Outcome trajectories in extremely preterm infants.
OBJECTIVE
Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization.


METHODS
Data on infants with birth weight ≤ 1.0 kg admitted to 18 large academic tertiary NICUs during 1998-2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months.


RESULTS
Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30.


CONCLUSIONS
Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual "outcome trajectories" and evaluate impact of possible morbidities on outcome.
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama 35249, USA. ambal@uab.edu
Namasivayam
N
Ambalavanan
Waldemar A
WA
Carlo
Jon E
JE
Tyson
John C
JC
Langer
Michele C
MC
Walsh
Nehal A
NA
Parikh
Abhik
A
Das
Krisa P
KP
Van Meurs
Seetha
S
Shankaran
Barbara J
BJ
Stoll
Rosemary D
RD
Higgins
D000367:Age Factors; D001724:Birth Weight; D003661:Decision Support Techniques; D002658:Developmental Disabilities / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000401:mortality; D008607:Intellectual Disability / Q000175:diagnosis*; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D008962:Models, Theoretical; D015999:Multivariate Analysis; D011379:Prognosis; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000401:mortality; D012720:Severity of Illness Index