A clinical prediction rule for histological chorioamnionitis in preterm newborns.
BACKGROUND
Histological chorioamnionitis (HC) is an intrauterine inflammatory process highly associated with preterm birth and adverse neonatal outcome. HC is often clinically silent and diagnosed postnatally by placental histology. Earlier identification could facilitate treatment individualisation to improve outcome in preterm newborns.


OBJECTIVE
Develop a clinical prediction rule at birth for HC and HC with fetal involvement (HCF) in preterm newborns.


METHODS
Clinical data and placental pathology were obtained from singleton preterm newborns (gestational age ≤ 32.0 weeks) born at Erasmus UMC Rotterdam from 2001 to 2003 (derivation cohort; n = 216) or Máxima MC Veldhoven from 2009 to 2010 (validation cohort; n = 206). HC and HCF prediction rules were developed with preference for high sensitivity using clinical variables available at birth.


RESULTS
HC and HCF were present in 39% and 24% in the derivation cohort and in 44% and 22% in the validation cohort, respectively. HC was predicted with 87% accuracy, yielding an area under ROC curve of 0.95 (95%CI = 0.92-0.98), a positive predictive value of 80% (95%CI = 74-84%), and a negative predictive value of 93% (95%CI = 88-96%). Corresponding figures for HCF were: accuracy 83%, area under ROC curve 0.92 (95%CI = 0.88-0.96), positive predictive value 59% (95%CI = 52-62%), and negative predictive value 97% (95%CI = 93-99%). External validation expectedly resulted in some loss of test performance, preferentially affecting positive predictive rather than negative predictive values.


CONCLUSIONS
Using a clinical prediction rule composed of clinical variables available at birth, HC and HCF could be predicted with good test characteristics in preterm newborns. Further studies should evaluate the clinical value of these rules to guide early treatment individualisation.
Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands. jasper.been@mumc.nl
Jasper V
JV
Been
Sizzle F
SF
Vanterpool
Jasmijn D E
JD
de Rooij
G Ingrid J G
GI
Rours
René F
RF
Kornelisse
Martien C J M
MC
van Dongen
Christel J A W
CJ
van Gool
Ronald R
RR
de Krijger
Peter
P
Andriessen
Luc J I
LJ
Zimmermann
Boris W
BW
Kramer
D002821:Chorioamnionitis / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D012372:ROC Curve