Document Detail


Outcome trajectories in extremely preterm infants.
MedLine Citation:
PMID:  22689874     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization.
METHODS: Data on infants with birth weight ≤ 1.0 kg admitted to 18 large academic tertiary NICUs during 1998-2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months.
RESULTS: Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30.
CONCLUSIONS: Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual "outcome trajectories" and evaluate impact of possible morbidities on outcome.
Authors:
Namasivayam Ambalavanan; Waldemar A Carlo; Jon E Tyson; John C Langer; Michele C Walsh; Nehal A Parikh; Abhik Das; Krisa P Van Meurs; Seetha Shankaran; Barbara J Stoll; Rosemary D Higgins; ;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-06-11
Journal Detail:
Title:  Pediatrics     Volume:  130     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-03     Completed Date:  2012-09-10     Revised Date:  2014-05-01    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e115-25     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Birth Weight
Decision Support Techniques*
Developmental Disabilities / diagnosis*
Female
Humans
Infant
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / diagnosis*,  mortality
Intellectual Disability / diagnosis*
Intensive Care Units, Neonatal
Logistic Models
Male
Models, Theoretical
Multivariate Analysis
Prognosis
Respiratory Distress Syndrome, Newborn / diagnosis,  mortality
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
M01 RR125/RR/NCRR NIH HHS; M01 RR16587/RR/NCRR NIH HHS; M01 RR30/RR/NCRR NIH HHS; M01 RR32/RR/NCRR NIH HHS; M01 RR39/RR/NCRR NIH HHS; M01 RR44/RR/NCRR NIH HHS; M01 RR6022/RR/NCRR NIH HHS; M01 RR633/RR/NCRR NIH HHS; M01 RR70/RR/NCRR NIH HHS; M01 RR7122/RR/NCRR NIH HHS; M01 RR750/RR/NCRR NIH HHS; M01 RR80/RR/NCRR NIH HHS; M01 RR8084/RR/NCRR NIH HHS; M01 RR997/RR/NCRR NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD21397/HD/NICHD NIH HHS; U10 HD21415/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27871/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27881/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; U10 HD36790/HD/NICHD NIH HHS; U10 HD40461/HD/NICHD NIH HHS; U10 HD40492/HD/NICHD NIH HHS; U10 HD40498/HD/NICHD NIH HHS; U10 HD40521/HD/NICHD NIH HHS; U10 HD40689/HD/NICHD NIH HHS; UL1 RR024148/RR/NCRR NIH HHS; UL1 RR024160/RR/NCRR NIH HHS; UL1 RR025008/RR/NCRR NIH HHS; UL1 RR24139/RR/NCRR NIH HHS; UL1 RR24160/RR/NCRR NIH HHS; UL1 RR25008/RR/NCRR NIH HHS; UL1 TR000041/TR/NCATS NIH HHS; UL1 TR000454/TR/NCATS NIH HHS
Investigator
Investigator/Affiliation:
Laptook / ; Oh / ; Cashore / ; Gargus / ; Moore / ; Stephens / ; Walden / ; Barbara Alksninis / ; Angelita Hensman / ; Dawn Andrews / ; Kristin Angela / ; Lainwala / ; Theresa Leach / ; Martha Leonard / ; Lucy Noel / ; Victoria E Watson / ; Fanaroff / ; Wilson-Costello / ; Nancy Newman / ; Harriet Friedman / ; Bonnie Siner / ; Schibler / ; Donovan / ; Bridges / ; Steichen / ; Yolton / ; Barbara Alexander / ; Teresa Gratton / ; Cathy Grisby / ; Jody Hessling / ; Holly Mincey / ; Marcia Worley Mersmann / ; Goldberg / ; Cotten / ; Goldstein / ; Kathy Auten / ; Gustafson / ; Melody Lohmeyer / ; Jain / ; Adams-Chapman / ; Ann Blackwelder / ; Carter / ; Ellen Hale / ; Maureen Mulligan LaRossa / ; Gloria Smikle / ; Higgins / ; Wright / ; Elizabeth McClure / ; Poindexter / ; Lemons / ; Dusick / ; Diana Appel / ; Lon Bohnke / ; Bull / ; Ann Cook / ; Eaken / ; Dianne Herron / ; Kardatzke / ; Lytle / ; Lucy Miller / ; Minnich / ; Leslie Richard / ; Leslie Wilson / ; Das / ; Poole / ; Betty Hastings / ; Elizabeth McClure / ; Newman / ; Jeanette O'Donnell Auman / ; Carolyn Petrie Huitema / ; Scott Schaefer / ; Kristin Zaterka-Baxter / ; Stevenson / ; Adams / ; Ahlfors / ; Fleisher / ; Hintz / ; M Bethany Ball / ; Baran / ; Bentley / ; Bond / ; Brudos / ; DeAnda / ; Anne DeBattista / ; Jan Epcar / ; Hajdena-Dawson / ; Kohn / ; Kuelper / ; Lee-Ancajas / ; Pyle / ; St John / ; Stebbins / ; Bailey / ; Biasini / ; Monica Collins / ; Chopko / ; Shirley Cosby / ; Mary Beth Moses / ; Nelson / ; Peralta-Carcelen / ; Vivien Phillips / ; Julie Preskitt / ; Rector / ; Sally Whitley / ; Finer / ; Wozniak / ; Rasmussen / ; Vaucher / ; Martha Fuller / ; Kathy Arnell / ; Rene Barbieri-Welge / ; Ayala Ben-Tall / ; Renee Bridge / ; Clarence Demetrio / ; Chris Henderson / ; Elaine Ito / ; Meghan Lukasik / ; Deborah Pontillo / ; Donna Posin / ; Wade Rich / ; Cheryl Runyan / ; James Wilkes / ; Bauer / ; Duara / ; Maria Calejo / ; Alexis Diaz / ; Ruth Everett-Thomas / ; Silvia Frade Eguaras / ; Yamiley Gideon / ; Hiriart-Fajardo / ; Amy Mur Worth / ; Alexandra Stroerger / ; Papile / ; Conra Backstrom Lacy / ; Laadt / ; Debra Long / ; Lowe / ; Rebecca Montman / ; Strong / ; Phelps / ; Myers / ; Linda Reubens / ; Julie Babish Johnson / ; Erica Burnell / ; Diane Hust / ; Rosemary Jensen / ; Emily Kushner / ; Joan Merzbach / ; Mary Rowan / ; Yost / ; Lauren Zwetsch / ; Korones / ; Bada / ; Tina Hudson / ; Marilyn Williams / ; Yolton / ; Sánchez / ; Rosenfeld / ; Salhab / ; Broyles / ; Heyne / ; Sally Adams / ; Dooley / ; Alicia Guzman / ; Gaynelle Hensley / ; Jackie Hickman / ; Heyne / ; Christine Lupino / ; Linda Madden / ; Susie Madison / ; Nancy Miller / ; Janet Morgan / ; Catherine Twell Boatman / ; Lyndon Baines Johnson / ; Kennedy / ; Evans / ; Jiminez / ; Morris / ; Siddiki / ; Esther Akpa / ; Nora Alaniz / ; Dieterich / ; Anna Lis / ; Georgia McDavid / ; Margaret Poundstone / ; Maegan Simmons / ; Patti Pierce Tate / ; Stacey Reddoch / ; Sharon Wright / ; O'Shea / ; Dillard / ; Washburn / ; Welch / ; Deborah Evans Allred / ; Goldstein / ; Barbara Jackson / ; Nancy Peters / ; Carroll Peterson / ; Ellen Waldrep / ; Melissa Whalen Morris / ; Hounshell / ; Delaney-Black / ; Johnson / ; Pappas / ; Rebecca Bara / ; Geraldine Muran / ; Deborah Kennedy / ; Debra Driscoll / ; Laura Goldston / ; Ehrenkranz / ; Patricia Gettner / ; Monica Konstantino / ; JoAnn Poulsen / ; Elaine Romano / ; Janet Taft / ; Joanne Williams /
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