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A Respiratory Intervention Intensity Index for Supplemental Oxygen Use at Postnatal Day 28 in Preterm Infants Using
Jianhua Chen1, Yuhang Wang1, Honghong Zheng2
1Department of Pediatrics, Yiwu Maternity and Children Hospital (Yiwu Hospital of Children's Hospital, Zhejiang University School of Medicine), Yiwu, Zhejiang, 322000, People's Republic of China.
Background:
It remains uncertain whether correlated respiratory-management measures add information on day-28 supplemental oxygen use beyond gestational age. We developed a respiratory intervention intensity index and evaluated incremental within-cohort stratification.
Methods:
This single-center retrospective cohort included preterm infants admitted to a neonatal intensive care unit between 2021 and 2024. Invasive ventilation days, noninvasive ventilation days, caffeine treatment days, and surfactant administration were assessed from birth through postnatal day 28. A Bayesian weighted quantile sum index was constructed with nonnegative weights summing to 1. Its association with day-28 supplemental oxygen use was evaluated in logistic regression adjusted for gestational age. Apparent performance and weight stability were assessed internally; decision-curve analysis was exploratory.
Results:
Among 246 infants, 98 (39.8%) received supplemental oxygen on day 28. Posterior median weights were 0.42 for invasive ventilation, 0.29 for surfactant, 0.20 for caffeine, and 0.09 for noninvasive ventilation. The BWQS index was associated with supplemental oxygen use after gestational-age adjustment (OR=17.85 per 1-unit increase, 95% CI 5.76-55.30). Apparent AUCs were 0.8355 for gestational age alone and 0.9117 after adding BWQS; the paired difference was 0.0763 (95% CI 0.0438-0.1097). The Brier score decreased from 0.1531 to 0.1173, and observed oxygen use increased from 11.3% in the lowest BWQS-index group to 75.4% in the highest.
Conclusion:
The BWQS index was associated with day-28 supplemental oxygen use and provided incremental stratification beyond gestational age within this cohort. It should be regarded as a candidate process-based measure, not an early prognostic or treatment-decision tool. Temporal and multicenter validation is required.
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