Development and validation of a model to predict mortality risk among extremely preterm infants during the early postnatal period: a multicentre prospective cohort study

被引:0
作者
Zhang, Wen-wen [1 ]
Wang, Shaofeng [2 ]
Li, Yuxin [3 ]
Dong, Xiaoyu [4 ]
Zhao, Lili [5 ]
Li, Zhongliang [6 ]
Liu, Qiang [7 ]
Liu, Min [8 ]
Zhang, Fengjuan [9 ]
Yao, Guo [10 ]
Zhang, Jie [11 ]
Liu, Xiaohui [12 ]
Liu, Guohua [13 ]
Zhang, Xiaohui [14 ]
Reddy, Simmy [15 ]
Yu, Yong-hui [3 ]
机构
[1] Shandong First Med Univ, Jinan Matern & Child Care Hosp, Jinan, Peoples R China
[2] Shandong First Med Univ, Jinan Matern & Child Care Hosp, Jinan, Shandong, Peoples R China
[3] Shandong First Med Univ, Shandong Prov Hosp, Jinan, Shandong, Peoples R China
[4] Shandong Univ, Shandong Prov Maternal & Child Hlth Care Hosp, Jinan, Shandong, Peoples R China
[5] Liaocheng Peoples Hosp, Liaocheng, Shandong, Peoples R China
[6] Weifang Maternal & Child Hlth Hosp, Weifang, Peoples R China
[7] Linyi Peoples Hosp, Linyi, Shandong, Peoples R China
[8] Linyi Maternal & Child Hlth Care Hosp, Linyi, Shandong, Peoples R China
[9] Shandong First Med Univ, Dept Rheumatol, Affiliated Hosp 1, Jinan, Shandong, Peoples R China
[10] Taian City Cent Hosp, Tai An, Shandong, Peoples R China
[11] Hebei Med Univ, Petr Clin Med Coll, Langfang, Hebei, Peoples R China
[12] Shi Jiazhuang Matern & Child Hlth Care Hosp, Shijiazhuang, Peoples R China
[13] Linfen Maternal & Child Hlth Hosp, Linfen, Peoples R China
[14] Qindao Univ, Med Coll, Yantai Yuhuangding Hosp, Yantai, Shandong, Peoples R China
[15] Shandong Univ, Cheeloo Coll Med, Jinan, Peoples R China
来源
BMJ OPEN | 2023年 / 13卷 / 12期
关键词
PAEDIATRICS; Clinical Decision-Making; Neonatal intensive & critical care; OF-LIFE DECISIONS; INTENSIVE-CARE; CRIB-II; OUTCOMES; ASSOCIATION; MORBIDITY; PH; GUIDELINES; GESTATION; PREGNANCY;
D O I
10.1136/bmjopen-2023-074309
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Recently, with the rapid development of the perinatal medical system and related life-saving techniques, both the short-term and long-term prognoses of extremely preterm infants (EPIs) have improved significantly. In rapidly industrialising countries like China, the survival rates of EPIs have notably increased due to the swift socioeconomic development. However, there is still a reasonably lower positive response towards the treatment of EPIs than we expected, and the current situation of withdrawing care is an urgent task for perinatal medical practitioners.Objective To develop and validate a model that is practicable for EPIs as soon as possible after birth by regression analysis, to assess the risk of mortality and chance of survival.Methods This multicentre prospective cohort study used datasets from the Sino-Northern Neonatal Network, including 46 neonatal intensive care units (NICUs). Risk factors including maternal and neonatal variables were collected within 1 hour post-childbirth. The training set consisted of data from 41 NICUs located within the Shandong Province of China, while the validation set included data from 5 NICUs outside Shandong Province. A total of 1363 neonates were included in the study.Results Gestational age, birth weight, pH and lactic acid in blood gas analysis within the first hour of birth, moderate-to-severe hypothermia on admission and adequate antenatal corticosteroids were influencing factors for EPIs' mortality with important predictive ability. The area under the curve values for internal validation of our prediction model and Clinical Risk Index for Babies-II scores were 0.81 and 0.76, and for external validation, 0.80 and 0.51, respectively. Moreover, the Hosmer-Lemeshow test showed that our model has a constant degree of calibration.Conclusions There was good predictive accuracy for mortality of EPIs based on influencing factors prenatally and within 1 hour after delivery. Predicting the risk of mortality of EPIs as soon as possible after birth can effectively guide parents to be proactive in treating more EPIs with life-saving value.
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页数:9
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