title: Can Machine Learning Methods Predict Extubation Outcome in Premature Infants as well as Clinicians?
abstract: BACKGROUND
  Though treatment of the prematurely born infant breathing with assistance of a mechanical ventilator has much advanced in the past decades, predicting extubation outcome at a given point in time remains challenging. Numerous studies have been conducted to identify predictors for extubation outcome; however, the rate of infants failing extubation attempts has not declined.
  
  
  OBJECTIVE
  To develop a decision-support tool for the prediction of extubation outcome in premature infants using a set of machine learning algorithms.
  
  
  METHODS
  A dataset assembled from 486 premature infants on mechanical ventilation was used to develop predictive models using machine learning algorithms such as artificial neural networks (ANN), support vector machine (SVM), naïve Bayesian classifier (NBC), boosted decision trees (BDT), and multivariable logistic regression (MLR). Performance of all models was evaluated using area under the curve (AUC).
  
  
  RESULTS
  For some of the models (ANN, MLR and NBC) results were satisfactory (AUC: 0.63-0.76); however, two algorithms (SVM and BDT) showed poor performance with AUCs of ~0.5.
  
  
  CONCLUSIONS
  Clinician's predictions still outperform machine learning due to the complexity of the data and contextual information that may not be captured in clinical data used as input for the development of the machine learning algorithms. Inclusion of preprocessing steps in future studies may improve the performance of prediction models.
authors.affiliation: Division of Biostatistics and Epidemiology; Medical University of South Carolina, Charleston, SC.
authors.forename: Martina
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Department of Pathology Informatics, University of Alabama at Birmingham, Birmingham, AB.
authors.forename: Jonas S
authors.initials: JS
authors.lastname: Almeida
authors.affiliation: Sanofi Pasteur, Cambridge, MA.
authors.forename: Romesh
authors.initials: R
authors.lastname: Stanislaus
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Wagner
keywords: Premature infant; extubation; machine learning; mechanical ventilation; prediction