活跃围产管理的极度早产婴儿的五年结果:临床预测模型
Caroline Diguisto1,2, Andrei Scott Morgan1,3, Laurence Foix L'Hélias1,4
1Université Paris Cité, Université Sorbonne Paris Nord, Inserm, INRAE, CRESS U1153, EPOPé, Paris, France.
BJOG : an international journal of obstetrics and gynaecology
|August 18, 2023
概括
一种新的临床预测模型有助于预测接受积极产周护理的极度早产婴儿的预测结果. 该模型使用妊娠年龄,小于妊娠年龄的状态和性别来预测在5岁时没有神经发育障碍的生存率.
科学领域:
- 新生儿医学 新生儿医学
- 围产期结果 围产期结果
- 临床预测建模临床预测建模
背景情况:
- 接受主动围产管理的极度早产婴儿 (怀孕24至26周出生) 面临重大风险.
- 准确预测长期结果对于临床决策和家庭咨询至关重要.
研究的目的:
- 开发和验证一个临床预测模型,用于在5岁时没有中度或重度神经发育障碍 (NDD) 的生存.
- 确定影响这一弱势群体结果的关键因素.
主要方法:
- 国家前性队列研究EPIPAGE-2包括活产新生儿 (怀孕24至26周),在2011年在法国接受活跃周产管理.
- 开发了一个逻辑回归模型,使用妊娠年龄,小到妊娠年龄 (SGA) 状态和性别.
- 模型性能通过校准和区分与内部验证使用引导方法进行评估.
主要成果:
- 在557名新生儿中,72%的新生儿存活到5年,59%的新生儿没有NDD.
- 没有NDD的预测存活率因妊娠年龄 (45-64%) 和SGA状态 (47%为SGA,62%为非SGA) 而有所不同.
- 该模型表现出良好的校准,但歧视不大 (C指数为0.59).
结论:
- 一个简单的预测模型,包含易于确定的产前因素,可以帮助临床决策.
- 该工具支持医疗保健提供者和家庭在积极围产护理下管理极度早产新生儿.
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