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BPD prediction model for very preterm infants integrating chest X-ray scores within 7 days: a retrospective
Liping Xu1,2, Shuzhen Dai2, Licong Lin2
1Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
This study identified key risk factors for bronchopulmonary dysplasia (BPD) in preterm infants, developing a predictive model using birth weight, chest X-ray scores, and mechanical ventilation status. The model shows good performance for early BPD risk assessment.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Medical Informatics
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants, impacting long-term respiratory health.
- Early identification of infants at risk for BPD is crucial for timely intervention and improved outcomes.
- Existing prediction models for BPD may lack accuracy or require further validation in diverse populations.
Purpose of the Study:
- To determine independent risk factors associated with BPD development in preterm infants (gestational age < 32 weeks).
- To construct and validate an early prediction model for BPD in this vulnerable population.
- To enhance clinical decision-making for managing preterm infants at risk of BPD.
Main Methods:
- A retrospective case-control study was conducted at a tertiary neonatal intensive care unit.
- 762 preterm infants (gestational age < 32 weeks) were analyzed.
- Multivariate logistic regression was used to identify predictors, and a prediction model was developed and validated.
Main Results:
- Independent predictors for BPD included lower birth weight, higher chest X-ray scores (at 24 hours and day 7), and prolonged invasive mechanical ventilation (to day 7).
- The developed prediction model demonstrated strong performance with an Area Under the Curve (AUC) of 0.873 in the training cohort and 0.848 in the validation cohort.
- Calibration curves and decision curve analysis confirmed the model's good agreement with observations and clinical utility.
Conclusions:
- Elevated chest X-ray scores within the first week of life and extended invasive mechanical ventilation are significant risk factors for BPD.
- The developed prediction model, incorporating birth weight, early chest X-ray findings, and mechanical ventilation status at day 7, shows promising predictive performance for BPD.
- This model can aid clinicians in identifying high-risk preterm infants for targeted respiratory support and management.
Objective:
To identify risk factors and develop an early prediction model for bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age (GA) under 32 weeks.
Design:
A single-centre, retrospective case-control study.
Setting:
A tertiary neonatal intensive care unit in Fujian Province, China.
Participants:
762 infants (GA under 32 weeks, survived beyond the corrected GA of 36 weeks) who were hospitalised in our department between January 2018 and December 2023.
Intervention:
None.
Main Outcome Measures:
The primary outcome was the diagnosis of BPD at 36 weeks of corrected GA, with diagnostic criteria based on the 2018 criteria established by the National Institute of Child Health and Human Development.
Results:
A total of 762 infants was enrolled in the study, including 572 in the training cohort, among whom 138 (24.13%) had BPD. Multivariate logistic regression identified the following as independent predictors for BPD development: birth weight (OR=0.997, 95% CI 0.996 to 0.998, p<0.001), chest X-ray score within 24 hours of birth (OR=1.777, 95% CI 1.253 to 2.521, p=0.001), chest X-ray score at day 7 after birth (OR=1.756, 95% CI 1.264 to 2.440, p<0.001) and extended invasive mechanical ventilation to day 7 after birth (OR=4.280, 95% CI 2.149 to 8.526, p<0.001). In training and validation cohorts, the area under the curve was 0.873 (95% CI 0.839 to 0.907) and 0.848 (95% CI 0.778 to 0.917), respectively. In addition, the calibration curves showed good agreement between the column-line graph model and the actual observations. A decision curve analysis indicated a significantly better net benefit of the model.
Conclusions:
Higher chest X-ray scores within 7 days of life and extended invasive mechanical ventilation to day 7 after birth were significantly associated with BPD. The model had good predictive performance for predicting BPD using birth weight, chest X-ray scores within 24 hours of birth and at day 7 after life, and the state of invasive mechanical ventilation at day 7 after birth.
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