Prediction of Bronchopulmonary Dysplasia by Postnatal Age in Extremely Premature Infants
Prediction of Bronchopulmonary Dysplasia by Postnatal Age in Extremely Premature Infants
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DOI：
10.1164/rccm.201101-0055oc
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发表时间：
2011-06-15
影响因子：
24.7
通讯作者：
Walsh, Michele C.
中科院分区：
文献类型：
--
作者：
Laughon, Matthew M.;Langer, John C.;Walsh, Michele C.
理论基础：在极早产儿中确定支气管肺发育不良的危险因素的好处包括提供预后信息，确定可能从预防策略中受益的婴儿，以及对婴儿进行临床试验登记。目的：在出生后一天确定支气管肺发育不良的危险因素，以及相互竞争的死亡结果；确定哪些危险因素改善预测；方法：我们评估了在尤尼斯·肯尼迪·施莱弗国家儿童健康和人类发展研究所新生儿研究网络的17个中心出生的23-30周的婴儿，并参加了2000-2004年的新生儿研究网络基准试验。测量和主要结果：将支气管肺发育不良定义为分类变量(无、轻度、中度或重度)。我们利用胎龄、出生体重、种族和民族、性别、呼吸支持和FIO2建立和验证了6个出生年龄的支气管肺发育不良风险模型，并使用C统计量(曲线下面积)检验了模型。共有3636名婴儿符合这项研究的条件。预测随着出生后年龄的增加而提高，从出生第1天的C统计数据0.793增加到第28天的最大值0.854。在出生后第1天和第3天，胎龄对预后的预测效果最好；在出生后第7天、14天、21天和28天，呼吸支持的类型也是如此。Https://neonatal.rti.org.Conclusions：上提供了一个基于网络的模型，提供了出生后对支气管肺发育不良的预测估计。使用有限数量的现成临床信息，可以准确地确定极早产儿出现支气管肺发育不良的可能性。
Rationale: Benefits of identifying risk factors for bronchopulmonary dysplasia in extremely premature infants include providing prognostic information, identifying infants likely to benefit from preventive strategies, and stratifying infants for clinical trial enrollment.Objectives: To identify risk factors for bronchopulmonary dysplasia, and the competing outcome of death, by postnatal day; to identify which risk factors improve prediction; and to develop a Web-based estimator using readily available clinical information to predict risk of bronchopulmonary dysplasia or death.Methods: We assessed infants of 23-30 weeks' gestation born in 17 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and enrolled in the Neonatal Research Network Benchmarking Trial from 2000-2004.Measurements and Main Results: Bronchopulmonary dysplasia was defined as a categorical variable (none, mild, moderate, or severe). We developed and validated models for bronchopulmonary dysplasia risk at sixpostnatal ages usinggestational age, birth weight, race and ethnicity, sex, respiratory support, and FIO 2, and examined the models using a C statistic (area under the curve). A total of 3,636 infants were eligible for this study. Prediction improved with advancing postnatal age, increasing from a C statistic of 0.793 on Day 1 to a maximum of 0.854 on Day 28. On Postnatal Days 1 and 3, gestational age best improved outcome prediction; on Postnatal Days 7, 14, 21, and 28, type of respiratory support did so. AWeb-based model providing predicted estimates for bronchopulmonary dysplasia by postnatal day is available at https://neonatal.rti.org.Conclusions: The probability of bronchopulmonary dysplasia in extremely premature infants can be determined accurately using a limited amount of readily available clinical information.