Machine Learning Models for Predicting Neonatal Mortality: A Systematic Review

Introduction: Approximately 7,000 newborns die every day, accounting for almost half of child deaths under 5 years of age. Deciphering which neonates are at increased risk for mortality can have an important global impact. As such, integrating high computational technology (e.g., artificial intelligence [AI]) may help identify the early and potentially modifiable predictors of neonatal mortality. Therefore, the objective of this study was to collate, critically appraise, and analyze neonatal prediction studies that included AI. Methods: A literature search was performed in PubMed, Cochrane, OVID, and Google Scholar. We included studies that used AI (e.g., machine learning (ML) and deep learning) to formulate prediction models for neonatal death. We excluded small studies (n < 500 individuals) and studies using only antenatal factors to predict mortality. Two independent investigators screened all articles for inclusion. The data collection consisted of study design, number of models, features used per model, feature importance, internal and/or external validation, and calibration analysis. Our primary outcome was the average area under the receiving characteristic curve (AUC) or sensitivity and specificity for all models included in each study. Results: Of 434 articles, 11 studies were included. The total number of participants was 1.26 M with gestational ages ranging from 22 weeks to term. Number of features ranged from 3 to 66 with timing of prediction as early as 5 min of life to a maximum of 7 days of age. The average number of models per study was 4, with neural network, random forest, and logistic regression comprising the most used models (58.3%). Five studies (45.5%) reported calibration plots and 2 (18.2%) conducted external validation. Eight studies reported results by AUC and 5 studies reported the sensitivity and specificity. The AUC varied from 58.3% to 97.0%. The mean sensitivities ranged from 63% to 80% and specificities from 78% to 99%. The best overall model was linear discriminant analysis, but it also had a high number of features (n = 17). Discussion/Conclusion: ML models can accurately predict death in neonates. This analysis demonstrates the most commonly used predictors and metrics for AI prediction models for neonatal mortality. Future studies should focus on external validation, calibration, as well as deployment of applications that can be readily accessible to health-care providers.