patients born between 2016 and 2020 with a gestational age (GA) between 23 and 30 weeks. Predictive equations were elaborated using methods of component variable selection collected on the 14th day of life; 70% of the sample was randomly selected for the construction of risk prediction equations and the remaining 30% for their validation, application, and comparison with the National Institute of Child Health and Human Development (NICHD) instrument. The sensitivity, specificity, and predictive values of the equations were calculated.
Results:
The equation that used variables with p < 5% in Fisher's exact test presented the best results: specificity of 98% and positive predictive value of 93% and could be used for BPD prediction of all small-for-gestational-age (SGA) infants. The NICHD calculator applied to our population had a specificity of 93% and a positive predictive value of 75% and could not be applied to extremely SGA infants.
Conclusion:
Our tool can predict the risk of BPD on the 14th day of life, has higher specificity and positive predictive value to our population than the NICHD instrument, and can be suitable for SGA infants. The results must be confirmed by applying it to other populations to validate our tool.
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