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Prediction of Developmental Outcomes in Preterm Infants: A Systematic Review
Julia S Meijer1, Maura M F J Breedveld2, Peter Andriessen1,3
1Department of Neonatology, Máxima Medical Center, Veldhoven, the Netherlands.
Insights
Prediction models for very preterm infants
Area of Science:
- Neonatal outcomes research
- Developmental pediatrics
- Prognostic modeling
Background:
- Increasing survival rates of very preterm infants necessitate better prediction of developmental outcomes.
- Accurate prediction models are crucial for informed perinatal decision-making.
Purpose of the Study:
- To systematically review and summarize existing prediction models for developmental outcomes in infants born very preterm.
- To assess the quality and applicability of current prognostic models.
Main Methods:
- Comprehensive literature search of major databases (Medline, Embase, Web of Science, Cochrane) up to June 2024.
- Inclusion of studies developing or externally validating prognostic models for very preterm infants (<32 weeks) or those with very low birth weight (≤1500 g).
- Rigorous data extraction and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool.
Main Results:
- Identified 38 publications detailing 99 newly developed models and 18 external validations of 11 existing models.
- The primary outcome predicted was neurodevelopmental impairment, with prediction timelines from 18 months to 10 years post-birth.
- All models exhibited a high risk of bias, primarily due to concerns in outcome definition and data analysis.
Conclusions:
- The high risk of bias across all reviewed studies prevents recommendations for the most accurate prediction model.
- Despite numerous models, external validation is infrequent, and quality is often compromised.
- Future research should focus on validating and updating existing models to enhance their utility in clinical practice.
Context:
Increased survival of very preterm children raises concerns about later outcomes. Prediction models for developmental outcomes can support perinatal decision-making.
Objective:
Summarizing prediction models for developmental outcomes after very preterm birth.
Data Sources:
Medline, Embase, Web of Science, and the Cochrane database were searched for publications up to June 2024.
Study Selection:
All developed or externally validated prognostic models predicting developmental outcomes of infants born very preterm (<32 weeks) or with a very low birth weight (≤1500 g) were included.
Data Extraction:
Data extraction and risk of bias (RoB) assessment were done independently and in duplicate by 2 researchers using the Prediction Model Risk of Bias Assessment Tool.
Results:
Thirty-eight publications were identified describing 99 (85%) newly developed models and 18 (15%) external validations of 11 different existing models. The most predicted outcome was a composite measure of neurodevelopmental impairment, with prediction horizons ranging from 18 months to 10 years after birth. RoB was high for all models, mostly because of concerns regarding outcome and data analysis.
Limitations:
Because of a high RoB among all included studies, no recommendation for the most accurate prediction model could be provided.
Conclusions:
Although many prediction models for developmental outcomes after preterm birth exist, external validation is rare, and RoB is high. Future research is needed to validate and, if needed, update existing models to support perinatal decision-making.
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