title: Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia.
abstract: OBJECTIVE
  To estimate the risk of death or tracheostomy placement (D/T) in infants with severe bronchopulmonary dysplasia (sBPD) born < 32 weeks' gestation referred to regional neonatal intensive care units.
  
  
  METHODS
  We conducted a retrospective cohort study in infants born < 32 weeks' gestation with sBPD in 2010-2011, using the Children's Hospital Neonatal Database. sBPD was defined as the need for FiO2 ⩾ 0.3, nasal cannula support >2 l min(-1) or positive pressure at 36 weeks' post menstrual age. The primary outcome was D/T before discharge. Predictors associated with D/T in bivariable analyses (P < 0.2) were used to develop a multivariable logistic regression equation using 80% of the cohort. This equation was validated in the remaining 20% of infants.
  
  
  RESULTS
  Of 793 eligible patients, the mean gestational age was 26 weeks' and the median age at referral was 6.4 weeks. D/T occurred in 20% of infants. Multivariable analysis showed that later gestational age at birth, later age at referral along with pulmonary management as the primary reason for referral, mechanical ventilation at the time of referral, clinically diagnosed pulmonary hypertension, systemic corticosteroids after referral and occurrence of a bloodstream infection after referral were each associated with D/T. The model performed well with validation (area under curve 0.86, goodness-of-fit χ(2), P = 0.66).
  
  
  CONCLUSIONS
  Seven clinical variables predicted D/T in this large, contemporary cohort with sBPD. These results can be used to inform clinicians who counsel families of affected infants and to assist in the design of future prospective trials.
authors.affiliation: Department of Pediatrics, Feinberg School of Medicine, Northwestern University and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Murthy
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center and the Children's Medical Center of Dallas, Dallas, TX, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Savani
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin and the Children's Hospital of Wisconsin, Milwaukee, WI, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Lagatta
authors.affiliation: Department of Analytics, Children's Hospital Association, Overland Park, KS, USA.
authors.forename: I
authors.initials: I
authors.lastname: Zaniletti
authors.affiliation: Department of Pediatrics, University of Central Florida and the Florida Hospital for Children, Orlando, FL, USA.
authors.forename: R
authors.initials: R
authors.lastname: Wadhawan
authors.affiliation: Department of Pediatrics, University of Missouri-Kansas City School of Medicine and the Children's Mercy Hospitals & Clinics, Kansas, MO, USA.
authors.forename: W
authors.initials: W
authors.lastname: Truog
authors.affiliation: University of Colorado School of Medicine and the Colorado Children's Hospital, Aurora, CO, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Grover
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Asselin
authors.affiliation: Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Durand
authors.affiliation: Department of Pediatrics, George Washington University School of Medicine and Children's National Medical Center, Washington, DC, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Short
authors.affiliation: Department of Pediatrics, University of Missouri-Kansas City School of Medicine and the Children's Mercy Hospitals & Clinics, Kansas, MO, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Pallotto
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Padula
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and the Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
authors.forename: F D
authors.initials: FD
authors.lastname: Dykes
authors.affiliation: Department of Pediatrics and Center for Perinatal Research, The Ohio State University College of Medicine and the Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Reber
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Evans
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000401:mortality* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D014139:Tracheostomy / Q000706:statistics & numerical data*