Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network
Assessment of an Updated Neonatal Research Network Extremely Preterm Birth Outcome Model in the Vermont Oxford Network
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DOI：
10.1001/jamapediatrics.2019.6294
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发表时间：
2020-05-01
期刊：
影响因子：
26.1
通讯作者：
Higgins, Rosemary D.
中科院分区：
文献类型：
--
作者：
Rysavy, Matthew;Horbar, Jeffrey D.;Higgins, Rosemary D.
Eunice Kennedy Shriver国家儿童健康和人类发展研究所新生儿研究网络（NRN）的极端早产结局模型被广泛用于照顾期待极端早产的家庭的从业者的解释。该模型提供了从1998年到2003年的平均结果的信息，并没有说明美国医院之间的结果的实质性变化。目的为了更新和验证NRN极早产结局模型，用于美国大多数极早产儿。设计，设置和参与者这项预后研究包括3个观察队列，从2006年1月1日至12月31日，2016年，在NRN的19家美国中心（推导队列）和佛蒙特牛津网络（VON）的637家美国中心（验证队列）。研究了妊娠22周0天至25周6天出生的体重为401至1000 g的积极治疗婴儿，包括2006年至2012年NRN的4176例，2006年至2012年VON的45179例和2013年至2016年VON的25969例。VON队列占美国合格出生人数的85%以上。数据分析时间为2017年5月1日至2019年3月31日。暴露量原始模型中使用的预测变量，包括婴儿性别、出生体重、多胎数、出生时胎龄和产前皮质类固醇暴露。主要结局和指标主要结局为出院前死亡。次要结局包括18至26个月矫正年龄时的神经发育障碍和医院资源使用指标结果在NRN队列的4176例积极治疗的婴儿中，（48%女性;平均[SD]胎龄，24.2 [0.8]周），原始模型时代的3702名婴儿的存活率为63% vs 62（47%女性;平均[SD]胎龄，24.2 [0.8]周）。在同期（2006-2012年）VON队列中，45179例积极治疗的婴儿（47%为女性;平均[SD]胎龄为24.1 [0.8]周）的生存率为66%，2013 - 2016年的25969例婴儿（48%为女性;平均[SD]胎龄为24.1 [0.8]周）的生存率为70%。模型C统计量在2006-2012验证队列中为0.74，在2013-2016验证队列中为0.73。通过使用决策曲线分析将该模型与仅胎龄方法进行比较，更新后的模型显示出预测优势。出生医院的贡献同样多的预测生存胎龄（20%），但低于其他因素的组合（60%）。结论和相关性一个更新的模型，使用众所周知的因素来预测极早产儿的生存进行适度以及适用于大型美国队列。由于存活率随时间而变化，该模型需要定期更新。出生医院对结果预测有很大贡献。
Importance The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) extremely preterm birth outcome model is widely used for prognostication by practitioners caring for families expecting extremely preterm birth. The model provides information on mean outcomes from 1998 to 2003 and does not account for substantial variation in outcomes among US hospitals.Objective To update and validate the NRN extremely preterm birth outcome model for most extremely preterm infants in the United States.Design, Setting, and Participants This prognostic study included 3 observational cohorts from January 1, 2006, to December 31, 2016, at 19 US centers in the NRN (derivation cohort) and 637 US centers in Vermont Oxford Network (VON) (validation cohorts). Actively treated infants born at 22 weeks' 0 days' to 25 weeks' 6 days' gestation and weighing 401 to 1000 g, including 4176 in the NRN for 2006 to 2012, 45 179 in VON for 2006 to 2012, and 25 969 in VON for 2013 to 2016, were studied. VON cohorts comprised more than 85% of eligible US births. Data analysis was performed from May 1, 2017, to March 31, 2019.Exposures Predictive variables used in the original model, including infant sex, birth weight, plurality, gestational age at birth, and exposure to antenatal corticosteroids.Main Outcomes and Measures The main outcome was death before discharge. Secondary outcomes included neurodevelopmental impairment at 18 to 26 months' corrected age and measures of hospital resource use (days of hospitalization and ventilator use).Results Among 4176 actively treated infants in the NRN cohort (48% female; mean [SD] gestational age, 24.2 [0.8] weeks), survival was 63% vs 62% among 3702 infants in the era of the original model (47% female; mean [SD] gestational age, 24.2 [0.8] weeks). In the concurrent (2006-2012) VON cohort, survival was 66% among 45 179 actively treated infants (47% female; mean [SD] gestational age, 24.1 [0.8] weeks) and 70% among 25 969 infants from 2013 to 2016 (48% female; mean [SD] gestational age, 24.1 [0.8] weeks). Model C statistics were 0.74 in the 2006-2012 validation cohort and 0.73 in the 2013-2016 validation cohort. With the use of decision curve analysis to compare the model with a gestational age-only approach to prognostication, the updated model showed a predictive advantage. The birth hospital contributed equally as much to prediction of survival as gestational age (20%) but less than the other factors combined (60%).Conclusions and Relevance An updated model using well-known factors to predict survival for extremely preterm infants performed moderately well when applied to large US cohorts. Because survival rates change over time, the model requires periodic updating. The hospital of birth contributed substantially to outcome prediction.